HIV Testing - Very Worried

[NervousTick]

Thank you so much for providing a great forum. 20 days ago, I (male) was intoxicated and performed oral sex on an unknown man that I met online. The man told me that he was disease free. After the incident, he told me that he was tested, but had been with other people since the tests were performed.

I performed unprotected oral sex on him, without ejaculation in my mouth and I do not think that any semen was in my mouth, but I can't be certain. The oral sex part lasted about 5 to 10 minutes. Additionally, he performed oral sex in my anus area and tried inserting his fingers before I stopped him. Also, there was a considerable about of body contact.

Immediately after the situation I went to an urgent care center to see what I could have possibly gotten myself into. They gave me a shot and prescription for gonorrhea and chlamydia. I have since seen my primary care physician who offered me the PEP treatment even though I was at 96 hours post exposure to the person. I declined after reading posts where the benefits may not out weigh the costs of getting such treatment. Since I have had soreness in my joints and muscles, under my ribcage and have a newly developed irritation in my lymph nodes under my arms. They are beginning to be irritated and feel general discomfort. I am also very tired all the time.

At 10 days and 16 hours post possible exposure, I had my blood drawn for a RNA by PCR test with the assumption that the CDC was correct in stating that it takes 9 - 11 days for the HIV to show up on those tests. My Dr. stated that these tests came back negative - however I am worried because I've read a couple of websites that stated these tests aren't reliable until after 14 days. I am going to take the standard anti-bodies test, but am wondering if the DNA by PCR test would be an acceptable test at 28 days.

My Dr. prescribed anti anxiety medicine which does little to suppress the constant feelings that I have been infected - i'm crippled with fear.

[Edward W Hook, MD]

Let me start by telling you just how pleased I am that you chose not to take PEP. It would be too late, a waste of money, have placed you at risk for drug related sides effects and only prolonged what, in your case, is totally misplaced anxiety.

If you acquired HIV in the context of the exposure you describe , you will be the first such person that I or Dr. Handsfield has seen acquire HIV in this way since the epidemic began nearly 30 years ago.  Your risk of HIV if infinitesimal.  Here is why I say this:

1.  Your partner is very unlikely to have HIV.  He has been tested and was negative.  While he certainly could have gotten HIV since his last test it is unlikely.
2.  Your exposures were virtually no risk. There is no risk for HIV from bodily contact or from his use of his fingers to stimulate you.  As for giving or receiving oral sex, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.
3.  You have a negative HIV PCR at a time when nearly all tests would be positive in recently infected persons.  When this is considered in the context of the other reasons for stating that you were not at risk, you can now be confident that you did not get HIV from the exposure you describe.

If you wish to repeat your test for your peace of mind, do so.  Even before you do, I can assure you that, irrespective of whether you get a repeat PCR (I would not- waste of money) or standard antibody test, at any time, I am confident the result will be negative.

I am sorry for your anxiety over this.  You need to consider this in your future decisions about partners and sexual activity.  I worry that it may repeat itself.

Hope my comments help.  Take care.  EWH

[Edward W Hook, MD]

These conversations should be taken to the HIVCommunity site.  EWH

[NervousTick]

Since my last post I have lost 10 pounds. Can anyone tell me what the probability is of the standard HIV antibody test will pick up HIV at 5.6 weeks.

[bottlewater]

It is your mind that is making you feel this way. Anxiety is the issue. Remember you asked an expert who deals with this on a daily basis for years. I would suggest is to find a therapist to talk to. I am currently doing the same for myself.

[NervousTick]

I know that the thread was ended and do not expect an answer from Dr. Hook, but will anyone else be willing to answer. However, I am experiencing nasea, vomiting and Thrush in my mouth at 5.6 weeks after exposure. Every morning, the last four days I have had the urge to vomit and no longer have an appetite at all. Lost a lot of weight. Additionally, I have inflammation, soreness in both knees, elbows and feet. I continue to have no energy. And while I have had the following tests all come back negative, I know that I am not making the symptoms up.  

RNA by PCR 10 days
Standard Antibodies. 10, 23, 33 and 39
DNA by PCR 33 days

[NervousTick]

Thank you sir!

[Edward W Hook, MD]

This will be the last answer I provide as it appears that my comments seem to feed you anxiety rather than help.  Joint pain of the sort you describe is not a sign of early  HIV infection and is in no way suggestive of septic arthritis.  You need to work to put this behind you.  You do not have HIV from the encounters you describe and should not be investing so much emotional energy into worrying about it.

This ends this thread.  Take care.  EWH

[NervousTick]

In conclusion of this thread. I have additional question. I took a home access HIV 1 test at 23 days. According to a thread by Dr. HHH, antibodies will be present in 70 to 80 % of people. The test was negative and my RNA by PCR test was negative at 10 days. You said above that my chance of being infected was tiny, however there are symptoms that I cannot shake- one- dull pain in side of knees and back of knee. It comes and goes. Additionally, sharp pains in elbow. Can this be septic arthritis associated with HIV infection at 30 plus days after exposure? Additionally, I feel very well in the morning, but my energy fades to muscle discomfort after 5 pm or so. I've taken my temp like every couple hors and am always b/w 98 and 99. I really just want to know if the joint pain is a predominant symptom 4 to 5 weeks post exposure.

[Edward W Hook, MD]

What you describe does not sound like HSV or, for that matter, any other STD.  If new lesions appear or if these persist, you may want to have your doctor take a look.  For me to try to give you and accuarte diagnosis over then internet would not be in your best interest.  EWH

[NervousTick]

Thanks so much for your help Dr. Hook. I have since developed four or five very small blood blister looking dots on one scrotum. They are not sore and don't seem to resemble the many photos I've seen of genital herpes. Can these bumps be related to an STD?