The bottom line and the response to your main question is that your HIV test results are conclusive and you definitely do not have HIV.

In fact, you weren't even at risk -- or at least at no higher being infected with HIV than one chance in millions. In the US and most industrialized countries, well under one percent of female sex worker has HIV, so it is unlikely your partners had it. Second, condoms work well, so the vaginal exposures were little or no risk. Finally, there has never been a proved case of HIV transmitted by oral sex (oral to penis). If you had come to the forum right after the exposures, we would have advised that testing really wasn't necessary for HIV; or for other STDs.

CDC's 45 day advice about the AgAb (4th generation) blood tests is the same as ours. However, over 99% of the time the test is positive by 28 days. Equally important, you are correct about the RNA/PCR test, which is conclusive (all by itself, without the AgAb tests) any time after 11 days. (We and many other experts used to advise people with negative RNA tests at 11+ days that it's a good idea to also have AgAb tests at 28-45 days. However, experience over the last 10 years makes it clear the RNA test is 100% conclusive by itself.)

The tests in most labs' "comprehensive" STD test panels are mostly not needed after just one or two exposures, and 28 days isn't really long enough for one that is, syphilis blood test. For a conclusive result, it needs to be done 6 weeks or more after exposure. OTOH, your risk of syphilis from these exposures was almost as low as for HIV -- and absence of symptoms (i.e. chancre, syphilitic sore) on our penis is itself strong evidence you didn't get it. But if you feel you would like the confirmation of conclusive blood test, you'll need to have one at 6+ weeks.

Aside from maybe a follow-up syphilis test, you definitely do not need any more testing -- including for HIV -- to be 100% confident you aren't infected.

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

HHH, MD

A couple of follow-ups and I’ll be on my way (I know these are possible “anxiety” fueled so forgive me in advance)

1) in the super low chance one is an elite controller would 4th gen antibodies show up at 42 days in absence of RNA ? Does the combination of 4th gen & RNA testing together bear more weight after a certain number of days in terms of conclusiveness (eg 28) ?

2)do drugs like for eg cocaine increase chances of catching hiv biologically? 

3)does sharing a straw with a bloody nose carry a transmission risk? (I know this one is non sexual issue but curious given you may have come across this question)

4) does using shampoo with biotin in it or taking anti-anxiety meds interfere with test accuracy? 

2,4) There are no drugs, medications, or health problems that have any effect on timing or reliability of any of the standard HIV tests -- except for anti-HIV drugs themselves, if taken to prevent HIV.

3) In theory, this might be a risk. But in fact I'm not aware of any known cases of HIV from such exposure. So the actual risk must be minuscule if it exists at all.

Thanks. Clear. 

From my last question-

HIV test results overrule everything else. No matter how high the risk of infection during the exposure, and no matter what symptoms someone might have, the test results are to be believed. There are no exceptions, ever. Your negative test are absolute proof you do not have HIV and that something other than HIV is the cause. And your symptoms are not typical for HIV anyway. You caught a cold -- or maybe flu or covid. But not HIV.

You came here for our professional advice. You have it, and I would think you would find my assessment reassuring. It's time to stop worrying!

That completes the two follow-up comments and replies include with each question and so ends this thread. I hope you found it helpful. Best wishes and stay safe.