[Question #11088] HIV

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17 months ago
Had protected sex with black female prostitute in Vegas. Very intoxicated. Passed out to find condom still on flaccid penis but had been robbed. Blood on sheets from a cut on my finger & possible menstruation. Had Covid 7 days after encounter. Negative RNA at 10 days & negative 4th gen at 29 days. At 6 weeks had tender / swollen lymph nodes in stomach / pectoral & ulcers in mouth at 8 weeks. I have read that your practice has not ever seen someone test positive for HIV at 6 weeks after testing negative at 4 weeks. Assuming someone has what are my chances of being negative at 6 weeks & what circumstances can cause this delay between tests? Could a co-infection of Covid be a factor?
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thank you for your confidence in our services.

That sounds like a pretty stressful situation, all right. I understand how worried you were and why.

However, you have pretty much answered your own question. I'm glad to see you're thinking objectively and understand, intellectually if not emotionally, that nobody ever takes longer than 6 weeks to have positive AgAb (4th generation) test and roughly 10 days for RNA testing. Also, when both kinds of tests are done, negative RNA at 10 days plus negative AgAb (4th gen) at 4 weeks also is 100% conclusive. In addition, regardless of how long after exposure, test results ALWAYS are positive in the presence of symptoms caused by HIV. It is impossible that the symptoms you describe, following your test results, are due to HIV. Here too there has never been an exception.

The problem now is getting beyond your worries -- as implied, an emotional/psychological challenge only. The science is 100% clear: unequivocally you do not have HIV. "What circumstances can cause...delay [in test results]? There are none (including covid) that can delay positive AgAb or RNA tests. The only exception would be if you had taken anti-HIV drugs after the event (post-exposure prophylaxis, i.e. PEP) -- but you did not. There are no other infections, medical conditions, or drugs that have such effects. (You can find information to the contrary online, but that's always either just plain wrong, although it might have happened very rarely for older stand-alone HIV antibody tests not in use for nearly 20 years.)

So all is well. No further testing is needed. You do not have HIV. If you have a regular partner, you can safely continue your normal sexual relationship without putting that person at risk.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Dr. Handsfield, thank you for the very concise and speedy reply. I truly appreciate it. With the HIV testing at 10 & 29 days from exposure being conclusive I will refrain from additional HIV testing. With that said at 29 days I also did a full std panel (std check.com) with everything returning normal with the exception of HSV 1. Although I’ve never had symptoms my suspicion is it’s either a false positive or an old infection that was likely acquired as a child since my father had cold sores. My only remaining concern is potentially being positive for other stds that the testing at 29 days missed. My question is when can I safely rule out other infections such as, HSV 2, Syphilis, Hep B & C, and HPV. My spouse had HPV years ago and we both likely cleared it. I know there’s many different strains however. It’s currently been 10 weeks since my exposure and I’ve had no symptoms of stds thus far. Upon your guidance I’ll seek a final test to rule out any other infections and hopefully put this nightmare behind me. Thanks again for your time and assistance. 



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H. Hunter Handsfield, MD
17 months ago
Thanks for the thanks. I'm glad to have helped.

You have already had conclusive HIV testing. The combination of negative RNA at 10 days and negative AgAb (4th generation) test at 29 days is conclusive. There is no point in additional HIV tests.

The chance of the other infections you mention is very low from any single exposure, but it would be reasonable to have a syphilis blood test after 6 weeks. Testing is not recommended for HSV2 or hepatitis B or C in this situation. Hep C was zero risk anyway -- ONLY sexually transmitted by traumatic anal sex in men having sex with men. No heterosexual transmission, contrary to online discussions about it. And probably you were vaccinated against hep B in childhood, so no point in testing for it either. Absence of symptoms is itself strong evidence against herpes, and the HSV blood tests are too inaccurate and never recommended after an exposure like yours. 

There is no test for HPV, and everybody gets HPV, and you and your spouse probably have had other infections aside from the one your wife was known to have. (Even when HPV is present, testing usually is negative.) This single event did not further elevate your risk of having HPV.
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