[Question #1452] HIV Testing

48 months ago
To Dr. Hunter Handsfield:
On 10/3/16 i was potentially "exposed" with what later i found out was a he/she. i was drunk i could not tell as it looked like a girl even the voice. anyways he/she performed oral on my penis and well next thing you know i inserted JUST half head of my penis thru anal intercourse and pulled out right away realizing i did not have a condom on. i went to the doctors on 10/7/16 to test for HIV 1/2 antigen (blood) and std's (Urine) all results came back NEGATIVE except on Herpes type 1, something the doctor told me i shouldnt worry (ive had this before, tested 12/18/15 so was my gf). On 11/1/16 i took another HIV 1/2 antigen (blood sample) and came back NEGATIVE. 18 days later 11/18/16 i took an HIV 1/2 Antigen and Antibody 4th generation w/rfl and that test as well came back NEGATIVE. i have an appointment 12/9/16 to test again with the initial doctor. 1. should i keep re-testing until i hit the 3 month mark? 2. is there anyway the next tests will return positive? 3. can i proceed to have sexual intercourse with my gf without protection? 4. how accurate are all of these tests? 5. if any antibodies were present at month 2 (12/9/16) will it show on my upcoming appointment? please help... ps. i went to mexico for bloodwork for anemia, cholesterol etc etc and Typhoid fever was present in blood. does this have anything to do with HIV? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome to the forum. Thanks for your question.

Unprotected insertive anal sex with a man who has sex with men (which also applies to many but not necessarily all M to F transgenders) is high risk in regard to HIV. However, "high risk" is relative. On average, this exposure has been calculated to have 1 chance of 500 of transmitting HIV, if the anal partner is infected. But with such brief insertion, your risk probably is a lot lower than that. And you don't know she is infected. So even without testing, I would put the chance you caught HIV at well under 1 chance in a thousand, probably a lot lower than that. Still, you were wise to seek HIV testing. You'll be happy to hear that your results already are conclusive:  you don't have HIV. Three months for conclusive results is old news. With the 4th generation (antigen-antibody) tests, testing is conclusve any time at 4 weeks and beyond. In other words, you can be 100% certain you were not infected and do not need any more tests.

Those comments pretty well cover your specific questions, but to be explicit:

1) There is no need for further testing. Your Nov. 18 result was conclusive.

2,4) Nobody ever develops positive HIV tests after a negative 4th gen test at 4+ weeks. Your test results are 100% accurate.

3) You could have safely resumed sex with your regular partner after the Nov. 18 result and certainly can do so now.

5) I wonder if your doctor is a bit behind the times about HIV testing, or maybe just especially conservative. Your current results are conclusive. If you go ahead with another test Dec. 9 or any other time, and if you don't have another risky exposure, the result will be negative.

I'm not sure I understand the business about testing in Mexico for those things. If you are anemic, it's not because of HIV or anything else from the sexual event Oct. 3. There is no useful blood test for typhoid fever. If you have ever been exposed to typhoid or similar bacteria, you could have a positive antibody tests. But it is meaningless if you are otherwise healthy. But if in doubt, discuss your test results with your doctor.

I hope these comments have helped. Let me know if anything isn't clear.

HHH, MD
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48 months ago
If i WERE to be infected, would i show symptoms of it? is the std urine test conclusive? keep in mind i have not had any itching, burning or discharge. the only thing i  have is loose stools, but then again would that be because of the anxiety, stress and worry?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
That's an irrelevant question. The tests show for sure you were not infected. So you could have had any symptom you can think of, or all the symptoms typical of a new HIV infection, but you still would not have HIV. The test results overrule everything else. There are no exceptions.

But to answer your question: Depending on how carefully people with new HIV infection are paying attention to symptoms, anywhere from about 20% to 80% notice something wrong. But the symptoms of HIV do not include any of the ones you mention. And yes indeed, such symptoms are commonly "because of the anxiety, stress and worry". Also, whenever someone suspects his or her own symptoms have an emotional or psychological origin, usually s/he is right.

Do your best to separate your likely shame and guilt over a sexual decision you regret from the infection consequence of that decision. They aren't the same. Deal with the former as you need to (talk with a friend or partner, seek professional counseling, meditate -- whatever it takes). But forget the latter. It's not an issue.

Does that help?

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48 months ago
Yes that makes sense. Now to terminate this thread, how sure are you, that the tests will remain the same (negative). and that if any test is taken in the future will be 100% accurate? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Absolutely certain, 100%, assuming you don't have another potential exposure in the meantime. At a personal level, if you were my son I would advise against any more testing; or if somehow I were in your situation, I would not have another test adn would be having unprotected sex with my wife without worry.

You seem to understand each question comes with two follow-up comments and replies, so that concludes the thread. Best wishes and stay safe.

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