[Question #11677] In the clear yet?

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12 months ago

(1) Stand by Dr. Handsfield statement?

RNA test detects 100% by 3 weeks, ag/ab combo blood test 4 weeks conclusive

(2) Based on negative tests day 29, is HIV chance 0%, no further testing:

Ag/ab combo blood test and RNA test

(3) Would symptoms starting on day 29 change your opinion? Would tests be more accurate a week after symptoms started?

4) Are the symptoms below ARS?

Heterosexual encounter, protected with condom, legal sex worker, condoms counterfeit. Symptoms started day 29, 1 week: fatigue, serious extremity aches, anorexia, day 30 left mandibular lymph node, white tongue, mild sweats, minor throat discomfort, day 31 jaw pain, serious fatigue, L arm numbness, mild headache, day 32 fatigue, R shin pain, day 33 throat congested, heavy lower legs, serious fatigue, last day minimal brief cough, felt better in evening

NO: fever, diarrhea, sore throat, skin rash, no other lymph nodes

(5) Didn’t do PEP but curious: For 100% certainty, would you do RNA test and AgAb combo 6 weeks after PEP? 

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H. Hunter Handsfield, MD
12 months ago
Welcome to the forum. Thank you for your confidence in our services.

1. For the RNA tests, close to 100% by 2 weeks, certainly by 3 weeks. Six weeks for the AgAb tests, not 4 weeks.

2. Probably correct. I've never heard of anyone who had this combination of test results and later was found to have HIV after all.

3. No, symptoms starting at that time would not change my opinion about it. The symptoms of a newly acquired HIV infection do not start later than 2-3 weeks after exposure.

4. No, these symptoms themselves are not typical of ARS, and as noted above, they started too late. And there are numerous other likely causes of such symptoms, all much more common than ARS.

5. From a medical standpoint, I would not advise further testing. However, reassurance of the patient also is a legitimate reason for testing. If you would be more confident and more able to stop worrying by additional testing, feel free to do it. You definitely should expect those result to also be negative.

Perhaps it will also help you to know that in the 20 years of this and our preceding forum on MedHelp.org, with thousands of questions from persons concerned about possible HIV and their test results, not one has yet informed us that they eventually tested positive. You won't be the first. If and when it finally happens, I'm confident the test results will detect infection within the usual time frame.

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

HHH, MD
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12 months ago
Thank you, Doc! (1) Correction: both tests were on day 30. Would another RNA test on day 34 be conclusive, or is the Ag/Ab blood combo at 6 weeks needed, too? Or stop here? (2) The entire STD panel checkup was normal (negative). Anything specific you'd recommend rechecking based on the symptoms I had, like Hep C or others?

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H. Hunter Handsfield, MD
12 months ago
For encounters like yours (heterosexual, condom protected) I would have advised against any HIV testing at all. Even before testing, your risk of catching HIV probably was well under one chance in a million. With testing now that is at least 99% conclusive, your chance of having HIV becomes well under one chance in a hundred million. I would consider that conclusive and see no need for additional testing.

Contrary to common perceptions, the hepatitis C virus isn't even an STD, with no risk from male-female sex. (It's regularly sexually transmitted only in men having potentially traumatic anal sex practices with other men.) And HCV isn't a likely cause of the symptoms you describe. I'm sure your symptoms are not from any infection from the sexual exposure -- something else entirely.
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12 months ago
Thanks, Doc! I understand. I'll take the opportunity for my final follow-up to understand your overall risk assessment: if condoms are used in heterosexual sex, no risk for HIV and some risk for STDs. If condoms aren't used in a low-risk heterosexual encounter, what STDs could be transmitted? What STDs could cause symptoms (fatigue, aches) instantaneously like 1 day after the encounter and what tests would be recommended at what intervals? Thank you again!
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H. Hunter Handsfield, MD
12 months ago
It isn't true that condoms for sex between men and women are "no risk for HIV". There's always some risk.

"If condoms aren't used in a low-risk heterosexual encounter, what STDs could be transmitted?" All STDs are possible. You can find lists of them with my listing the 10 most common or the total 20-30 of them.

"What STDs could cause symptoms (fatigue, aches) instantaneously like 1 day after the encounter and what tests would be recommended at what intervals?" There are no STDs that cause such symptoms; and few if any infections of any kind can cause any symptoms in less than 36-48 hours.

That concludes the two follow-up comments and replies included with each question and so ends this thread. Best wishes and stay safe.

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