[Question #13319] Testing post pep

12 days ago

Hi doctors - thanks for all your work on this forum. Wanted your opinion on the following. I (male) had unprotected exposure (vaginal insertive) with a woman. This happened in NY. Took 28 days of PEP next day. My test results post the last drug of PEP are:

- day 18: rna pcr negative

- day 23: ab/ag gen 4 and rna pcr negative

- day 30: ab/ag gen 4 (blood drawn from finger) negative

How conclusive are these results?

4 days after end of pep, started having some symptoms: itchy eyes (think allergy driven, resolved with nasal spray), pain on the right of neck (felt like a torticollis, resolved alone in 1 week), small rash on shoulders and back (dermatologist thinks it’s a follicular inflammation due to heat). If these were ARS driven, I think my tests would have been positive, am I correct?

Partner took OraQuick test 1 week after encounter and tested negative.

Thanks

Edward W. Hook M.D.

12 days ago

Welcome to our Forum and thanks for your confidence in our service. I’ll be glad to comment. The encounter you described was low risk. Most women don’t have HIV and even in the unlikely situation that she did have untreated HIV less than one in 2000 exposures of the sort you describe would lead to infection. Both her subsequent testing and your own prove that you could not have been infected. If she were infected, her 1 week test would have been positive and your own RNA and 4th generation tests after completion of PEP also prove you were not infected. Your results are conclusive and there is no reason for further testing. The symptoms you describe are certainly not related to your exposure. Please don’t worry. EWH ---

12 days ago

Thanks a lot Dr Hook

Two follow up questions:

1. How conclusive are my tests in their own right (vs it being a story of negative tests + PEP + negative partner)? What I am trying to get to is that while the negative partner test on OraQuick is good news, it is a test that has a 90 days window period, which means there is a very unlikely period that she could have been infected and the test would not pick it up. Also, am trying to wrap my head around testing guidance post PEP - ie is it still required to test at 6 weeks post last drug or is a negative rna pcr at 11+ days conclusive

2. Could my symptoms be caused by other STDs? I did full panel (hep b/c, syphilis, chlamydia/ gonococcus) at 43 days post exposure - all negative

Many thanks

Edward W. Hook M.D.

12 days ago

1. Testing with 4th generation tests at 28 days after completion of PEP is more than 98% conclusive.

2. Sure, an STI such as syphilis could cause a rash but syphilis or other STIs are unlikely. Your other symptoms do not suggest STI. if your rash were syphilis a syphilis test would be positive now.

One follow up remaining

I think you are worrying needlessly. EWH

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12 days ago

Great - thank you Dr Hook. Have a great day.

Edward W. Hook M.D.

11 days ago

I’m glad I could help. Closing the thread now. Take care. EWH---