Scared Seeking Guidance

Long story short--I was the recipient in an incident of receptive anal sex.  The condom broke during this exposure.  But as soon as it happened 1-5 seconds, my partner pulled out.  He did not ejaculate inside me.  I am not sure how much precum was in contact with me.  I do not know the status of my partner--at least I cant confirm it.  I received the treatment of an HIV specialist and have been on PEP for 28 days.  I started PEP approximately 65 hours and was on kaletra, truvada, and norvir.    I am seeing the doctor on monday for a follow-up.  I went this morning for a rapid HIV test.  It was negative.  I know I am within the window period still, but I am trying to understand if that test was at all good news, or meant nothing.  

As for symptoms, I know they are unreliable, but if you can help explain what 'unexplained weight loss' means--is it like 5 lbs or 25 lbs--I weigh 210.  Also, I hear that 'stiff neck' is a symptom--I know it can be a symptom of many things so I am trying to not worry, but I dont know why it would be one of ARS.  Lastly, I have one chancre sore on my mouth, is that the oral sores that I should be worried about?  

I am sorry for all my questions.  I hope they make sense.

In short,

1) does a negative 4 week test, after being on PEP mean anything?  
2) If I was feeling symptoms today prior to my test but it was negative does that tell me they are unrelated to exposure?
3) Does the cold sore present concern?  
4) I can find the post for the sore neck if you'd like, but should I be concerned that it is very stiff.

Any guidance would be great.  Thank you.  

[Edward W Hook, MD]

Sorry to hear of your exposure.  First and most important question is, do you know your partner's infection status.  This, of course is the single most important determinant of your risk.  The fact that your exposure was brief and that your partner stopped ASAP after breakage also works in your favor.  

In addition to that, PEP is effective and certainly reduces your risk of infection.  At the same time, it can also delay seroconversion.  That you had a negative test is good news but you need further testing,a s you know.   As for your specific quesitons:

1.  See above.  
2.  Your symptoms mean nothing to me.  Symptoms are totally non-specific and  are subject to the influence of anxiety and other factors.  In addition because of the non-specificity of symptoms, only one out of 100 persons with symptoms suggestive of ARS turn out ot have HIV.  Thus your symptoms mean nothing.
3.  Your exposure was rectal. Having a cold sore in your mouth is irrelevant.
4.  See 2 above.

Hope this helps.  Sorry but you need to wait for additonal tesing downstream to be sure.  EWH

[scaredguy78]

Dr. Hook-
A couple of weeks later, I wanted to update you, and seek your interpretation.  

Six weeks after my possible exposure I had a rapid HIV test (the finger *****).  It came back negative.  That was this morning.  My doctor also took an HIV-viral load test.  I should expect results in a week.

Is there anything we can tell from the six week rapid test?  I dont get my viral load tests back for a week.  Once I do (fingers crossed it is negative), is there anything we can learn or deduce from that?

I have one completely irrational questions (I hope).  When my blood was drawn this morning, I didnt see them open the needle, should I have any worries about this, or am I now just letting my nerves get the best of me.

Thank you.

[Edward W Hook, MD]

You are overdoing this.  You took unneeded PEP and now are testing more frequently than you need to. The probability that you are infected is now less than when you were tested at 4 weeks.  You have been told to wait till 12 weeks to test.  I will not answer additional, anxiety-driven follow-up questions.  You do not seem to listen to my advice anyway (this is OK with me, just stop asking)

Your needle concerns are silly- get over it

End of thread.  EWH