[Question #1507] Confirmation of HIV Test Results

45 months ago
I'm asking this more for peace of mind than anything else.  On 8/1/16, I had an sexual encounter with a married bottom guy (I was the top). He performed unprotected oral on me and inititally, there was a brief few moments of unprotected insertive anal. I thought better of it and used a condom for the rest of the encounter. At the end, I can't recall if I took the condom off and came on his anus, again briefly having unprotected insertive anal.  A week later (8/8/16), I had a separate encounter with a bottom guy. Same deal, unprotected oral but this time completely protected anal for the entire encounter.  In both cases, the condoms were intact and never broken in any obvious way. Had a 4th gen hiv antibody and anitgen test along with the Aptima HIV RNA test as well as a panel of tests for chlymidia, gonorrhea, herpes, and syphillis on 8/30/16 - all of which came back negative.  So here are my questions:

1) Would I be correct in thinking that since the second encounter did not include any unprotected insertive anal sex, that the risk of HIV transmission is virtually zero and that the results of my 4th gen test and HIV RNA test being negative are definitive and conclusive since the risk was really in the first encounter for those moments of unprotected insertive anal?

2) In both cases for unprotected oral, I've read numerous times from both Dr. Handsfield and Dr. Hook that no one needs to test for HIV from oral sex. So can I assume that my test results from 8/30/16 would be conclusive for the other STIs I was tested for?

3) Would you recommend any further testing? Everything I'd read from both Dr. Handsfield and Dr. Hook make me very confident in my results being completely reliable and conclusive since its past the 4 week mark (29 days), but I guess I just want the peace of mind from either of you.

Many thanks in advance for your time and responses!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question; I'm glad to help, and indeed my thoughts should serve to give you the peace of mind you're hoping for.

1) Indeed, the only seriously possible risky component of these events is the unprotcted portion of anal sex with the first partner. Even though it was brief, there was real risk. But your negative 4th generation HIV test at 4 weeks proves you weren't infected. The RNA portion was superfluous, with no need and no benefit over the 4th gen test itself. But it also confirms that you weren't infected. And I agree that for practical purposes the second encounter was zero risk for HIV.

2) There have been a few cases of confirmed HIV by fellatio, from penis to oral; there have been no proved cases, last I heard, oral to penis. For these two kinds of exposures, CDC once estimated risks of 1 in 10,000 and 1 in 20,000, respectively. These are equivalent to giving or receving BJs with infected partners once daily for 27 or 55 years, respectively, before infection might be considered likely. So perhaps not zero risk, but low enough that such exposures almost neger warrant testing for HIV.

3) There is no need for further HIV testing unless and until you have further potentially risky exposures.

I hope this has helped. Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

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45 months ago
Thanks very much Dr. Handsfield. So just to confirm, although unprotected oral may carry some risk, it in no way rises to the level to warrant any additional testing correct? 

You have given me such relief Doctor. I've had no other risky encounters since the two I described to you. So grateful that I didn't bring anything home to my significant other! Learned a valuable lesson and will remain faithful to my partner going forward (and have since those two encounters!). 

Thanks so much for the work you do and the invaluable expert information you give through this service! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
First statement correct. Thanks for your kind words about our service.

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45 months ago
Just one last follow up from Dr. Handsfield. I can certainly consider my test results as 100% reliable and conclusive right? 

I know both yourself and Dr. Hook have said repeatedly that when symptoms and test results clash, the test results always rule.

Wanted to be certain I could have unprotected sex with my partner. 

Thanks again for all of your help with this! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Same question repeated, same answer. Testing always overrules symptoms. You can safely resume sex with your partner.

That completes the two follow-ups and replies included with each new question, and so ends this thread. Glad to have helped -- please move on without further fear or doubt.
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