Q. How to confirm HIV?

Answered by
Dr. Sidharth Sonthalia
and medically reviewed by Dr. Sneha Kannan
Published on Dec 11, 2015 and last reviewed on: Mar 02, 2019

Hi doctor,

I had unprotected anal and oral sex with a guy. This makes me very stressful. The symptoms I encounter after the incident are as follows. I am feeling very tired from day 10, and I think it as stress. From day 12, I am having some sort of difficulty in breathing and numbness all over the body. On day 14, I have experienced itch inside the penis with clear watery discharge like urine, and it lasted only for a few days. On day 17, I had fever and headache which was cured in a day with treatment. I got an itchy rash on the chest, back, face and scalp on the 19th day. It lasted for about five days and got reduced, but still remains some. Then other symptoms persist till date which occurred gradually are sore throat, lower back pain, abdominal pain, joint pain, coating on tongue, bumps on back of tongue, red spot on tongue with irritation, itchy legs and hands without rash, blurred vision, painful itchy and sore armpit, thigh, genital area and buttock areas. I have attached the photos, please have a look. Do these symptoms suggest acute HIV infection? Or can it be other STDs?

I have undergone the following tests to check HIV. Rapid blood test on day 19 and the result was negative, and I repeated the same test on day 35 and that too negative. My partner tested in front of me one day before sex, and it was negative. He claimed that he is clear and safe. But, he said that he had one partner three or four months ago and also many partners before. If my partner is truly clear and safe and I am HIV negative, then what cause all these symptoms?

My doctor said I have very similar symptoms of acute HIV which makes me freaked out and nervous. I made mistake to have unprotected sex with him. I am going to get married soon. I will decide my marriage according to my HIV test result only. Please answer my questions and give advice. Thank you.

Dr. Sidharth Sonthalia

Cosmetology Dermatology HIV/AIDS Specialist Hair Transplant Surgeon Venereology
#

Hi,

Welcome to icliniq.com.

Thanks for providing the clinical pictures (attachment removed to protect patient identity). I would try to provide you with the best possible answers to your questions.

The symptoms you have mentioned for example fever, general feeling of not being well, vague body aches may be a hint of acute HIV (human immunodeficiency virus) syndrome. They may also, in reality, be hypochondriacal that is due to stress and you are giving a lot of importance to them.

The skin eruption that you mentioned and the pictures are suggestive of urticaria or hives. This may also see even as a response to mild fever or medicines that you may have taken or may even erupt in absolutely healthy people. Itchiness without any lesions in the groin area may be due to sweat, exacerbated by stress levels.

The prominence of tongue swelling is nothing abnormal. They are the normal lingual papillae which mean that normal texture of the tongue present in all. When a person is psychologically stressed, often these normal tongue markings are interpreted as being abnormal. So, do not worry about this.

Genital discharge you mentioned may or may not be normal. You must attend an STD (sexually transmitted disease) or STI (sexually transmitted infection) specialist to get yourself checked for the discharge, which may be a sign of urethritis - infection of the urethra. For this, a urethral swab or swab dipped in the discharge will be taken to rule out.

Having said that, the possibility of acute HIV syndrome cannot be ruled out with 100% certainty based on these symptoms, although apparently, the chances are too low.

Yes, you can contract HIV even from a single exposure. The risk is moderate, from being the passive partner and allowing unprotected intercourse and passage of your partner's seminal fluid into your anorectal mucosa. Further, your partner agreed to have been promiscuous himself.

A rapid HIV test is just a modification of the standard ELISA (enzyme-linked immunosorbent assay) test. The only difference between rapid and standard HIV test is that the results are given out within 20-30 minutes of having given the blood sample in rapid test module whereas have to wait for a period of a week for the results in the standard test protocol.

The more confirmatory test would be a western blot or p24 antigen assay or HIV RNA PCR. These tests can confirm or rule out HIV within a maximum of 12 days of the last suspected exposure. So, get them done to put your mind at peace.

My final advice does not panic. Visit an STD-HIV specialist as soon as possible for evaluation of the genital discharge and request to get the fourth generation test done. Also, the additional blood tests mentioned below. Get back to us with the report of these tests and take treatment for urethritis, if it is confirmed.

No need to panic even if your fourth generation test comes out positive for HIV. It takes an average of 10 years for HIV positivity to convert into AIDS syndrome. And with a healthy lifestyle, positive thinking and available anti-HIV drugs, most patients who have full-blown AIDS, are also able to live healthy in the present medical era.

Have you been vaccinated for hepatitis B? You must get tested for hep B and C and VDRL (venereal disease research laboratory) syphilis. If you have not been vaccinated for hep B, get vaccinated as soon as possible.

Maintain good oral hygiene. Your tongue seems to be coated due to lack of oral hygiene. Use a mild cleansing mouth wash and also get your tongue swab tested for fungus.


Investigations to be done:

1. Fourth generation HIV testing assay.
2. Western blot test.
3. Urethral discharge or urethral swab evaluation for gonococcal and non-gonococcal infections.
4. Additional blood tests - serology for hepatitis B (HBsAg -hepatitis B surface antigen test) and hepatitis C (Anti-HCV - hepatitis C virus antibodies), VDRL.
5. Tongue swab for fungus.

Preventive measures:

Always use protection in the form of condom for any sexual activity. Never trust any sexual partner about his/her promiscuous nature or HIV status.

Hi doctor,

Thanks for telling that the chance is too low for HIV. But my doctor said anal sex is of very high risk. I agree with the fact that more advanced medicine is available now. But, I want to live longer and healthier than this. One more thing is that I am from a poor family, how can I afford the treatment? I have consulted many doctors, some said it is not acute HIV symptoms but some said it is. It makes my mind confused. What is the chance that I get HIV? Can I get married after PCR (polymerase chain reaction) and 4th generation negative? HIV is not accepted in my village and how could I get married if I have HIV? My partner said he used to get tested for every six months but I do not know how can I believe him? Please advice.

Dr. Sidharth Sonthalia

Cosmetology Dermatology HIV/AIDS Specialist Hair Transplant Surgeon Venereology
#

Hi,

Welcome back to icliniq.com.

I did not say your chance of HIV acquisition is too low. I categorically mentioned this with respect to the symptoms you are mentioning and suspecting acute HIV syndrome based on them. So clearly, I was mentioning that your symptoms seem much more likely to be due to stress or some intermittent fever. But the pictures (attachment removed to protect patient identity) you sent are not evident enough to suggest a possibility of acute HIV syndrome.

The reason I used the term moderate risk instead of high risk was because of the fact that your partner had taken a rapid HIV test before the intercourse, so assuming that the test result was reliable. In his case also, just like yours, the confirmation of HIV positivity can only be confirmed by a fourth generation test or repeating ELISA after 3-4 months.

But in any event, at least his rapid test was negative; so even if he becomes HIV positive, his HIV viral load will not be very high. Thus his risk of transmission of HIV to you would still be much lower than a partner who has active AIDS syndrome.

Honestly, if you do become HIV positive, you have no other choice but to take medicines. Anti-HIV medicines are very effective and a person who is HIV-positive can have a life almost as long as a non-infected person.

Further, anti-HIV drugs have now been made free of cost available to most developing countries by WHO. You have to check with your nearest healthcare professional about the status of the anti-HIV program and places from where you can get further testing and free medicines.

As per the statistics of CDC (centers for disease control and prevention), your risk as the receptive anal intercourse partner, assuming your dominant partner to be HIV infected - 138 in 10,000. However, in your case, the HIV infectivity status of your partner is not clear. So the above figure is of statistical significance and just a hint of your chances, that too if your partner is proven to be HIV positive later.

Other factors that impact HIV acquisition include - sexually transmitted diseases in you or your partner, status of HIV infection, and viral load of your partner if he is infected, circumcision, etc.

Only after an effective counseling session for you, your prospective bride and your families can resolve the issue. It is beyond the scope of discussion here.

Thank you doctor,

Here are my new questions, hope you will answer them clearly. If my partner is truly HIV negative, can I get HIV? I do not think my symptoms are due to stress. Because, I was stressed from my childhood but it was about other matter such as financial and study, not HIV. If I were HIV positive what is the probability of transmission of HIV to my spouse? And if my wife were HIV positive could she transmit HIV to my baby? How could I prevent HIV transmission to my wife without using condom? Some website said HIV can be cured with herbal or traditional treatment. Are they real or scam? What cause my tongue coating? How long can people with HIV live if he/she takes medicine or treatment? How people with HIV die without bad picture of AID? If I were HIV positive, could I get married if my fiancée agree to? Does AZT-Azidothymidine affect the HIV test? Thanks.

Dr. Sidharth Sonthalia

Cosmetology Dermatology HIV/AIDS Specialist Hair Transplant Surgeon Venereology
#

Hi,

Welcome back to icliniq.com.

I would prefer to go for the investigations that I had requested you to get done and re-enforced regarding getting them done and sharing the reports with us.

Please understand that you are taking extraordinary stress due to this unfortunate incident. We totally sympathize with you regarding your stress and confused state of thinking.

In fact, if I start providing you with all the answers right now, when we are not even sure if you have HIV or not, this information will not help you. Rather end up giving you more stress, something which is not good for you at all.

I am sure, if all is well and hopefully your HIV is ruled out based on negative results of fourth-generation assays, your anxiety and stress will abate. We would be more than happy to still answer your queries, after that.

So, please take this response in the utmost positive way, as we are trying to help you de-stress by letting out information and knowledge that you should know at this point of time and withholding excessive information since it will do you no good, but end up making you more stressed out.

Hi doctor,

I got my fourth generation test negative at eight weeks. Some doctors said only after three months the test is conclusive. But, now I have a lot of symptoms like cold sores, very dry mouth cause bleeding and coating on tongue, bumps on back of the tongue, itch on palms and soles, deep tiredness and difficulty in breathing, night sweat, pain and itch with rash under right armpit and genital area, mild fever and headache, swollen node on neck with mild pain, diarrhea, numbness even the whole body sometime, fatigue, bloating, heart burn, small rash on body. They look very similar to ARS. All these are my current symptoms. Surely, I will test again at three months but I afraid the result would turn out to be positive. Please advice.

Dr. Sidharth Sonthalia

Cosmetology Dermatology HIV/AIDS Specialist Hair Transplant Surgeon Venereology
#

Hi,

Welcome to icliniq.com.

First of all, unfortunately, we still do not have the complete list of investigation reports that were suggested to you. That included testing for hepatitis B, hepatitis C, VDRL, urethral discharge, and tongue swab for fungus.

Fortunately, your fourth generation report has come negative. The possibility of a false negative report at this stage is 0.02% which is extremely low.I had also suggested for the RNA PCR as a confirmatory test if you want to get over with this continuously lingering on fear of you being HIV positive.

As per the protocol, repetition of fourth generation assay at 3-4 month of the primary exposure needs to be done for 100% confirmation, but you may get tested for western blot or RNA PCR right away to confirm the negativity right away.

Your symptoms are the same as you mentioned earlier. They only reveal a coated tongue, perhaps because of lack of hygiene - please ensure regular tongue cleansing and use of Betadine mouthwashes. Aphthous ulcers can be a result of stress, and deficiency of vitamins/minerals. Kindly make your diet better and take a multivitamin supplement daily for a month.

The symptoms still seem to be non-HIV related and the ARS normally does not last beyond four weeks. In view of your negative fourth generation assay, which has a 99.8% predictive value even at this stage, and lack of any specific symptoms of ARS, please get the tests as advised. The plan of your treatment depends on the test results. This is the only way of getting relieved from your stress.


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