[Question #13093] MY EXPOSURE

2 months ago

Hello Doctors, I am 27 male straight guy

My Exposures : April 19, Water leaking out of the condom near the tip via a small hole after protected vaginal sex- GIRL 1 - age 22

APRIL 23-29 - 3 times unprotected vaginal sex with a girl and 5 times protected sex. I did unprotected because I made her tested 3 months back for hiv via a rapid blood test ( JAN RAPID HIV TEST - NEGATIVE)- GIRL 2 - age 20

April 30 - Protected sex with GIRL 1 but unprotected oral.

This was in Thailand. When the condom had a small hole with GIRL 1, i was freaking out of hiv as i have health anxiety but i told myself to calm down as stats show only 800 new infections in thailand among the 15-24 age group every year in women and chances of passing via vaginal sex is low.

2 months ago

After returning home, 11 days later on MAY 11 after a night out, i woke up middle of night with itchy throat and next day nose started to run and 2 day was sneezing 20-30 times a day. i thought this was ARS so i contacted the GIRL 2 to get her tested because there was a chance she could have been infected in the past 3 month after her last test in january. she did go to the local hospital on MAY 20 and got a rapid blood test (TRILINE HIV 1/2) and it was negative so when i met her on APRIL 23 which is thirty days prior - she did not have it. Then i said to myself , maybe it was the condom hole from GIRL 1 OR the unprotected oral on april 30. So I waited for 28 days since my unprotected oral with GIRL 1 and 40 days since condom hole incident and got tested with a lab based ag/ab assay with blood drawn from vein ( CMIA ) and the result was negative ( OD 0.06) Cut off was 1.0.

This test was taken about 17 days after my symptoms.

Based on my history, do you recommend further testing and whats the best course of action ?

Have you even seen a man get it from a women in a one time encounter or in long term relationships in your clinical experience ?

Chances of my 28 day test turning positive ?

Edward W. Hook M.D.

2 months ago

Welcome to our Forum. Thanks for your questions. I'll be glad to comment. Several comments:

FYI, the so-called "water test" is unreliable and misleading. If your condom appeared to be intact, it was. When condoms fail, they do not have pin hole leaks but break wide open.

Second, all of these exposures were relatively low risk. As you point out, most women in Thailand do not have HIV and even with unprotected exposures do not lead to infection. In your case you used condoms for the most part, you were reliably protected.

Finally, your 28 day 4th generation test results virtually assure that you were not infected. The symptoms you describe are not those of the ARS and, more importantly, if the symptoms you experienced were due to HIV, your test would be positive any time after the symptoms began. Further, at 28 days, results of 4th generation tests are more than 98% conclusive making it very unlikely that you acquired HIV from the exposures you result.

What to do? Testing is a personal choice. The likelihood that you were infected is close to zero. If you choose to test to be entirely confident that you were not infected, results of 4th generation tests will be conclusive at any time more than 6 weeks after your exposure.

I hope this information is helpful. EWH

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2 months ago

Thanks doctor for the reply. For the past 8 years every time after sex i used to fill the condom with water to check for holes. This has become an OCD for me, I will stop doing this.

I'm a physicist myself and I took the time to delve into the studies of window periods( posted on this forum )and i found that they mentioned 99% of 4th gen hiv tests turn positive 10-11 after RNA detection in blood. However on the studies, they mentioned it's very hard to know when the person was infected before first rna detection so they decided to use a simulated eclipse period upto 33 days. Even the authors mention they are overestimating this period.

Have you seen anyone take 33 days to get detectable rna ?

But as you mentioned earlier on this forum rna tests take a maximum of 12-14 days to appear. So going by those values, 99% of tests would be positive by 24-26 days.

In your clinical experience have you seen anyone turn positive after 28 days ?

Have you also come across a straight guy who got it from a women ?

Edward W. Hook M.D.

2 months ago

I think what you’re reading is overly conservative. I’ve never seen or heard of an HIV RNA PCR test which took more than 11 days to become positive.

We have not seen nor head of someone who had a negative test at 28 days go on to become positive.

There are certainly heterosexual men who have acquired HIV sexually. It is far less common than for men who have sex with other men, but it certainly has happened.

Please don’t worry. You have one follow up remaining. EWH.

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2 months ago

Thanks for the reply doc. I don't feel the need to get tested anymore because chances of me getting infected was very unlikely before I even tested ( 1 in a million ) and at 28 days my test showed that even if I was in the unlikely group, I'm 99% not there in it. Plus many doctors all tell me the same thing as they have never seen a person getting negative on 28th day and still test positive later

My final questions

1) Should i worry about hiv 2 ? Is it rare in the world and do people develop antibodies to hiv 2 at the same rate as hiv 1 so the 4th gen picks it up ?

2) The girl who I had unprotected sex with had a negative hiv rapid antibody blood test 30 days after i met her. What are the chances she was infected when I met her 30 days before ? She also had a negative test 3 months prior.

3) Since the 4th gen hiv test detect antigen , is it the same as detecting the virus indirectly ? So by 28 days if I have no antigen, it means I don't have circulating virus ?

Thanks for the good work you are doing !

Edward W. Hook M.D.

2 months ago

These will be my final replies. There should be no need to return with further questions.

1) Should i worry about hiv 2 ? Is it rare in the world and do people develop antibodies to hiv 2 at the same rate as hiv 1 so the 4th gen picks it up ?

Antibodies to HIV-2 may take longer to develop than for HIV however HIV-2 is rare in Thailand and your testing thus far would have detected most HIV-2 infection if present. I would not worry about hIV-2.

It is very, very unlikely that she had HIV that had not been detected.

3) Since the 4th gen hiv test detect antigen , is it the same as detecting the virus indirectly ? So by 28 days if I have no antigen, it means I don't have circulating virus ?

The antigen is the out protein of the virus. As I said before, at 28 days of 98% of recent infections would have been detected by a 4th generation, combination HIV antigen/antibody test.

I would stop worrying if I were you. EWH

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