Hi doctor, I want to tell my case and I would appreciate a detailed answer on this subject. About five months ago, I had sex with a CSW during a vacation. The relationship included oral sex and vaginal sex. The relationship was completely protected (also oral) and I put on a condom (I do not know if it got broken). After two days of the incident, I noticed a small red bloodbath on my scrotum, which later grew (the skin doctor diagnosed it as an angerectomy). After about two weeks after the incident, I began to have severe pain in the legs and feet that have gone and are still coming today randomly. In addition, 10 days after the incident, my temperature rose to 37.5 for about a month and a half. After a month or so, I started to get a lot of wounds in my chest, shoulders, and back (the dermatologist diagnosed it as a folliculitis). These wounds are coming and going today. In addition, many small red dots (about 50 to 60) have begun to appear on the skin especially in the chest and arms to this day, more and more news appears (the skin doctor claimed to be hemangiomas). It looks like a little blood blister. Also, I suffer from severe dehydration in the skin and palms for a long period of three months, there is really a white layer of dryness and even hand cream does not help. Lately, I have also realized that my tongue always feels dry and the color is white with a little white bump in the end. I have lost weight about 5 kg for a period of two months. In addition, strong head pain that comes and goes and a painkiller does not help at all, and also suffers from fatigue all the time. I have done a lot of testing of HIV combo Ag-Ab, fourth generation, and all were negative. In addition, two weeks ago (four and a half months of the case), I tested hepatitis B and C (negative result). As well as an antibody test for syphilis SCR by ELISA (negative result). In addition to the above, about a week after the incident, I began to feel a stab at the end of the penis, and I also had a feeling of burning at the end of urination. I have done many urine tests that include PCR from urine for chlamydia, gonorrhea, trichomoniasis, mycoplasma and/or plasma several times, all of which returned negative. About two months ago, I started a transparent discharge from the end of the penis. I repeated the tests, negative, also a general urine test without findings (no leukocytes) and urine culture returned without findings. Here are the questions:  Have the tests I performed and returned negative throughout the period clearly indicate that I have not contracted HIV from the case described? Can there be a case in which the virus is not detected and more time is required for further testing? If so, when to do it? In light of all the symptoms I have described, what can it be? What more can be checked that expresses itself in such a way? Are light symptoms recommended to perform a different method test like PCR for example? Has the combo test detected HIV types 1, 2, O? Does the test detect all sub-types and all strains of the virus? Can it be that I have HIV 2 and the test cannot detect antibodies because it can take a longer time? I read that sometimes in rare cases it can take a year to detect enough antibodies and before that all the test will be a false negative, is that really possible? Is there anything new that has emerged in the medical literature at this time that figured out from what all I have said?
Hello. I have viewed the images (attachment removed to protect patient identity). Your screening tests for HIV are conclusive. A three months intervening period between risk exposure and HIV screening tests (fourth generation HIV antigen-antibody combo test and third-generation HIV antibody screening test) is considered enough for a test to be considered conclusive. There is no need to do another type of test. The combo test is suited to the strains, types and subgroups of HIV prevalent in a particular area and therefore unlikely to miss HIV strain, type or subgroup. HIV 2 can be detected by a combo test and it has the same window period (three months) as it has for HIV 1. Delayed seroconversion is only possible in case of immunosuppression like organic transplant recipients or those on oral steroids. Not otherwise. Your tongue looks normal. The little white bumps, in the end, are circumvallate papillae which are quite normal. The bumps on chest and shoulders are perhaps acne rather than folliculitis whereas the red dots are perhaps cherry angiomas. However, I request you to kindly upload a few more good quality images of the affected areas so that I am able to confirm and guide you better. For more information consult a HIV AIDS specialist online -->