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    Getting married,dont want to infect my fiancee
    spideyzj posted:
    Hi Doc,Am 27 year old male from India
    1st Exposure :Protected vaginal &unprotected oral with CSW in Mar -May 2009 in UK.I got a sore throat which was diagnosed with chronic pharyngitis later
    2nd Exposure:Protected oral &vaginal with CSW in India Dec 2009, CONDOM BROKE
    Jan 2010:tonsillectomy,septoplasty&sinus surgery
    Feb 2010:Fever(100F), Sore throat, palm rashes.CBC:RA +ve ,Elevated ESR-35 &Neutrophils
    April 2010:tested HIV -ve(4 months after 2nd Exposure)H.Pyolri was +ve &.RBS was low(50)still had sore throat
    3rd Exposure:May 2010:protected oral &vaginal with indian CSW ,hand to genital transfer of genital liquids
    4th week to 9th week:had tender lymph nodes in neck &armpits, sore throat & fever (99F)
    6th week:I tested -ve HIV 1&2 (4th Gen ELISA) &my CBC showed elevated Neutrophils &Eosonophils.ESR normal
    11th week:developed a fever (99F), sore throat, tender lymph nodes in armpits &neck.CBC was normal.
    12th week:I tested -ve for HIV 1&2 (4th Gen ELISA),HEP B& C ,VDRL,HSV2 but +ve for HSV1.-ve for Malaria &Typhoid.CBC showed Elevated ESR -23 &Neutrophils ,RBS was Normal
    13th week:I tested -ve for HIV 1&2 (ELISA- 3rd Gen),TB,LDH,Chest Xray was normal.RBS was Normal.still had sore throat,fever,aching armpits.
    18th week:I tested -ve for HIV 1&2 (4th Gen ELISA ),CT scan showed slight sinusitis
    19th week- tender Lymph nodes behind knees,Thigh pain,low grade fever(99F),sore throat,aching armpits.still have all these
    21st week(146 days):HIV 1 & 2 4th Generation Chemiluminesense->NON REACTIVE
    NUCLEIC ACID TESTING FOR HIV-1(RNA)-->Lower than detectable limits(Analytical sensitivity 53 UI/ml)
    1. How conclusive is a -ve HIV 1& 2 4th generation test @ 21 weeks from my last exposure for some one like me who has an undiagnosed condition or a weak immune
    2. Does NAT HIV-1 RNA cover all subtypes of HIV-1?
    3. Should i go for HIV-2 RNA? Since HIV-2 is prevalent in India unlike US ,Am more worried about HIV-2 because the 4th generation antibody test looks for P24 antigen for HIV-1 and antibodies for HIV 1& does not look for P-24 antigen for HIV-2
    4. Assumming if some one has Common Variable Immunodifficiency (CVID),How long will it take for such person to produce antibodies ,will it still be within 3 months
    5.What medical codition can cause delayed seroconversion? What about a person like me who gets recurrent infections every 2 weeks ?
    6. I have tested -ve for all STD's except for HSV-1 which was +ve,Can HSV-1 cause sore throat,tender lymph nodes in neck,armpit and behind knees and low grade doc is clueless about whats wrong with me 7. Can i be 100% sure that i am clear?am getting married this week so i don't want to infect my fiancée
    Nieciedo responded:
    Let's get right to the heart of the matter.

    Only one of your "exposures" could even possibily be considered a risk for HIV, and that was the 2nd "exposure" with the broken condom.

    In that situation, however, the risk of infection was extremely low, even if the sex worker was HIV (an unknown variable which only serves to lower your risk). The average estimated risk of infection for a man engaged in an average act of vaginal intercourse with a woman known to be HIV is about 1 in 1,000. Your risk is much, much lower because of the extremely short duration of the contact and the uncertainty of your partner's status.

    Also, none of your symptoms match up with those symptoms reported by people having been recently infected with HIV. The symptoms, when they occur, are identical to the flu and appear 2 to 6 weeks after infection and then disappear after a week or two.

    I don't think you have any reason to be concerned about HIV. You may want to consider a test specifically for HIV-2 if that will ease your worries, but I don't think your risk is significant enough to warrant any panic.

    spideyzj replied to Nieciedo's response:
    Thanks for your reply Dan

    I have tested 10 months post my condom break incident and 21 weeks post my 3rd exposure with a HIV Antibody 1 & 2 4th Generation Chemiluminesense and NAT HIV-1 RNA

    Irrespective of my symtoms , is it conclusive? or should i test @ 6 months?

    There is no HIV NAT test for HIV-2 in market,so i cant test that.
    Nieciedo replied to spideyzj's response:
    Thank you. In the midst of all the detail in your post, I missed the fact that your test at 10 months after the 2nd exposure was for HIV 1 and 2.

    Since that test was conducted 7 months after the end of the window period, it is accurate for both strains of HIV. You do not have HIV. It is accurate and conclusive and no further testing is necessary.

    spideyzj replied to Nieciedo's response:
    Thanks for your reply dan

    What about my 3rd exposure? I only tested 21 weeks after it...though it was protected .. Nobody says protected sex is 100% safe?

    Should i test 6 months post my 3rd exposure? and should i avoid ANY phyisical contact with my wife?
    Nieciedo replied to spideyzj's response:
    Protected sex is 100% safe if the protection does not fail. HIV cannot cross through an intact latex barrier. The only reason "nobody says protected sex is 100% safe" is because protection (i.e., condoms) can break, as occured in your 2nd encounter.

    Since the intercourse was protected and since manual genital stimulation is not a risk for HIV, there is no risk from this encounter.

    Also, your test was done over 13 weeks after the encounter. HIV tests are accurate and conclusive at 90 days/13 weeks post exposure, so this is even more reinforcement.

    No further testing is necessary. You do not have HIV. There is no reason why you cannot be intimate with your wife.

    spideyzj replied to Nieciedo's response:
    Thanks for your Dan

    am sure the condom dint break,but i dint check the condom properly for any holes since the room was dark

    Many people in AIDSMEDS state they got infected even if they had protected sex.

    Am just worried about delayed seroconversion?

    Less research has been done on HIV -2 , i read a post in THE BODY where a person stated he seroconverted after 6 months
    Nieciedo replied to spideyzj's response:
    HIV 1 and HIV 2 both work the same way. The virus has to get from the infected person's body into another person's blood stream.

    HIV can't pass through latex condoms.

    A very small minority of the population, less than 0.1%, can need longer than 3 months to produce enough antibodies to test positive. These people have either recently undergone intensive medical procedures like organ transplants or cancer treatment, or they suffer from pre-existing illnesses that have compromised their immune system and prevent them from producing antibodies.

    You would know if you belonged to either group. Since you do not, you can rely on the fact that everyone else would have produced enough antibodies by 90 days/13 weeks post-exposure.

    Your tests have conclusively proven that you do not have HIV. It's up to you to accept that fact and move on with your life.

    David J Malebranche, MD, MPH responded:
    dear sir,

    thanks for the detailed letter and questions. I agree with Dan, your risk for HIV-1 is low, but your concern about HIV-2 is real, and given the higher prevalence of HIV-2 in India and other areas, that would be reasonable.

    all the ve herpes 1 test tells you is that you've been exposed at some time in your life. and herpes 1, the cause of cold sores and fever blisters, is so common wordlwide, that you could've been exposed by anyone you kissed in your entire life... HSV 1 should not cause all those symptoms, only a fever blister around the mouth in times of stress, and possibly lymph nodes in the neck when the blister appears.

    You should both get tested for everything so that you know you will not get anything from her as well... sexual transmission of stds goes both ways you know..

    spideyzj replied to David J Malebranche, MD, MPH's response:
    Thanks for your reply doc/dan

    My wife was a virgin before our marraige,so there is no way she could have any STD's

    I got married but i have been using condoms with my wife, she got a flu with all ARS like symtoms 15 days after we started having protected sex and 2 days after i had a condom break incident with her

    I really got worried and went to private lab got tested for HIV 1& 2 @ 27 weeks post my last exposure along with an RPR test.. Both were negative

    But i still have a sore throat(bumps back of my throat),sinusitis, itchy skin, painful armpits and pain behind my knees

    I have been on constantly on antibotics,not sure whether that would have any effect on my RPR test..
    Nieciedo replied to spideyzj's response:
    Let's look at the facts:

    1. You do not have HIV. This is an established and proven fact, reconfirmed by your most recent tests. Antibiotics have no effect on the accuracy of HIV tests.

    2. You do not have HIV and your wife had not had sex with anyone before you. Therefore, she does not have HIV. Her flu-like symptoms were caused by the flu.

    3. Your throat, sinus, and skin issues have nothing whatsoever to do with HIV, both because HIV does not cause these symptoms and because it has been demonstrably proven that you do not have HIV. It sounds like you could have some kind of autoimmune illness and so you should continue to work with your doctor to find the proper cause and treatment. But you do NOT have HIV.


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