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Scared of late seroconversion
Apr 22, 2011

Hi Dr. Bob,

I had a risky encounter with a TS escort 5 1/2 months ago. I performed oral sex on her without a condom. We also had intercourse (me giving, she receiving) but that was with a condom and to my knowledge, the condom did not fail. I did not taste any pre-cum and she did not ejaculate in my mouth. However, I am convinced now despite the tests that I have taken, that I am HIV positive. I had the classic ARS symptoms about 3 weeks post-exposure (flu-like, sore throat, swollen lymph nodes under my jaw, muscle aches, malaise) and I still have swollen lymph nodes under my jaw today (that has not fully gone away since the 3-week mark).

I have taken several tests, but I am sure that I will be one of the few to test positive outside of the 3-month window. I've had a few DNA PCR tests (performed by LabCorp) and they were negative, that latest one being 4-months post-exposure. And I've had ELISA-antibody tests nearly every week either through Home Access, or LabCorp, those too have all been negative.

I've read that approximately 60,000 new cases of HIV are reported every year. And supposedly, the 3-month window period is accurate to more than 97% accuracy, but that still leaves 3% of people who test positive between 3 months and 6 months. That's still a lot of people! (around 1,800 if I'm doing my math right). That's what has me extremely worried. In the meantime, I have developed thrush on my tongue and my wife (who I am deathly afraid has contracted HIV as well through my stupidity and selfishness) has developed a mucocele on her lower lip. I found a study online that says that mucoceles have a strong relationship to early HIV infections. I am freaking out.

My wife won't have anything to do with me now (for good reason) and she hasn't decided yet if she'll take an HIV test. We've had sex 3 times since my encounter with the escort.

Many sites (thebody.com included) state that a 3-month negative test is conclusive, yet I still have very troubling symptoms. I'm just trying to figure out what I should do next. Thanks and I recently donated to your foundation.

-Jim

Response from Dr. Frascino

Hello Jim,

You may be "sure that (you) will be one of the few to test positive outside the three-month window," but I certainly am not sure. In fact, I'm absolutely confident you are HIV negative.

Your HIV-acquisition risk is very low. Protected sex is "protected," assuming the latex condom was used properly and didn't break. Oral sex carries only a very low risk for HIV acquisition. Your repeatedly (and excessive) HIV-antibody tests out to 5.5 months combined with your undetectable HIV PCR DNA tests out to four months are definitive and conclusive. HIV is not your problem. No way. No how. Your fears of delayed seroconversion are unwarranted. Please note that PCR DNA testing has nothing to do with the development of anti-HIV antibodies. PCR DNA testing assays directly for a piece of the virus's genetic material. So even though these tests were not necessary (or warranted), they provide additional and irrefutable evidence that you are not HIV infected (and are not experiencing any delay in seroconversion!).

Regarding "symptoms," they are notoriously unreliable in predicting who is and is not HIV infected. A negative HIV-antibody test outside the window period trumps symptoms each and every time. I can't diagnose the cause of your symptoms over the Internet. But what I can do with absolute certainty is advise you what's not causing them: it's not HIV!

As far as what to do next, I'd suggest you seek psychotherapeutic counseling to help you confront your guilt and your irrational fears of being HIV infected.

For peace of mind, get a six-month HIV-antibody test. The result will undoubtedly be negative.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Regarding your conclusive and definitive HIV tests, WOO-HOO! (You may not believe it yet, but I'm confident eventually you will.)

Dr. Bob



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