[Question #12257] HIV Concern and Test Enquiries

9 months ago

Hi Drs,

On 24/08/23, I had a condom protected oral sex in Amsterdam with an escort, whose agency CLAIMED that she was tested all negative 25 days before the exposure and 3 months later (a bit equivocal for this one). My test results were negative at 3, 6, and 8 weeks post exposure using 4th-gen tests. What makes this scenario more complicated was that during the 8-week's phlebotomy, I did not see the nurse change needle and because the blood was drawn in the infectious disease department, I was super anxious and got PEP for 28 days (was seeking for a mental reassurance at that time). Now is 3 days after PEP. Questions:

1. After the oral, the condom APPEARED to be intact and no blood on it. If somehow there were openings on the condom and some small amount of blood had contacted urethra, would this be considered a risky event?

2. Originally I was planning a follow-up test at 13 weeks to be a final reassurance. But because of this bit foolish PEP decision at 8 weeks, I think I need to postpone the test. I don't know what time post PEP will be appropriate for a conclusive test. 4 weeks? 6 weeks? Or 3 months? Just would like to know what earliest date can be a most reassuring choice.

3. I know that HIV-2 is rare in Netherlands, but since it is also a possibility, I would like to ask if a 8-week 4th-gen negative could rule out HIV-2 infection? Because for HIV-2 the Ag/Ab tests are essentially 3rd-gen Ab tests, I am wondering what is a more accurate window period for it, 45/50/56/60/90 days?

Thank you.

H. Hunter Handsfield, MD

9 months ago

Welcome back, but I really don't understand why you found it necessary. I see nothing in these questions that was not covered in your previous thread a month ago -- or whose answers are not obvious from that discussion. That discussion was primarily about syphilis, but the answers are basically the same for HIV. You were at little or no risk for HIV.

That you "did not see the nurse change needle" or because your blood "was drawn in the infectious disease department" means nothing. Nobody in the world ever caught HIV from having blood drawn or because of the clinic environment.

1. Given the low chance of HIV in your escort partner and use of a condom that did not break open, this event would not be considered a risky event. I would have strongly recommended against PEP; in fact, I'm surprised you found a doctor or clinic willing to prescribe it. In my clinic, we would have refused that request. Also, from your description, it sounds like PEP was begun a few weeks after the exposure (???). PEP has no effect when given more than 3 days after exposure.

2. Most experts consider HIV testing conclusive within the time you were tested after your last dose. The results prove (again) you do not have HIV.

3. The tests already done are conclusive for HIV2 as well as HIV1.

You are in the city with perhaps the world's most reliable and expert clinics and public health progams for HIV prevention. If your frankly irrational concerns continue, contact GGD for in-person advice.

HHH, MD

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9 months ago

Thank you for your response Dr. HHH. The PEP was taken after the 8 weeks' test because I suspect that the nurse may not change the needle, and I happen to be in a place where PEP could be obtained easily so to reduce anxiety I took it. The timeline is basically oral exposure - 3 weeks test - 6 weeks test - 8 weeks test, on the test day start to take PEP - 12.5 weeks post exposure (now).

So my 8 week negative test result has already been conclusive for both HIV-1 and HIV-2? And provided with the timeline of my encounters, if I just want to take a final test (well, may or may not) for physiological reassurance, at what time should I take the test, from now (12.5 weeks after oral and 4 days after possibly unnecessary PEP)? Thank you.

H. Hunter Handsfield, MD

9 months ago

That might be the most irrational explanation for PEP that has ever come to my attention, either in person or on the forum. I won't advise you about test timing after such a dumb move. Since you were not at risk, you cannot have a positive test so there's no point in testing again. You're on your own.

Please note the forum policy against repeated anxiety driven questions. This being your second, it must be your last on these topics; any attempted future ones will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism; repeated answers often tend to prolong anxiety rather than relieving it. In addition, such questions have limited educational value for other users, one of the forum's goals. Thank you for your understanding. Goodbye.

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