[Question #12305] Question about HIV tests

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8 months ago
Thank you for the amazing work you do!

I am a man and I had a series of three casual encounters with women over the course of 6 weeks. The first involved unprotected oral (giving and receiving) and protected vaginal intercourse, however the condom broke towards the end.

The other two involved the same except with no condom breakage. All three women were low risk (western country, not sex workers).

The last encounter was on a Friday at 11 pm and I took an hiv gen 4 duo lab test alongside an hiv rna test ordered by my doctor exactly 4 weeks later on a Friday at around 10:30 am, both negative.

Two questions: Based on this forum it sounds like this is 100% conclusive for ruling out hiv? And is that because anyone who would potentially test positive on a gen 4 test at week 6 would have had to have rna in their blood by week 4? Also, does the fact that it was 27.5 days matter?

I also tested for other stds which are all negative.

Thank you!
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H. Hunter Handsfield, MD
8 months ago
Welcome to the forum. Thank you for your confidence in our services, and for looking at other discussions about situations like your own.

You describe very safe exposures, with almost no risk of HIV and low risk for other STDs. (I'd bet not 10 people in the US acquire HIV every year from exposures such as you describe.)

Most important and in response to your main questions, your conclusions are exactly right:  the combination of those two tests at 4 weeks is conclusive proof you don't have HIV. In fact, the RNA test alone is conclusive any time 11 days or more after exposure. 27 vs 28 days makes no difference for either test.

It's also good to hear you also tested negative for other STDs, which presumably included at least urine testing for gonorrhea and chlamydia, which staistically were the greatest STD risks from these exposures; and a blood test for syphilis. That raises the only slight issue for consideration:  the syphilis blood tests are not conclusvie until 6 weeks after exposure. That said, the risk for syphilis from such partners and exposures is near zero, and absence of symptoms (a non-healing sore at an exposed site, i.e. penis or mouth) is also strong evidence you weren't infected. But if you feel you need the reassurance of a conclusive test, have another at 6 weeks.

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

HHH, MD
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8 months ago
Thank you!
For future reference, is it true that the instances without condom ruptures carried no hiv risk, since insertive oral and cunnilingus don’t transmit hiv?

Also, my blood draw was a bit difficult (due to morning dehydration) and the nurses discussed that one tube wasn’t quite full and that they’d use another sample to fill it up. I assume this is because some of these tests use the same additives and is routine?
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H. Hunter Handsfield, MD
8 months ago
Nobody can say that cunnilingus and insensitive penile-oral contact are zero risk for HIV, but there have been few if any clearly documented cases, so the risk is extremely low. Such events can be considered zero risk for all practical purposes.

The amount of blood in the collection tube or halting blood flow have no effect on HIV test results or their reliability.
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8 months ago
Thank you very much! You can close the question.
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H. Hunter Handsfield, MD
8 months ago
Thanks for the thanks. Take care, stay safe and happy holidays.---