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Had unprotected sex. Are HIV, HERPES TESTS conclusive?

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Hi, I am a male and about 2 year back I received unprotected oral sex from a stripper. 4 weeks from then I had fever and swollen lymph nodes. I also tingling sensation on the penis right after the exposure for about a week and had the same few weeks later. I got early detection tests done for HIV and herpes 32 hours post exposure - HIV came negative and herpes was equivocal. I have had 4-5 Hiv antibody tests done from then and all have been negative. I had one at 15th month HIV 3rd generation Antibody test (HIV-1 Antibody and HIV 1/O/2 Abs, Qual) which also came back negative. I have experienced chest pain, shortness of breath and chronic diarrhea and intermittent dry cough. Shortness of breath has been constant and I do not have any nasal congestion or sinus issues. I feel dull pain near my ribs, chest and abdomen when the breathing issue increases. My PCP has done EKG, chest xray and some blood tests and has no reasoning for this.

I am so worried about this being HIV and it not showing up on my tests. I have read on forums that tests after 6 months are conclusive but these symptoms without explanation are terrifying. As of now, I have the following main symptoms 1. Chronic Diarrhea - been going on for more than 6 months now. Endoscopy done which didn't find anything. 2. Cottage cheese like whiteness on the tongue and redness on the inside upper mouth 3. Neck pain/stiffness I got another HIV test (HIV Screen 4th Generation wRfx) which was non-reactive and this test was done 2 years old patientfrom the date of exposure.

Searching medical sites suggests that there are cases where people are hiv positive but it doesn't get detected on tests for a long period of time as the tests are not 100% guaranteed (antibodies develop differently in different people). I am worried if I am one of those people as I have so many symptoms with no medically explainable reason behind them. What are the chances of me having it without it turning up in the tests that have been done so far?  Medical sites and chronic symptoms without explanation make me question whether the results are conclusive?

Category: HIV- AIDS Specialist

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Thank you for your query at DoctorSpring.com
I understand your concern.
Let me start by reassuring you that from your history it is not possible to get HIV. The only way HIV comes from an infected partner, is if you have unprotected intercourse. Oral sex can't spread HIV, because HIV is not excreted in human saliva. Similarly it can't be spread by kissing. Did you also get a screening done for other STDs?
Now coming to the tests. You had a 15th month HIV 3rd generation test done, and if it is negative, then again HIV is completely ruled out. You're right that the sensitivity of the test and the way people form antibodies are different. That's why we go for serial testing, and you had multiple HIV tests done, the fact that all of them came negative, rules out HIV completely. You got one done at 2 years old patienttoo, and 4th generation test has 99 % sensitivity at the end of 3 months from exposure.
So kindly do not be anxious about HIV and we need to find out what is causing your symptoms.
The chronic diarrhea you're having. that for the past 6 months, mostly indicates IBS. I need you to elaborate more on the diarrhea. How many episodes per day? Any particular food leading to diarrhea? Any abdominal cramps? Is it intermittent or continuous? The cottage cheese like whiteness can be due to fungal infection, mostly candidiasis, and Flucanazole will be helpful in that case.
Again the shortness of breath and the congestion can be due to other causes such as untreated LRTI ( Lower respiratory tract infection ) and it won't show up in X-RAY. Did you take any antibiotic for the chest infection?
I strongly feel once you're given adeqaute treatment, you will recover. Kindly let me know if you received any medicines till now, and elaborate more on the diarrhea.
Once again, i will reassure you that it is not due to HIV.
Feel free to discuss further,

Patient replied :

To be honest, I am really concerned about your statement that oral sex can't spread HIV. It's a low risk activity and has been mentioned in ton's of places including CDC site. Not sure why/how a specialist would term it as not possible to spread HIV.
In regards to diarheea, it occurs 3 times a day every day continously. No particular food is causing it. No abdominal pain. I have colonoscopy and upper endoscopy done for diarheea and shortness of breath and nothing turned up in those tests. No medications taken so far for the two. I have just started oral mouthwash for thrush since yesterday.
I am troubled with the symptoms that all indicate HIV (all are on the list of things that one should look out for for HIV). Typically, adults don't get thrush unless they are undergoing cancer treatments or antibiotics - neither is true for me. All the things mentioned started after my sexual activity, none of them existed before that. I have had tests for all other STD's as well and were all negative.
What kind of people develop HIV antibodies later than 6 months? Various sites mention cases where people do not develop antibodies in the typically expected time. I am concerned if I am one of those and being a family man, it's super critical for me to ensure I do not have HIV so that I don't pass it to my life partner.

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Thank you for your follow up.
I can understand your concern about my statement. But what i told you is based on practise. HIV is mostly spread through unprotected intercourse, contact with contaminated blood or blood products or body fluids, perinatal transmission, or through IV drug abuse, where the needles are infected. Yes theoretically oral sex can cause HIV, even though the risk is minimal, but till now it has not been proved. Kindly refer to the CDC link just for you reassurance.
As you can see in the link, receiving oral sex or receiving fellatio, carries little or no risk. This little part comes into picture, because the studies are inconclusive, and people who mostly engage in unprotected oral sex, also engage in a lot of other sexual activities, which can make them at ' high-risk '. The highest chance of spreading HIV through oral sex comes when the infected man, ejaculates in the mouth of the partner. Hence the reaon why i told you oral sex won't spread HIV in your case.
Coming to your diarrhea, 3 times contiuously every day for 6 months, points towards IBS. IBS can itself occur secondary to causes such as food allergirs, malabsorption, gluten intolerance, sudden change in diet ( e.t.c ). It needs to be treated and i will advise you the following for your chronic diarrhea :
- Tab. Rifaximin 550 mg twice daily for 2 weeks after food
- Tab. Loperamide SOS, after every 6 hours, to control the frequency of diarrhea.
Also if possible you can get your stool examined for ova/parasites/cysts.
Regarding the shortness of breath i will advise you to try the following medicine for about a week and let me know if there is any significant improvement :
Tab. Montelukast 10 mg, once daily at bed time for 7 days.
Oral thrush or candidiasis is mostly common in people receiving anti cancer treatment or those who are taking antibiotics for too long. It is also common in patients taking long term steroids, amd diabetics. But even without this features, candidiasis can occur sporadically in certain individuals, which can be attributed to slight impairment in the immune system. Yes i do agree, that again oral thrush is present in HIV patients but as i pointed out earlier, the exposure you had carries no risk at all. So i am not basing my diagnosis around HIV.
Only severely immuno compromised people develop antibodies beyond 6 months. And such people have bad immunity since childhood. How has your health been otherwise? Were you prone to infections as a child? Did you get recurrent cold/ fever? The 4th generation test as i mentioned, has 99 % sensitivity, which means 99 % of the times it is able to identify HIV antibodies in the serum, if tested at the end of 3 months. If this was the only isolated test you got done, i would have asked you to repeat it because there is still a 1 % chance of being false negative. But you had gotten HIV tests done even earlier, and all of them have been negative.
I also understand your concern for your life partner. But from my side, i can reassure you, considering your exposure, evidence based facts,and the investigations you have gotten done, you're not HIV positive.
Hope this was helpful,

Patient replied :

Thanks for the detailed response.
I had stool test done a few months back and that didn't uncover anything.
Yes - the number of HIV tests that I have taken so far do provide some confirmation but these symptoms have been the cause of my concern. I have not had any medical concerns in my life thus far, normal healthy childhood.
I had also had HIV DNA by PCR test at ~18 months from exposure and that was negative (non detected). What is the sensitivity of these tests? Are they conculsive as well? Most of these tests were done by going through sites tstd, todaylabs etc to maintain confidentiality. These sites use LabCorp for their tests. Any concern there?
Also, I am slightly anemic - do these tests get impacted by that?

Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Thank you for getting back.
The fact that you had a normal childhood, proves that you are not immunocompromised, so there is no real cause to worry.
HIV DNA PCR is 100 % sensitive. That means HIV is ruled out completely. At 18 months, no matter even if you're immunocompromised, there would have antibodies in your serum, which PCR would have picked up. Hence i said earlier, the 4th generation test, as it came negative, HIV is ruled out completely. PCR is the best test that can be done to rule out HIV. Only other tests such as Western Blot and ELISA are 95-99 % sensitive.
I will advise you to take the medicines for a week and update me on whether you have any relief in your last follow up.
And yes LabCorp has reliable diagnostics, so there is no concern there. Moreover no matter where you get it done from, PCR won't give false results.
Hope this was helpful,

Dr. Deepu Sebin Sebastian
Category: Select Speciality
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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