5 months ago i had intercourse with a csw from thailand .

My exposure was un protected oral and protect vaginal sex but the condom slipped and i continued for 6  to 7 sec . 

Symptoms 

At day 14 rash that stayed for 2 3 days and went away and came back and left again on my torso as big as a hand in shape of streaks like scratch marks ,Like this for a month

At day 21 severe diarrhea for 2weeks

At day 40 swollen lymph node on right side of my neck 2 weeks 

 My tests 

3rd generation antibody test at day 26  lab test  

2 Ora quick saliva at day 90 at home 

3rd generation insti rapid test at home day 120 blood from finger .

 all the tests were negative till now 

My questions 

Are this results conclusive and enough to prove that i am hiv negative , as i did not do a fourth generation test .

2-if not conclusive what are my chances of testing postive later 

—-Do you think i should go back to the csw and ask her to test on ora quick ?as i am not sure if she will accept a finger prick test might be afraid .

—-should i travel to another country and do a 4th generation test as here in my current country i doubt everything and testing is very critical.

Thank you 

You describe an exposure that had essentially zero chance of HIV infection. First, HIV is not as common in female sex workers as it once was and it is statistically quite unlikely your partner has HIV (probably no higher than a 5% chance and 1% probably is a more likely estimate). Second, your condom protection was nearly complete; even with entirely unprotected vaginal sex (e.g. 5-10 minutes in duration), the average transmission chance of HIV female to male is around one in 2,500.

As for your symptoms, they are not due to HIV. Your negative test results prove it. ARS symptoms are not caused by HIV itself but by the immune response to it, which is reflected in antibody to the virus. Therefore everybody with HIV has detectable antibody. In any case, most of the symptoms you report are not as typical for HIV/ARS as you might think. Based on your symptoms alone, of course I would have recommended HIV testing if not already done -- but I would expect the results to be negative.

Those comments pretty well cover your two questions, but to assure no misunderstanding: 

1. The main advantage of the AgAb blood tests (4th generation) is in timing:  they are positive sooner than the standalone antibody tests. But beyond 8-10 weeks, antibody alone is just as conclusive. They prove without doubt you do not have HIV.

2. There is zero chance you have HIV or that any future HIV tests will be positive (assuming, of course, no new high risk exposures). And the exact same tests, with the identical equipment and technologies, are used for all HIV tests in all countries, including Thailand (or wherever you might be). There is no point in traveling elsewhere for further testing.

Should you ask your CSW partner to be tested? From a strictly medical/risk standpoint, there is no need; it is already certain you do not have HIV. OTOH, you undoubtedly would find it reassuring if she tests negative. However, a positive result probably would worry you despite your own test results--but that's an unlikely outcome. If you do it, be sensitive and diplomatic: I think you would agree she has no obligation to test on your behalf.

The bottom line is that you do not have HIV. Any continuing symptoms have other causes. If they continue and you remain concerned, keep working with your doctors. But please do not worry further about HIV or any other STI as the cause.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

1- even though the condom slipped my 7 seconds are considered low risk ? 

2- even that rapid tests miss some infection but that i have two from ora quick and insti post 90 days they would rule that out ? 

3-is the window period /theory or fact based or from experience? Because i read alot of contradicting information some suggesting 6months some even going to 12 months with anitbody only tests and say some do not develop antibodies and etc as you know … sure i trust what u say without doubt over theirs but just to sort out things in my mind ? 

Again thanks alot doctor , i had 5 months of hell , no sleep and not wanting to eat … u helped alot and relieved my anxiety  alot 

2. The oral fluids tests miss 2-5% of HIV infections regardless of duration. But all blood tests, including rapid tests like Insti, miss none; that result is conclusive.

3. There is no reliable medical source that asserts a window period for any test longer than 3 months. No HIV antibody or antigen-antibody (4th generation) tests currently in use miss any infections; they are positive for life, no exceptions.

FYI, in the first line of my response above, my comment about the low rate of HIV in CSWs was meant for Thailand in particular. HIV prevention in Thai CSWs has been very effective in recent years.

Thanks for the thanks; I'm glad to have helped!