[Question #11409] Trans CSW Incident and HIV RNA PCR Reliability

Avatar photo
14 months ago

In the early hours of Monday 20th I visited a Transexual brothel in Barcelona. She showed me some test results but I'm not sure the specifics. The Cuban CSW 100% penetrated me for literally 1 second unprotected against my wishes (we were drunk). I immediately stopped her and we proceeded to completion protected (me bottom). There was also mutual unprotected oral.

I tested “Not detected” today on HIV-1 Qualitative RNA PCR at Teletest Barcelona at 10 days 7 Hours. Is this reliable and can I stop worrying?

I drink a lot of Lapacho tea daily for candida. I know this may also inhibit HIV. Would this affect the reliability of my test? (classed as natural PEP maybe?)


Avatar photo
14 months ago
I´m not sure why but the character count seemed to be under and would not let me add more :( Hope you dont mind me adding ..
- I have no symptoms. Also went back to the brothel and they said she is tested every 2 months
- Is follow up antibody testing definitely required in this situation?  Can I continue sex with my regular partner?
Any reassurances you can give to a very silly, worried guy would be much appreciated. Thanks Doctors, really
Avatar photo
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thank you for your question.

Based on all you say, I would consider this to have been an entirely safe sexual exposure:  it is unlikely your partner has HIV; the unprotected anal penetration was very brief; and the condom should have been nearly 100% effective after that. And oral sex is little or no risk for HIV transmission. So even without your negative test result, I would judge that there was under one chance in thousands you were infected.

As for the test itself, a negative RNA PCR test at 10 days is highly reliable. However, it's not quite 100%:  that level of certainty is reached at 11-12 days. There are no medications or medical conditions that have any effect on test reliability or timing, except for anti-HIV drugs themselves. (I've never heard of "lapacho tea" and can't imagine it actually has any benefit in preventing or treating Candida infections, but I see no reason to suspect it would be the only drug or medication that would have any effect on the HIV PCR test.)

To your two questions:

1. Even if you had typical symptoms of a new HIV infection, I would discount them. Despite common online information and advice, symptoms almost never are reliable indicators either for or against a new HIV infection. When people do ask about symptoms, we always advise them to ignore symptoms entirely and rely only on HIV test results.

2. Most experts advise an antigen-antibody test (i.e. 4th generation, "combo", "duo" test) in addition to RNA PCR testing. A negative AgAb test 4 weeks after exposure would confirm and support the negative PCR result. However, the chance you actually have HIV is probably under one in a million, and even that probably is too high an estimate. While nobody can give you truly 100% reassurance, if somehow I were in your situation, I would continue unprotected sex with my wife at this time, with no worries about infecting her.

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

HHH, MD
---
Avatar photo
14 months ago
Thanks so much for the quick reply Dr Handsfield, it is much appreciated and certainly very helpful. I can be quite an anxious person in regards to HIV and having a hard time separating "risk" from "shame" right now. (Worst 10 days of my life)
Damn that is quite frustrating I was just 1 day off 100% reliability for the PCR test.. the lab "Teletest" actually claims the window period as 3-7 days on their site, which I now know is strange and very low. I guess that means it would be a highly sensitive test at least. I actually  thought I was erring on the side of caution going for 10 days post exposure but there you go..It still gives me good re-assurance. I´m certain the condom remained intact for the remainder as I remember seeing it afterwards whilst she was inspecting it. I just have a couple more follow up questions if you dont mind:
- Should I be worried the PCR only checked for HIV-1? and not HIV-2 also?
- Have you ever had a patient, or heard of one,  testing negative on a PCR test at 10 days go on to test positive on a 4th generation antibody/antigen test later? (Apologies if that is hard for you to answer due to being so specific)
Avatar photo
H. Hunter Handsfield, MD
14 months ago
Conceivably the lab has legitimate scientific data their PCR test is conclusive as early as 7 days. That would be inconsistent with general understandings of the timing of viral replication after acquiring the virus, but I can't say it's impossible.

Are you certain the PCR was only for HIV-1? While that was the norm for a long time, many labs now use tests that detect both virus types. In any case, I don't see that this matters. HIV-2 is virtually absent in the US, almost entirely limited to people who were infected in Africa or their spouses and other long term partners.

No, I've never had nor even heard of anyone who tested negative at 10 days and later proved to be infected. But that's meaningless anyway. Rare things happen. I've also never cared for a patient struck by lightning, but that has no bearing on your risk of being struck. (But don't press your luck: You should not point a golf club toward the sky during a thunderstorm.)
---
Avatar photo
14 months ago
Thanks again for the reply. Regarding the test, I´m not sure if I´m allowed to post links (please remove if not) but you can check it out here www.teletest.es/producto/hiv-1-pcr-cualitativo/ (I am in Barcelona). It only mentions HIV-1. Thats re-assuring to hear though anyway regarding HIV-2, although the CSW was Cuban I am not based in the USA, I take it would be just as rare in Europe in that case. 
So from everything you say I guess can move on from this, and can for all intents and purposes expect a negative result testing 4th gen in a couple of weeks? Believe me, I will certainly not go playing golf antenna any time soon or be repeating any of the actions that brought me here..
Avatar photo
H. Hunter Handsfield, MD
14 months ago
Indeed I assumed the US. It would not be surprising if the PCR done is not directly comparable to those in use in the US. But no, we don't examine lab reports, clinical images, etc; this comes too close to practicing medicine from a distance, which we scrupulously avoid. If the report specifies HIV-1, probably it does not exclude HIV-2; but I believe HIV-2 is similarly rare in most of Western Europe as in North America. In any case, I think you indeed can be very confident you do not have HIV, although it still would make sense to have an AgAb test in a few weeks for confirmation.

That completes the two follow-up exchanges included with each question and so ends this thread. I'm glad the discussion has been helpful. Best wishes and stay safe.
---