[Question #12457] HIV RNA Testing

7 months ago

Greetings. Before proceeding with my inquiry, i’d like to contextualize my situation by disclosing that in prior years I had a seriously bad alcohol problem that often found me engaging in risky sexual behaviors like seeing prostitutes. In those times I didn’t really care much about anything so I would test every so often with no real understanding of my actual risks. Now i’m in a multi year relationship with someone but have in recent months found myself falling back into my bad ways and fell so far as to see a sex worker 9 days ago for an unprotected blowjob. My anxiety is absolutely torturing me which leads me to ask to; how accurate is an HIV RNA test at 9 days? I want to test asap for everything, especially HIV, so I can put to rest my anxiety and continue to be intimate in my relationship.

7 months ago

To add to that: If me or someone else was experiencing symptoms BECAUSE of HIV would that make it so the test would have to be positive or would there still be the possibility for it to come back negative?

H. Hunter Handsfield, MD

7 months ago

Welcome to the forum.

Congratulations on your apparent success in addressing your alcohol problem, and also in your recent awareness of sexual safety. As for your current risk for STIs, oral sex is very safe -- not entirely free of risk but far lower chance of infection than for unprotected vaginal or anal sex. And the risk of HIV is zero or close to it: there have been few if any proved cases of HIV transmitted oral to penis. And based on how people believed they were infected with HIV (which is often mistaken), CDC has published an estimate of one chance in 20,000 if the oral partner has HIV. That's equivalent to receiving BJs by HIV infected partners once daily for 55 years before catching the virus might be likely. And assuming female sex workers, and also assuming you're in the US or other industrialized country, the chance your recent partner has HIV is very low, under 1% chance and likely under one chance in a thousand.

So there is definitely no need for RNA testing after such an exposure. But if you insist, wait until 11 days; after that time the HIV RNA PCR tests detect 100% of new HIV infections. In response to your follow-up comment, you are exactly right: the HIV tests (RNA and others) always are positive if symptoms are caused by HIV, no matter how recent the exposure was.

Other STIs of concern from oral sex are gonorrhea, herpes due to HSV1 (the cause of oral herpes, i.e. cold sores), and nongonococcal urethritis (NGU). Absence of symptoms within 1-2 weeks is good assurance against both HSV1 and NGU, and there are no good lab tests for either one. If you caught gonorrhea, you would know it within 4-5 days (pus dripping from penis, painful urination), so testing is optional. Chlamydia and HPV are little or no risk from oral sex.

If somehow I were in your situation, I would not be tested for anything and would continue unprotected sex with my wife without worry.

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

HHH, MD

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7 months ago

How accurate are the RNA tests after 9 days? It may be placebo but I feel as if i’m starting to experience some symptoms and am worried sick my partner will to.

H. Hunter Handsfield, MD

7 months ago

As a rough estimate, probably the negative result will be 80-90% reliable. It seems ridiculous to not wait two more days. And do you really suspect you're going to be the first person in the world known to have caught HIV from oral sex? ---

7 months ago

it’s probably more due to anxiety racing and a desire to get results as soon as possible. My guess is you would say that taking the test 10 days would also be pointless, irrespective of how accurate it would be given that just a day later would leave no room for doubts.

I gave my partner oral sex maybe a day post seeing the sex worker and am dreading the idea she tells me she’s feeling sick in the coming days.

How soon after acquiring HIV does one become infectious?

H. Hunter Handsfield, MD

7 months ago

HIV has never been known to be transmitted by cunnilingus (oral-vaginal contact); and neither HIV nor any other STI can be transmitted only a day after catching it. And you can't catch an STI in your genital tract and have it then show up and be transmitted from your mouth and throat. HIV cannot be transmitted sooner than a week or so after catching it. It takes a while for HIV to grow to a point of transmissible levels from blood or other body fluids. That's why the times are similar to both transmissibility and conclusive RNA testing. Whatever symptoms your partner has, it isn't HIV.

It remains dumb to cut corners just because you're irrationally anxious! Wait for testing until day 11.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please do not return with a new thread to tell us your negative test result. But here's a deal for you: should it be positive, return to let us know and we'll refund your posting fee. (It won't be.)

I hope the discussion has been helpful. Happy new year.

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