Dear Doctors,

at 11 Nov I had unprotected Sex with an asian trans hooker (in Germany).

First I received and gave oral (unprotected, no ejaculation). Then I had receptive anal sex (first with condom). In the middle, she tooked the condom of and we had sex without condom (no ejaculation). I dont know her status. 

I had an urine PCR test 10 days after the encounter, came back neg. I was so concerned, I tooked at day 13 800mg Cefexime and 1.5g Azithromycin.

At day 28, I got infected with Covid-19.

At day 30, I went to an urologist and told him my story. He took blood from my vein and tested: HIV Ag AK, 4th. Gen; Syphilis; Hep C; and urethral swap and PCR for Chlam and Gono. He gave me a shot with 2g Ceftriaxone and 7 days 200mg Doxycycline. All tests came back negative. 

Is my test at day 30 reliable in the case of HIV? I know, the usual recommondation are 6 weeks. But in your experience, can become a  tests after day 30 positive? Should I get another test?

Thank you!

As you are aware, this was a very high risk exposure, both for HIV and for other STIs. That said, it is virtually certain you do not have HIV or with any of the STIs for which you were tested. I suppose your urologist gave you similar reassurance. It is 100% certain you do not have gonorrhea, chlamydia or syphilis. Even if exposed and perhaps infected, the treatments you received -- either your own treatment or the later treatment by the urologist -- would have aborted or prevented any of these infections. You need not be tested again for any of these three STIs.

I am not familiar with the testing term HIV Ag AK; the standard terminology for the 4th generation blood tests is AgAb (antigen-antibody). At four weeks after exposure, these tests are at least 98% conclusive, and many experts consider them truly conclusive. However, official advice in the US is that 45 days (often rounded off to 6 weeks) is required for 100% certainty. Hepatitis C testing also may have been a bit early, but there was almost zero risk for hep C anyway; it is sexually transmitted only with traumatic anal sexual practices (i.e. with blood exposure).

Because of the slight uncertainty about the HIV AgAb test at 4 weeks, and in view of the high risk nature of the exposure, I would advise another test after 6 weeks or 45 days. Stay relaxed in the meantime -- you can expect another negative result. However, I hope this will be a learning experience for you:  be wary of such partners and use condoms consistently; or consider pre-exposure prophylaxis, which is highly effective in preventing HIV.

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

HHH, MD

thank you very much for your reply. Merry Christmas for you and your family also! 

Definitely, I learned from this encounter, i'll never have unprotected sexual activities with strangers again. My shame and my anxiety were too high.

With regard to HIV. You are right, the terminus was a "Combitest HIV-1 p24, HIV-1/-2-AK (ECLIA)". This test was done with veinous blood at day 30. I plan to retest tomorrow (day 45 after potential exposure).

Last Question: You ever saw in your practice or your sourroundings a negative test at 4 weeks become positive after 4 weeks? I read a lot, also in your forum, and you and your collegue mentiond that this is more a "theoretical" risk. Clear, nothing is 100%, but close to. 

Thank you in advance and a happy, healthy new year from Germany!

Thanks for the holiday good wishes. Happy new year to you as well!

finally, I took another HIV Test with veinous blood after 45 days. It came back negative.  So, I am conclusive negative.

Best regards and thank you for your service.