Hi Dr, I hope you can assess my situation in Mexico

[hello91]

Hi Dr,

I am a mexican male, 21 years old.

I had sex with a female csw on July 7, 6 weeks and 2 days ago. CSW was around 40 years old and was very fit, she said she runs marathons. Oral unprotected and finished around her mouth. Vaginal protected but my erection was not very hard (I was not drugged nor drunk). The condoms didn't break. My doubt is that if my erection was not so hard maybe the condom may have fallen without me noticing it.

2 weeks after - HIV ab test- Neg

35 days after exposure  felt what i think were two swollen lymph nodes on my jaw.

39 days (5.5. weeks) - went to an HIV clinic in Mexico. The counselor told me no risk. I had a rapid antibodies blood test (I believe it was INSTI test but I am not 100% sure). The test was negative. They will check my blood for Hepatits B C and Syphilis and they will run a 4th gen test on that blood as well. I will be getting those results on  August 29.

41 days post exposure I felt what I am sure is a swollen lymph node on the right side of my neck. Little movable pea inside my neck. I went absolutely crazy. I called a private lab and asked what HIV test they had and the girl thought a little bit and then told me it was a 4th gen test.

42 days post exposure I went to the private lab and I got the test.  Non reactive for antibodies and no p24(hiv-1) detected. The machine used was a Axsym System (Abbot) and the method was MEIA. I do not know if this is the same test done in the US or in the UK and I don't know if it is actually a 4th gen test or if it was an antibodies test and a p24 test done each individually.

I have had some night sweats but I don't know if i have had fever. I have completely stopped touching my body because I am afraid I will find more swollen lymph nodes.

I called the csw she told me she has no HIV but got a little bit worried.

I would like to know

What do you think of my situation?
What is my risk?
How reliable are my tests?
What do you think of my symptoms?

[hello91]

Thanks Doctor.

[Edward W Hook, MD]

REsults of a combined HIV antibody/HIV p24 antigen test are defintive at 28 days.  Beleive your test results.  EWH

[hello91]

Hi Dr. I was wondering if  I could get one last follow-up.

Today I got my results from the 39 days test for antibodies and ag p24 - non reactive.

The problem of both of my 4th gen tests is that I don´t know the limits of detection used, so I was wondering if it was possible for the limits of detection to be so high that even if I have HIV it would go undetected?

Thank you Doctor H.

[hello91]

Thanks Dr. If I get a test at 12 weeks I will post it here so future readers can see the results.

I really appreciate yor time.

[Edward W Hook, MD]

Delayed symptoms have NOTHING to do with the reliability of test results.

As far as tests are concerned, you said "42 days post exposure I went to the private lab and I got the test.  Non reactive for antibodies and no p24(hiv-1) detected. The machine used was a Axsym System (Abbot) and the method was MEIA." - this is 4th generation test that provides reliable results at any time more than 28 days after exposure.  Believe the result. EWH

[hello91]

Also all my tests were done in Mexico City

[hello91]

Thanks for answering Dr. It's great that internet let's us connect with people like you.

Just to clarify my 5.5 weeks test was just a rapid blood test for antibodies. The 4th gen test results for that day will be given to me in 9 days. It was a public HIV clinic, so it has high demand.

The 6 weeks test was the 4th gen test to which I have the results for. Private lab.

I suppose the machine and the methods used are irrelevant.

The 4th gen test is reliable even with delayed symptoms?
If I had a high risk exposure would the 4 th gen test at 6 weeks be as reliable?

Thank you for your answers. I think what is making me crazy is the lymph node on the right side of my neck.

[Edward W Hook, MD]

Welcome to our Forum.  In preparing to answer your questions I reviewed your earlier interactions on the HIV Prevention Community site and agree with what was said there- your exposure was a no risk event.   It is unlikely that your partner had HIV.  Condom protected sex is safe sex as long as the head of the penis is covered and slippage of the sort you describe is quite common.  There are no cases of persons acquiring HIV form receipt of unprotected sex oral sex. And finally and most definitively, you have been tested with approved tests which test for the HIV antibody and HIV p24 antigen at the same time and these tests are negative at times when these results are definitive.   At 28 days (4 weeks) these combined tests provide definitive results. thus we can safely say that the two exposures you have described (with the CSW and with your friend) were no risk events and you have conclusive evidence that you were not infected. There is no reason for further concern and no reason for further testing.


As for your specific questions:
What do you think of my situation?

See above- your exposures did not put you at risk for HIV.

What is my risk?

This is the same question- the answer is no different- zero risk.

How reliable are my tests?

Very reliable- believe them.

What do you think of my symptoms?

hey are not due to HIV.  Everyone has lymph nodes they can feel if they search long enough.

I hope my comment are helpful to you. EWH