ulta scared, exposure, timing, dna pcr, rash, etc...

[ohgeez]

doc.
my boyfriend and i had been having unprotected sex -i was the top.  we had both been recently tested and assumed in the clear.

about a week after our last sex, he had a fever 99/102 lasted 3.5 days. no other symptoms, no swollen lymphs. we also had staph or hsv1 like symptoms on our chin and ower lip(i have HSV1 and he had never had). i thought doc might conclude hsv1, but instead he thought this was staph and precribed bactrim.  he didnt think this would cause the fever. he ordered a rapid/HIV which was negative. a day later, he had a rash: mild sunburn but also had spots on his face, side, arms, etc.  i thought this was acute hiv infection, but the doctor (2 of them) who knew the history said this was a reaction to the Bactrim, switched meds. I am SHOCKED they didnt do RNA test to figure out HIV infection.  
1. i NOW wonder if he was with someone in last month.if so, would his negative test have missed the antibodies at 2.5 days into being sick with fever (1.5 days later he has no fever and feels fine)?
2.i took DNA PCR test at 10 days past last exposure (the one that would be in question where i could be positive). would that be enough time to give me peace of mind if it came back negative?
3.I am concerned: during this sexual encounter, i pulled out and had a little blood on my penis and i know that if he was in primary infection zone, i would be highly at risk.  but do you think that risk is possible or probable? at 14 days now i have no symptoms of ARS.

[H. Hunter Handsfield, M.D.]

That result is reassuring. For more information, use the search link and enter "time to positive HIV test" and also "HIV diagnosis".. You will find a large number of discussions of the issue.

[ohgeez]

hey doc.  i did finally get my undetected result from the DNAPCR test.  again, they drew the blood at 10 days and i got the result a week later.  is this enough time to be mostly assured?  i see different POVs regarding this test.  most say something would show new exposure around 5 days in, but some say you cant rely on it until 28 days.  the person that did the test said to trust the 10 day because the virus would show at this time.  curious of your thoughts and then ill drop off this chain.

thanks

[H. Hunter Handsfield, M.D.]

Sorry about the confusing PEP comments.  I was referring to the RNA PCR test, and also partly conflating your question with the one that immediately follows, which included a PEP question.  Apologies for any confusion.

1) True HIV transmission is most efficient during the window period.  But it's still less than 1 chance in a hundred (or maybe several hundred) during any particular episode of exposure.  In other words, "high risk" is relative; it's still a long shot on a case by case basis.

2) Symptoms are a less good predictor of antibody test result than the time since exposure.  In general, antibodies are detectable after 7-14 days of ARS symptoms, but generally not before then.

But all this is secondary to the overwhelming likelihood that your partner was not infected.

Thanks for the thanks about the forum.

[ohgeez]

thanks for your response.  PEP wasnt an option nor referenced.  it was too late for that.  the real concern i have here is i want to trust his negative result at the time he was sick - question one.  i am curious if the antibodies would be present more likely than not.

i actually get the result of the DNA PCR tomorrow so i am freaked of course tonight.

final questions.
1. i was the top in the experience with the blood.  i have read that if in the window period, i would be VERY high risk for acquiring HIV if he had it.  is it way higher than normal?

2.  again, antibodies DURING ARS - likely to not show up or possible?  just surprised if there wouldnt be antibodies at the time where he was sick, but then got better a day later.

still scared, but i want to thank you for your response.  i am sure it gets old to continue to cite variations of similar info - but you do a great service.

[H. Hunter Handsfield, M.D.]

Since two doctors believe acute HIV infection is not the problem here, I have to agree.  No online doc can have a good a clinical judgment as a provider who has examined someone personally, especially two of them.  I don't see any reason to be SHOCKED that PEP was prescribed, since all evidence is that neither you nor your partner is HIV infected.  PEP should be limited to situations in which one partner is likely to have HIV.  It sounds like the health professionals involved were following standard guidelines.

1) Yes, it is possible that your partner was incubating HIV, i.e. infected without yet having a positive blood test.  But the odds are low, certainly not high enough to warrant the side effects of PEP.

2) Yes, the negative DNA PCR test at 10 days is reassuring. It is very unlikely you have HIV.

3) Almost all anal sex probably involves some amount of anal trauma, i.e. blood exposure.  That is why anal sex is the highest of all sexual practices from the standpoint of HIV transmission.  That you saw visible evidence of blood probably doens't change the risk.  But most important, it seems your partner doesn't have HIV--in which case of course the blood makes no difference.

I cannot say that your partner does have HIV, or that you don't.  But from your description, the odds seem low.  Since your 2 health care providers both agree, I think you can be pretty confident about it.  But follow your providers' advice about further HIV testing, other diagnostic tests, etc.

Good luck--  HHH, MD