Dear Doctors, I did a stupid thing 45 days ago in the Dominican Republic (punta cana) where I visited a strip club/brothel and had protected vaginal/oral sex with CSW. I am scared because she had braces and worried if she put small hole/tear in condom and the fact that I did not inspect it afterwards. She did look at it closely and said nothing to me. Also, when I pulled out the vaginal fluid on condom touched my thigh and wiped it with paper towel.  4 days after the potential exposure I developed some burning when I urinate. Went to ER and had GC/CT APTIMA was negative and was given antibiotics inject/and oral. No symptoms in meantime. At 30 days, I took  oraquick HIV 1/2 test and was negative. Then at 37 days after potential exposure, went to PCP and had battery of tests HIV 1/2 antibody, RPR, GC, CT, HSV-2,HBSAG all negative. PCP said I was clear from STDs but was worried I'm still in window period. So, at 44 days, I went back to PCP and he ordered HIV 1 quantitative PCR. 1) Have you seen anyone ever seroconvert after negative HIV 1/2 antibody test at 37 days and no ARS? 2) Should I ask PCP to order HIV 2 quantitative PCR or will quantitative HIV 1 detect HIV 2 also? 3) Should I test to 3-4 months with HSV 2 IGG given no symptoms and negative 37 day test given her vaginal fluid touch my thigh? 4) Should I resume unprotected sex with spouse?  thanks so much

Also, the HIV antibody 1/2 test was likely a 3rd generation antibody test as when I asked the PCP he said it reflexes to P 24 and he could not talk to pathologist just the lab tech.  So we can assume 3rd generation stand alone antibody negative at 37 days.

Welcome to our Forum.  I will be glad to comment on your questions.  Let me first comment on the risk related to the exposures you describe and then on your test results.  Statistically, it is unlikely that your partner had HIV; despite the fact that your partner was a commercial sex worker, most CSWs do not have HIV.  Even if she did, from your description I would classify your exposures as being essentially no risk for HIV.  If your condom was intact during vaginal sex and the condom was used throughout the exposure this was a no risk exposure.  Further irrespective of whether a condom was used for receipt of oral sex, there are no proven cases of HIV acquired from receipt of oral sex.  Finally, contact of your partner's genital secretions with your thigh was also a no risk event- HIV is not spread through contact of non-mucosal (i.e. genital, rectal or oral) skin with infected secretions- it is for this reason that mutual masturbation with an infected partner is also considered a no risk event.  Thus if you had asked me if you needed testing related to this exposure, I would have told you there is no need for testing.

As for your test results, at 37 days a 3rd generation HIV test would detect well over 90% of recent HIV infections.  If the test was a 4th generation test, it would have been conclusive at 4 weeks.  In your case, since you also had a negative HIV PCR at 44 days, you should consider your tests to be conclusive - you did not get HIV from the exposures you have described.  Also, there is no need for further testing and no need for testing for HIV-2.  My advice is to be confident that you did not get HIV and to move forward without concern.  EWH

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Thank you Dr. Hook. However, I have NOT received my 44 day HIV-1 PCR results back yet. I am very nervous still. So, have you ever seen or heard someone test negative at 37 days with 3rd generation HIV 1/2 antibody and come back positive for HIV? What are my chances that the PCR HIV-1 is negative?? Also, should I ask my PCP to order HIV-2 RNA quantitative PCR assuming HIV-1 PCR will NOT detect HIV-2?? Finally, do I need to retest for HSV-2 at 3-4 months? Thanks Dr. Hook.

Your PCR will be negative.  When it is, you should accept that you did not get HIV from what I have told you was a NO RISK event.  Further, as I told you earlier, you DO NOT need HIV-2 testing of any sort.  This would be a waste of time and money.

Finally, I strongly recommend AGAINST blood tests for HSV-2 in this situation.  If you had gotten herpes you would have developed lesions within two weeks of your exposure.  you have not! Your chances of having a false positive result are much higher than anything else.  The exposure you described did not put you at meaningful risk for HSV-2. EWH

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Dr. Hook, you were correct and I was negative for HIV-1 at 44 days by quantitative PCR so I am 100% conclusive HIV-1 negative. However, I know you said to not worry about HIV-2 but there is there a tiny chance I can still have it? I question it because my antibody for HIV 1 and 2 was negative only at 37 days. You said its not 100% rule out HIV 2 at that point. I had ONLY quantitative HIV-1 testing at 44 days postexposure but not HIV-2. My PCP stated only 2 labs do HIV-2 PCR and one is in Europe. He said only found in West Africa but I can't be sure it did not spread to Dominican republic where I was. So, should I get an antibody test again (mostly worried about HIV-2 at 47 days today?) I doubt quantitative PCR for HIV-1 cross reacts with HIV-2 but I hope I am wrong. Sorry to be OCD but I don't want to spread anything to my spouse. Thanks.

HIV-2 is found almost entirely in West Africa and even there is is only a small proportion of all HIV infections.  Current generation HIV 1/2 tests would have detected over 90% of HIV-2 infections at 37 days when you were last tested.  The chance that your sex partner in the DR had HIV-2 is extraordinarily low. Testing at this time is not a good use of your time or money.  You are far more likely to be hit by lightening today than to have HIV-2.  Similarly for you to continue to worry is not justified.

My advice is to relax and move forward with your life.

This is my 3tdf and final reply to your questions.  This thread will be close later tonight.  EWH

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