[Question #10678] HIV Risk for Dr HHH
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20 months ago
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Hi,
I had unprotected sex 3 times with my boyfriend Nov 10th 2023. I thought we were committed but he cheated on me since May 2023. He and I both got tested for STDs prior to unprotected sex and when said he was negative and I know I was because I held my results in my hand.
In hindsight, I should not have trusted his word.
14 days post unprotected vaginal sex I took oraquick OTC and tested negative. Prior to that….
9 days post exposure I was tested with a 4th Generation duo test which was negative at urgent care but my MD said it’s only a “baseline” as most STDs have a window period and I am testing too early.
I got another it’s quick today, 16 days post exposure and tested negative on the oraquick antibody test from Walgreens. I did the test AGAiN because I have a BAD rash on my chest, neck, belly and back for the past 3 days that looks like hives… so clearly I’m nervous it’s acute HIV so I tested again. :/
What are the odds of my tests being accurate at 9 days at urgent care (a 4th gen duo test was negative at 9 days post exposure) and what is the accuracy of a 16 days Walgreens oraquick antibody gum/Saliva test post-exposure?
I plan to test again at 4 weeks but until then I just want some real life statistics aside from the 3 month political stuff that is more of a legal cover the booty talk.
If I have a rash for 3 days, and test, won’t it show positive on the oraquick saliva test ?
Only meds I’m on are high dose steroids x 3 days, Benadryl, Zyrtec, and Pepcid.
Thank you.
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20 months ago
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I’ll add one detail-
He “said” he was tested for all STDs in May 2023 and was “clean” but I never got proof. I trusted him.
Turns out, he confessed to having Multiple sexual encounters one night stands since May 2023 (while we were dating). I thought we were exclusive and committed but clearly we weren’t. I ONLY had sex with him Nov 10th 2023 …then a week later, found out he had other sexual encounters so that led to this.
Basically, his May “tests” that he said were negative (or not) clearly doesn’t matter to me since we had sex after he tested and after he cheated.
Fun stuff.
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H. Hunter Handsfield, MD
20 months ago
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Welcome to the forum. I'm happy to help put your fears aside! But be aware it is only by chance I'm answering. As stated in the forum's introductory information, users do not have the option of requesting the moderator who responds; it is by chance I am responding and not Dr. Hook. In any case, his and my experience and expertise are identical; we have been close colleagues and friends for four decades and have never differed substantially in our professional opinions or advice on the forum.
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It would help to know your sex in judging your risk for HIV. The overall context suggests female, but you never say explicitly. If you and your partner both are male, the HIV risks are a thousand times higher -- although still very low.
My first response should be very reassuring: your rash is not due to an HIV infection. Although it can take a few weeks for the HIV blood tests to become positive, regardless of the time since exposure it is not possible to have HIV symptoms with a negative test result. It isn't HIV itself that causes any symptoms at all, but the immune response to the virus, and immune response is indicated by HIV antibody. You seem to have some awareness of this, from your question whether your negative oraquick test 3 days after after onset is reliable: it is nearly 100% proof HIV isn't the cause of the rash. (More about oral fluids testing below.)
You describe a partner who almost certainly does not have HIV, especially if he doesn't have sex with other men. People can lie when asked directly about their HIV/STI status, but it's pretty uncommon. Of course you're a better judge of him than I can be.
I'm not sure I understand the timing. You were partners with him back in May, then not until November? That is, only a few exposures recently? If so, it further reduces the likelihood you have been infected.
You don't mention other STDs. You should be tested for gonorrhea, chlamydia and syphilis if not yet done (and another syphilis test 6 weeks after your last sexual contact with this guy).
Your medications do not alter the reliability of your negative HIV test results so far. However, I would encourage you to stop relying on the oral fluids test (Oraquick). It's the last test that should be used when worried about a particular exposure to HIV. Up to 5% of infected people never test positive, regardless of how long they wait. You should be relying entirely on lab-based antigen-antibody (AgAb, 4th generation) blood tests. However, the negative Oraquick still is nearly 100% proof your rash isn't due to HIV.
As for timing of the AgAb (4th generation) tests, you're exactly right about 3 month advice: medical conservatism. These tests almost always are positive by 4 weeks, and 100% by 6 weeks.
In summary: 1) You probably are at lower risk for HIV than you have thought. 2) Your rash is not due to a new HIV infection. 3) You can expect another negative HIV test result at 4 and 6 weeks.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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20 months ago
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Ok so I called the ex and got some answers but he wouldn’t text me the results- he only said them to me and I jotted down what I could.
He said his syphilis lab was 0.2 Al and the range was 0.0-0.8 Al . I have no idea what that means, but why is it not 0? Do I have a syphillis rash now. Lord have a mercy.
Then-
His Hep B was 2.0 low
Range 9-12
I guess I’m in more trouble than I thought. Might not be just HIV to concern me! I have antibodies to Hep B so maybe I don’t have to worry. He was not vaccinated. He’s 46 years old. I’m 38.
This stress is going to kill me. I was also given the HPV vaccine x 3. Hopefully I don’t get that next.
Both you and Dr Hook are great. Thank you.
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H. Hunter Handsfield, MD
20 months ago
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You're not in "more trouble than you thought". With these sorts of blood test, any value below the pos/neg cut off (in this case 0.8 for syphilis) is totally negative. He definitely doesn't have syphilis. I don't know what specific hepatitis B test he had, but the negative result is reassuring; and hep B is almost never transmitted heterosexually, and if you have antibodies you're immune to it anyway. Glad to hear you've been vaccinated against HPV too.
You haven't described your rash, so I cannot judge it's possible cause. But there is no realistic possibility of syphilis, HIV or any other infection from your (former?) partner. See a doctor about it.
Why are you taking "high dose steroids", by the way? What drug and dose?
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20 months ago
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Dx: Urticaria … well, presented as such . For edu purposes I had a hive-like reaction thanksgiving night presented as slightly red and raised macropapules about 2cm-3cm scatted on my chest, arms, and legs (ie) approx 15 “mosquito” bites but not itchy. paid it no mind until Friday morning I woke up itchy with a flat, red rash on my neck, ears, and scalp ie like a sunburn with tiny bumps. Then it spread mainly to my torso, back like hives.
Fri AM i took methylprednisone 4mg tablets; began 6 tablets po as a loading dose, Benadryl 25mg PO q8-12hrs prn itching, and Pepcid 20mg po qd and treated myself as if it were a thanksgiving food allergy and tested for HIV. I was then prescribed Prednisone 40mg PO daily x 5 days, dx urticaria by an online ER MD. I do have clear v dc and mild burning inside. It’s vague and can’t tell without testing. So I’m suffering a bit.
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20 months ago
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Hep B was his antibody test, no other testing was performed. He either was vaccinated and needs a booster (denies having had the 3 vaccines) or was exposed and it’s chronic. He was born in 77 and vax came out in 81 I think. He maybe was vax as a kid and doesn’t remember. I’m over the worry. What will be, will be.
Lesson learned with this dude.
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H. Hunter Handsfield, MD
20 months ago
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Neither HIV nor syphilis is a likely cause of urticaria. Hepatitis B never was a significant risk, regardless of your and his immunization status; I haven't seen or heard of a case of heterosexual transmission in 40 years (in the US). Your ages also are in your favor: regardless of sexual lifestyle, for reasons not entirely clear, the main STDs are increasingly rare as people age into their forties. All things considered, this was a very low risk situation for you in regard to HIV and all STDs. You can expect continued negative HIV and HIV tests, as well as gonorrhea and chlmydia once those have been done.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe!
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