Worried about acute hiv after 2-3 days exposure

[joejoeg]

I am a gay male. Mon Feb 24th I met 2 guys online. 1st guy was recently circumcised in Jan. The 2nd guy was uncut. I did oral sex on both guys unprotected, & then anal sex where they topped me & ejaculated into a condom. After they ejaculated into the condoms I gave unprotected oral sex to both guys. The 1st guy topped me again with a condom but no ejaculation. The 2nd guy topped me again & ejaculated into a condom while I gave oral to the 1st guy unprotected. The next day Tues Feb 25th my throat started to feel scratchy. Wed Feb 26th I had a sore throat. Thurs Feb 27th my throat was burning bad so I went to the ENT. I had a 99.6 temp; rapid strep test came back neg.  She said I had a viral infection & did not give me antibiotics. Said I should be better by Mon March 3rd, & if not to come back. Throat was red & burning still come Mon, so I went back. I have acid reflux & take nexium 40mg once a day in the morn; she thought the reflux was contributing to whatever I was fighting. Increased nexium to twice a day, & gave me the z-pack. Throat started to feel better Tues to Wed the 4th & 5th of March. But, I still wake up with a sore throat and mucus/drip. As the day gets going it seems to go away.  I had fever 1 day Thurs the 27th of Feb. Also been having weird feelings & very slight discomfort in my abdominal area, upper & lower. The sore throat did not have a runny nose, congestion or other cold symptoms. Could this be a sign of acute hiv?  After 1 week I got tested on Tues March 4th. Rapid Test came back neg, waiting for result of early detection test. Can the early detection test identify the virus after 1 weeks exposure? I am worried that residual semen on the 2 guys penises could have infected me. Symptoms so soon? 1 day of 99.6 fever?  Sore throat lasted a week.  What about the weird feeling with upper & lower abdominals? Is it the increase in nexium? Is it the z-pack? Still waking up with sore throats, but I think it is due to a nasal drip.  Please help.

[H. Hunter Handsfield, M.D.]

The HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition.  As long as enough time has passed since the last possible exposure, the test results overrule everything else.  It doesn't matter how high the risk (yours was zero for practical purposes) or what symptoms someone has.  The test results rule.  And the combination of tests you had proves 100% you don't have HIV.  Believe it, stop testing, and move on with your life.

That's definitely all for this thread.  No more comments.

[joejoeg]

Ok, Doc, I have one more question that I would appreciate your expert opinion on, so I can help ease my mind further.  I am now 6 weeks past the incident, and I am still not feeling myself.  The lymph nodes in my neck under my jaw have been tender for past few weeks.  Below is a summary of the tests I've had so far.  Can  you please just comment on these test results below for me?  Thanks so much!

8 Days: Neg Rapid, Neg Early Detection
17 Days: Neg RNA
30 Days: Neg OraQuick
36 Days Neg Rapid

[H. Hunter Handsfield, M.D.]

To the best of my knowledge, ~90-95% is about right, but it may depend on the specific test that was done by the lab you used.  "Early detection" is not a term used by most HIV experts -- more a marketing device by the lab.  The earliest 100% reliable testing comes at 4 weeks, with either a duo test (HIV antibody + antigen) or the combination of negative DNA/RNA plus antibody.

In any case, this doesn't change my overall opinion and advice -- that you had little risk of HIV from the events described and don't need testing at all.  Your symptoms certainly are typical for anxiety -- and whenever someone suggests his or her own symptoms have a psychological origin, usually s/he is correct.

That will end this thread. Time to move on.

[joejoeg]

Ok, so I got my Early Detection test results this morning and they came back negative.  I have a few questions though. I took this test exactly 1 week [on day 8] after the possible exposure; how accurate are these results? I know you said earlier, you were confident the test would be negative and that it would be 90-95% reliable.  I am asking again though because the counselor at the clinic told me that I was too early for this test.  According to him it has to be at least 11 days after exposure and he recommends doing it at 20 days or 3 weeks.  He told me to come back to run the test again at the 3 week mark.  What do you think of this?  I am not sure exactly what type of test they ran, all they refer to it as is the Early Detection test.  Being I took it at the 1 week mark how should I interpret the negative result?  I am very relieved that it came back negative; hopefully my stomach and abdominal issues will subside now.  That could have been due to stress and anxiety I am hoping.  Thanks for your help and advice.

[joejoeg]

I was able to get in touch with the 2nd guy. He says he is neg and std free last tested in December.  The 1st guy did not respond to me.  I am still feeling stomach upset\sour stomach and weird feeling in abdominal areas.  Actually, I think these feelings started before I took the z-pack because I remember telling the ENT that I had these feelings.  I started z-pack 1 week after the encounter.  The stomach abdominal issues began before.  I know that does not fit your timeframe b\c you said symptoms would not appear until 8-10 days after exposure.  I remain so scared and nervous.  The early detection results have not come back yet.  I will post again when I get them hopefully by the end of this week.

[H. Hunter Handsfield, M.D.]

Even with full oral sex to completion, with ejaculation in the mouth, if the penile partner has HIV, on average the transmission risk for the oral partner (receiving ejaculation in the mouth) has been estimated at once for every 10,000 exposures.  That's equivalent to giving BJs to infected guys once daily for 27 years before infection might be likely.  Your risk from the minor possible semen exposure you describe has to be a lot lower than that, even if your partners had HIV -- and of course you don't know that they do.

Given that low risk the chance your symptoms are due to HIV -- quite apart from their timing -- is zero for all practical purposes.

Accordingly, these comments do not change my assessment or advice.  The only other thought is that you speak with your partners now, since you apparently didn't do it earlier.  Ask their HIV status, knowing that most people don't lie when asked directly.  If not tested recently, you could request they do so.  If negative, of course you could stop worrying.  But even if that doesn't happen, do your best to accept the reasoned, science-based advice I have tried to give; focus on the facts and the science, not your emotions.

Feel free to return with follow-up comments to report your test result(s) or your partners'.  Until then, however, I won't have more to say.

[joejoeg]

Thanks Doc.  I am still having the strange abdominal feelings\discomfort.  I cannot remember exactly when they started.  I have taken the zpack before and have not experienced any gastrointestinal symptoms from it in the past.  I remain very nervous. It is now 11 days since the encounter.  I did not know that a common cold can show only the 1 sign of having a sore throat for a week and nothing else.  I had no other symptoms like runny nose, cough, congestion etc. You did not comment on the one days fever; acute hiv fever would be much higher and last a long time right?  The 2 guys did not ejaculate into my mouth, but after taking off the sperm filled condoms, I did do oral on them so semen did get into my mouth I assume.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Responding first to the title of your question, before reading any further:  Symptoms of a new HIV infection cannot start within 2-3 days of exposure.  The minimum is 8-10 days.

The sexual exposures described were safe, since oral sex carries little or no HIV risk and the other contacts were condom protected.  Your symptoms suggest a common cold, nothing more. You could have caught it during one of the sexual exposures described; obviously sexual contact provides a big opportunity to exchange garden variety respiratory virus.  But for sure it isn't HIV or any other STD.  I agree with your doctor's original advice to not treat with antibiotics, and I'm not surprised that azithromycin (Z-pak) hasn't completley cleared your symptoms.  It's all a virus, and antibiotics have no effect on viral infections.

As for the symptoms other than sore throat, indeed azithromycin commonly causes gastrointestinal symptoms like nausea, abdominal cramping, and diarrhea (but only for a couple of days, tops).

The antibody test you had at 1 week is irrelevant; too soon to be positive.  However, I'm confident your "early detection test" (probably a test for HIV RNA or DNA) will be negative. That result will be 90-95% reliable.  You'll also need an antibody test, or a duo test (for both HIV antibody and p24 antigen) at 4 weeks.  I'm sure that also will be negative.

So stay relaxed in the meantime.  It is exceedingly unlikely you have HIV.

Final comment and advice:  You don't mention your partners' HIV status, which probably means you didn't ask them before having sex.  That was a big mistake.  Asking new partners about HIV status is essential to safe sex between men.  You should never, ever let anyone top you -- even with a condomn -- without being assured he is HIV negative (or if positive, on treatment with a low viral load).  Perhaps you do this -- but if not, you're playing with fire.  Condoms are great, but they sometimes break, especially in anal sex.

I hope these comments have been helpful.  Best wishes and stay safe--

HHH, MD