When Can One Determine That HIV 1 Is Completely Ruled Out After Protected Vaginal And Oral Exposures?

Question : Good morning dear Dr. I am so sorry in advance because this question is going to be super long since it will include a lot of detailed information. Dear Dr, please take your time to carefully read and review the information I am going to provide. My top priority here is to receive a 100% accurate answer about my situation. Time is the last thing I will care about if compared to the accuracy of the answer. I will make my best to keep this question very organized. The question will be divided into 3 parts Dr. The story, the symptoms, and the tests.  ************************************ I will start with the story here. First of all, I am a 23 years old heterosexual white male. On December 27th 2017, I had sex with a sex worker in New York City (she was Asian). Condom was used for the whole thing. I received oral sex with her and I also had vaginal sex with her. I didn't say "I had protected sex" for a reason, because I have absolutely no clue if the condom did break at the end or not. I just checked it after ejaculation and there was no visible leak. But I have no idea if there were any small cuts at the tip of the condom itself. The vaginal intercourse lasted for no longer than 5 minutes. That's the end of the story.  ************************************ This is the symptoms section. Dear Dr, I think that I have been exposed to HIV from that sexual act I had on the 27th of December (which was actually my last sexual act until today). I am saying this because of two reasons. The first reason is that I don't know for sure if the condom was intact or not. The second reason is because I had a lot of acute HIV symptoms.  My symptoms are: 1- Swollen lymph nodes: approximately 10 days after the exposure, I had a lump in the right side of my neck (picture attached to show the location) which lasted for 6 days. The lump itself was invisible so I couldn't see it. But when I press my neck, I can definitely feel it, touch it and even hold it with my two fingers. But if you take a look at my neck, it is impossible to tell that I have it because it is invisible. This lump came back 2 months ago and it is still here until this moment. I also had another one in the same exact location but on the left side of my neck (so I currently have two of them) but the left one is a bit smaller. I also had some occasional swelling in my ear (picture attached to show the location) which went away by its own in 3 or 4 days. The ear swelling happened 3 times (2 times in my right ear and 1 time in my left ear).  2- Fever: I had some occasional low-level fever. It was not severe to make me sweat but I could feel that my body is warmer than usual.  3- Muscle pain/Joint pain: I also had some generalized muscles and joints pain throughout my body. Also, the pain was not severe at all. I didn't even think about taking painkillers for the pain because it was very mild. These aches lasted for approximately 4 days and they also went away.  4- Diarrhea: it gets really confusing when I talk about diarrhea because my diet is really messed. I eat a lot of spicy food which can cause diarrhea and abdominal irrational for sure. I also smoke a lot of cigarettes each day. Moreover, I eat a lot of fast food and drink a lot of fizzy drinks on daily basis. My diarrhea also comes and goes (I would say that I have diarrhea 2 days in each week).  5- Fatigue: I also had fatigue for two months. I am currently sleeping 10-12 hours everyday and I feel drowsy for the most of time.  6- small rounded white spots close to my tonsils: I have two of these small white spots close to my tonsils. They are not painful at all and I couldn't even feel them. I discovered them accidentally when I shed some light on my tonsils and I saw them. I have these two spots for 6 weeks and they are still there. (Picture attached to show the nature of the symptom, not to show the location itself).  These are my 6 symptoms dear Dr. ************************************ When it comes to testing, it gets seriously confusing and messy. I can say that I am spending 2-3 hours every single day from the day of exposure only reading about HIV testing and tests accuracy and window periods. On the 16th day post exposure (January 12th, 2018), I took two tests (my tests report is attached to show the exact names of tests taken). The first test was the 4th generation test and the second one was the HIV-1 RNA Qualitative test. Both of them came back negative. I know that 16 days is a bit early for the 4th generation test to detect new infections, but it is absolutely the good timing for the RNA test to detect any new infections since the viral load at 16 days is usually super high and the RNA tests are highly accurate. My doctor (he is not an HIV specialist) told me to believe my results and he was more than 99% sure that I do not have HIV (based on the tests). But unfortunately, I couldn't believe him because of my symptoms. When I tried to search for the accuracy or the RNA test in this website (health care magic .com), I found a lot of different opinions presented by many doctors. Some doctors here say this test is 100% conclusive is done after 7 days of the possible exposure. Some of them say it is conclusive after 9 days. Some of them say it is conclusive after 10 days. While also some of them said that this test is highly highly accurate only if done after 14 days of the last possible exposure. Where is the truth here Dr? Please help me. I seriously have no idea which opinion do I have to trust. The problem is that all of them are certified doctors and they keep saying different things which is driving me crazy. If I cannot trust doctors, then who am I supposed to trust? I am seriously feeling lost here and I really need your honest and reliable and expert advice here doctor. please Dr, if you feel that I need to test again , tell me to do so. I just need a 100% accurate answer to my dilemma.

Dear Dr XXXXXXX thank you so much sir for your detailed explanation. Dear Dr, based on your reply, I have some new questions here for you please.

1- Dear Dr, can you please tell me how accurate was my RNA test done at 16 days (in percentage please because numbers make me feel safer and they give me a better vision and understanding about the possibilities)?

2- Dear Dr, honestly, is there any need to repeat any test in the future to rule out the possibility of being infected with that last exposure back in December? Even if there is a 0.001% need or doubts, please tell me. I am currently in my 12th week post exposure.

3- Dear Dr, based on your long professional experience and based on the researches you have read, have you ever seen or heard about a negative RNA test done at the 14th OR the 15th OR the 16th day post exposure turn out to be a false negative and as a result end up with a positive result at the 12th week with an antibody test?

4- Dear Dr, what makes doctors here tell absolutely different opinions when they were asked about the accuracy of the RNA test? all of these doctors are here on this website and all of them are certified doctors and this is science and science is a really solid subject. So what makes these different opinions?

Thank you so much dear Dr in advance.

so Doctor the follow up 4th generation is ONLY for me, to relieve my anxiety and stress. it is not to double check if I am actually negative right? you have zero doubt that I was infected Dr and therefore, the follow up test is not meant to confirm my negative status. am I right doctor? or for both reasons?

hello Dr. I used the same condom for both oral and vaginal sex without changing it. oral sex lasted for approximately 5 minutes and vaginal sex also lasted for 5 minutes so the total is 10 minutes. I checked the condom after getting done from everything (after vaginal sex) and there was no (visible) leak in it.