Seeking your advice

[Appreciate]

Dear Doctors - kindly seeking your advice on situation described.

In Singapore had protected sex with a CSW (Kenyan who said she had recently divorced from her Canadian husband and had a young daughter).

Unfortunately the condom slipped off - I estimate 15 seconds until I realised and immediately withdrew and washed up. I have remained quite anxious over this exposure.

I tested -ve via Oraquick at 21 days post exposure.

I have not had a fever that I am aware of (have measured several times a day), nor sore throat, rash etc.

Today at day 25 I experienced some slight hip discomfort however I couldn't identify a particularly enlarged lymph node in the groin area; some discomfort in the left collar bone area and just now can feel a lump in left trapezius muscle area - is there a lymph node there? I cannot feel any abnormal nodes on my neck area & don't know where to look for them under my arms (and too anxious in case I find something).

I am trying to wait to day 28 for re-testing for a more definitive result.

I an anxious and would appreciate your advice.

Thank you.

[H. Hunter Handsfield, M.D.]

Zero for practical purposes, certainly under 1 in a million.  Please accept the reassurance you have had from two knowledgeable sources and stop arguing with it.  Follow your doctor's advice about whether and when to have additional testing.

That's all for this thread.

[Appreciate]

Dear Dr,

I suppose in short what I'm asking here is what would you assess as being the probability/risk of testing positive should I retest at 5/6 weeks given the scenario I've described & test timing to date?

Thank you.

[H. Hunter Handsfield, M.D.]

You can take 100% comfort from your doctor's opinion and advice.  From what you say, she seems wise and knowlegeable and I completely agree with her.

[Appreciate]

Dear Dr,  

I gave into my anxiety and visited my GP today and tested -ve at 27 days post exposure, again via Oraquick.

He checked my my groin/hip and neck area and found no node enlargement. He checked my shoulder/trapezius muscles and said I was very tense. He added that while there were lymph nodes in this region they were located under the muscle therefore would not appear as a large lump on the trapezius muscle.

My symptom remains pain/discomfort in the collar bone/shoulder/trapezius,shoulder blse area, primarily on the left side sometimes together with some neck tightness - today I thought I noted a mild dry cough. I continue to have absence of fever, rash etc.

My doctor said it was virtually impossibe any symptoms I would be experiencing at this time are due to ARS given the time that has elapsed since potential exposure & is very confident I have not contracted HIV.

My anxiety remains very high. I'd appreciate your view on how much comfort I can take given the above.

Thanks again.

[H. Hunter Handsfield, M.D.]

You describe a low risk sexual exposure.  First, probably your CSW partner didn't have HIV; when CSWs ask their customers to use condoms, it it NOT a sign they have HIV, just the opposite:  it generally means she is not infected and intends to stay that way.  But even if she had HIV, the chance of transmission from a single very brief exposure is very low, less than one chance in a couple thousand.  Second, you describe no symptoms that even hint at an HIV infection; hip pain and the other minor discomforts you describe cannot possibly be due to HIV, which does not cause such problems.  Third, although 21 days is too soon for completely reliable testing, most newly infected people would have positive tests by that time -- so your negative Oraquick test is reassuring.

In summary, there is no cause for worry here.  But feel free to have additional testing if you'll feel better with another negative test.  But 28 days also is a bit too early.  I suggest a single additional test at 6 weeks or so.  If you'll scan the threads on this forum, you will find many nearly identical questions, some with more detailed discussions of all the same issues.

Regards--  HHH, MD