[Question #12389] HIV RISKS & TESTING

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8 months ago

Hi doctors,
Bangkok Thailand, Exposure date - 27th November.
Took PEP after exposure  within 12 hour mark as couldn't CSW took away condom before I could examine. Handjob had genital secretions when removing condom. CSW tested 4th generation CMIA test on 14th & 15th December (Negative).

1. HIV expose to the air makes it non infectious ? However many Google suggest that HIV could still infect mucous membrane as I have uncircumcised.

2. Seeing that CSW tested negative twice does this mean that during my exposure she did not have HIV ? How is the window period calculated.

3. Can some remains of previous ejaculate live in her vagina and infected me but not her, hence her negative result ?

4. I had took PCR RNA Test 11 days Post PEP, how conclusive is this results ? When should I test

Thank you doctors for your work, ,I am dying with anxiety right now. However recently calm down when CSW tested negative but Google said that I have wasted my money & time as this does not mean anything. Pls help
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H. Hunter Handsfield, MD
8 months ago
Welcome to the forum. Thank you for your confidence in our services.

You describe a very low risk exposure. I don't know what concerns you about not examining the condom. The notion of small leaks that that allow HIV or STI transmission is an urban myth; if a condom doesn't break wide open, protection is complete. And handjobs do not transmit HIV, even when sexual fluids are used for lubrication. And your CSW partner's negative HIV tests prove she wasn't infected. You certainly did not need PEP after this event:  did you stop it after you learned her negative test result? Anyway, there is absolutely no possibility you have HIV.

Those comments pretty well cove your four questions, but to assure no misunderstanding:

1. HIV isn't killed all that fast by air exposure. This makes no difference. 

2. Yes:  Your CSW partner definitely could not have transmitted HIV to you. She doesn't have it.

3. This would be impossible even if she did have HIV.

4. Once you learned your partner's negative HIV test results, you did not need any testing at all. You do not need any more testing now. All is well. You shouldn't be at all anxious about this.

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

HHH, MD
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8 months ago
Hi doctor,
Hope you don't count this as a followup as I would like to clear some misunderstanding from your reply. 

Exposure was on 27th November 
CSW tested Using 4th Generation CMIA on 14 & 15 December, which is approximately 2 weeks post PEP which is around 48 days post exposure. 
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H. Hunter Handsfield, MD
8 months ago
I understood all that. No change in my reply. (And of course it's a follow-up comment. Why wouldn't it be? You have one more coming.)---
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8 months ago
Hi doctor,

1. Her negative test means that she could be negative at the time of exposure. I would like further explaination on this doesn't window periods affect accurate testing ? HIV may not have been manifested to show on the test ?

2. I have read on some of your posts that you have written saying even if HIV test is negative and in window period it will not be infectious ? Isn't it when in this period the HIV virus is highest viral load ?

3. Why is number 3, impossible does residual ejaculate die quickly inside the vagina ?

4. I have calculated from exposure date to when she was tested would be 48 days post exposure which would be conclusive for 4th Generation CMIA Antigen & Antibody test from exposure date ?

Please go into detail how window periods are calculated as some people on Reddit have argued on this
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H. Hunter Handsfield, MD
8 months ago
1,2. The second statement is correct. This doesn't matter. In general, nobody can transmit the virus until they test positive. And the statistical odds someone is in such a brief window is one in millions, even among the highest risk persons.

3. The brief exposure to another person's infected ejaculate isn't nearly intensive enough to transmit HIV. People tend to assume that "just one virus" is enough to infect another person. It doesn't work that way with HIV. Large amounts of virus must contact large numbers of certain types of cell deep inside the body. Even the woman with infected ejaculate in her vagina -- deep inside -- has only one chance in a thousand of becoming infected herself.

4. That's plenty of time for positive test results. 

The worst possible resource of information for health problems is on website run by and for people with that particular health problem or who are worried about it -- like Reddit. Anybody can write anything they want. Anxious persons always should stick to professionally run or moderated sites -- like this one, or public health, academic medical resources, etc.

You came here for our expert advice. We are not obligated to go into detail about the science behind it. Accept it or not, I don't care -- but this isn't a debate.

And perhaps you'd like to know that in the 21 years of this and our previous forum, with thousands of questions about people worried about HIV after a possible exposure, not one has yet reported they eventually tested positive. You will not be the first. If and when it finally happens, surely it will be a genuinely high risk exposure (think unprotected anal sex between men) and not a trivially risky event of the sort you are obsessed about.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion helps you accept the truth and to stop worrying.
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