You describe two essentially zero risk exposures in regard to HIV:  had you asked before now, we would have advised that HIV testing wasn't necessary at all. Ian any case, your test results prove you were not infected with HIV:  the combination of negative RNA testing at1 months and negative AgAb ("combo") test at 41 days is 100% conclusive. In fact, the RNA test wasn't needed:  the negative AgAb test was conclusive at 41 days all by itself.

The urgent care doctor apparently doesn't understand the performance of the HIV tests you had. Six weeks is plenty -- with no need for testing at 3 months. 

There are no drugs, medications, or medical conditions that affect the reliability or timing of the HIV AgAb blood tests. That includes valacyclovir, and the HSV infection you apparently have.

So all is well. You were at no risk of HIV to begin with, and your current test results prove for sure you don't have it. No further testing is needed.

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

HHH, MD

1) Around the day 47 4th generation test I developed an itchy rash on my stomach along with aches and tenderness - I have had shingles before and I suspected it could be that so I went to that urgent care doctor (the one that said 3 months) and she agreed with it probably being shingles and she prescribed me the valacyclovir. I’ve had crippling stress and anxiety ever since this encounter and she thinks it’s because of the stress. Does this sound plausible for the resurgence of shingles?

2) should I be worried about HIV-2?

3) it seems like plenty of doctors I talk to stick to the 3 month rule for hiv testing some even saying 6 months despite the CDC’s 45 day rule… is there a reason for this? Is there any scientific basis or reasoning to their stances on this?

1) Thanks for the info that you were not on valacyclovir prior to the sexual exposure; I hope your apparent herpes zoster (shingles) is improving with treatment. Shingles does occur with increased frequency in people with HIV, and can result in repeat episodes. However, the vast majority of shingles, including recurrent episodes, occurs in people without HIV. And having shingles has no effect on the reliability of your HIV test results; that is, your negative test results prove unequivocally you do not have HIV. I am aware of no data that support stress as a trigger, but it might be possible.

2) Your test results are equally valid for HIV-2 as for HIV-1. Internet buzz that says otherwise is all urban mythology!

3) I'm sure you're right that "many doctors" continue to advise 3 months for HIV testing, but the scientific data on the 45 day limit is very strong. Here are links to both the main publication that supports 45 days and an accompanying editorial from CDC, endorsing CDC's 45 day advice:  https://pubmed.ncbi.nlm.nih.gov/29140890/  https://pubmed.ncbi.nlm.nih.gov/29140891/

Here's another factoid that might increase your confidence: In the nearly 20 years of this and our preceding forum, with thousands of questions from persons worried about a recent HIV exposure, not one forum user has told us they eventually tested positive. If it had happened, I'm sure we would hear about it, and you won't be the first! If and when it finally happens, I'm sure it will be from a legitimately high risk exposure, not a minor risk exposure like yours. It also will not involve long delayed positive test results.