[Question #1913] Nervous Wreck follow up to few days back

45 months ago
Hi Dr's,

I am sorry to be back please dont be upset. As you know my exposure was a needle size hole in condom during insertive anal which i discovered after sex.  I have always used condoms and mostly avoided msm due to high risk. This was only the second time and was with condom and lots of lube. I even pulled out after 30 sec to apply more lube. The sex was 2-3 mins max. When i filled the condom with water, water was dripping down every 1-1.5 seconds. So when i squeezed the condom to see where it was it was 5-7 cm from tip of condom and when squeezed it came out like a fine needle like line.

The reason i write today is that it seems the recepetive partner beleives he is neg because his gf got pregnant and they did all types of tests on her but i told him its no way of knowing he is neg just cause she was. I have asked him to test and is now ignoring my emails and calls. This is what has worried me as now it seems he was not tested but his ex gf was. I cannot function at work now as i wait to test as tomorrow will only be 2 weeks since.

1. I figured if no ars like symptoms up until test it would be greater chance i am ok but yesterday afternoon i seem to have started with a bout of sore throat. Could this be the start of ars with fever and rash to follow?

2. Dr Hook mentioned a 1 out of 200 risk for insertive partner if bottom is infected without other considerations, i have re-checked cdc which states 1 out of 900 for circumcised insertive and Dr Hansfield just a few days ago to a pep efficiecy post said 1 out of 500. I am confused how to reconcile these so please advise.

3. For duo test i have to wait 2 weeks for results and it will make me very anxious if i take a 3rd generation hiv blood rapid test by Insti can you tell me % of infections picked up at 2, 3 weeks and 4 weeks before a 6 week conclusive test? If i can start to test sooner i will.

4. If by 4 weeks i dont get rash and fever how much does that add towards a good outlook?

5. Probably no studies on this but yo
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome back to the Forum.  I’m disappointed that your partner was unwilling to be tested and saddened that he does not appear to understand that just because his pregnant partner does not have HIV does not necessarily rule out his having HIV.  Clearly people can have many sexual encounters with infected persons without transmitting infection.  As I think I said earlier however, it is UNLIKELY that he has HIV on a purely statistical basis but that his partner has tested negative does not mean he is not infected.  Let’s work through your questions and then I will have a few more comments.

 

1.        That you have a sore throat does not suggest HIV.  The sore throat which is part of the ARS is typically severe and accompanied by high temperature, muscle aches and sometimes a rash or diarrhea.  Further, studies have shown that 99% of at risk persons who have ARS-type symptoms do not have HIV but have other problems such as the flu.  I would not worry about your sore throat as a sign of HIV.

2.       Estimates of the likelihood of HIV transmission/acquisition are quite variable and are influenced by many other factors including the amount of virus circulating in the infected person, whether the insertive partner is circumcised, etc.  The figure I gave you in my original reply was a bit conservative (i.e. higher than other estimates).  Further, there is really not much difference between 1 in 200 (a ½ of 1% chance) and 1 in 900 chance (slightly more than a 1/10th of 1% chance), particularly which you multiple that low likelihood by factors that it is statistically unlikely that your partner had HIV and that you used a condom that was most likely intact while you were having sex. 

3.       I’m not sure I understand the question.  4th generation, duo tests are definitive at 4 weeks.  You are now at about 2 weeks- a 4th generation test would detect over half of recent infections by now, perhaps more.  3rd generation tests are less sensitive than 4th generation tests.

4.       See my comments about symptoms above.  Only about half of persons who get HIV develop symptoms. On the other hand, at 4 weeks, DUO tests are definitive and 3rd generation tests would detect 85-90% of infections at 4 weeks.

5.       Your 5th question did not come across

 

Finally, let me reiterate that your condom most probably worked.  When condoms fail during sex they break wide open.  They do not develop pin hole leaks. The leak you describe is more likely to be due to your removal of the condom or the “water test” itself.  Further, the hole in the condom was well above your urethra which is where infection occurs.  My sense is that your condom probably worked.

 

I urge you not to worry too much about this.  The odds that you were infected in the encounter you have described are tiny.  EWH


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45 months ago
Thank you Dr. Hook. I was also disappointed he did not want to test but i cannot force him either but he clearly has misunderstandings of hiv. I tested a few days later and sent him my results and i like to test twice a year for peace of mind. I guess that is what worries me and the fact that he may be in a high risk group the fact he is always the receptive and is 25. I wish i hadnt let my curiosity allow me to hook with another male but whats done is done.

1. Its been more than 24 hours and the throat pain has not progressed to anything worse could have been a result of quitting smoking recently or stress.

2. I get it now. I am circumcised so hopefully that works out in my favor but if he had a recent exposure his viral load can be high so i guess that offsets any advantage i may have with the circumcision.

3. Sorry about the confusion with this question. I was typing on my phone and didn't realize i wasn't clear. What i meant was that here in Canada the duo test takes about 2 weeks to receive the results which would mean i would not receive results until 6 weeks after exposure. This would be the same time i believe as a conclusive 3rd gen rapid blood test so i'd rather proceed with the rapid test. My question was whether i can test at 2 and 3 weeks (you already answered about 4 weeks) with the rapid test to get a good indication of whether i was infected or not? What % of infections are picked up my the rapid blood tests at those intervals? This would be more for peace of mind so i can test as i wait along.

4. The reason i asked about ARS was again just to help ease my mind even if 50% people get and i dont it would give me some hope before a definitive test.

5. The question was whether such small holes the size of a single or double pin can allow fluid in to allow infection? Water was dripping out every few seconds.

I cannot also not be certain whether the condom broke during or after. If the hole was during sex it may be possible it didnt fully break wide open cause it was not at the tip or just that there was so much lubricant which allowed it to slide back and forth without much friction. This brings me to my final question:

6. We used a lot of lube would this in any way have helped if the virus came in contact with it by weakening it during mixing or even prevent a sort of barrier? 

You pointed out that the hole was not directly on my uretha which is true i just hope the virus didnt get moved in during the 2-3 mins.

Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
There are very few data about the performance of 3rd generation tests (rapid or otherwise) as early as two weeks.  Certainly a small proportion of infections might be detected at two weeks but I cannot give you a precise estimate.

I'm surprised that it takes two weeks to get results of a 4th generation test.  I suspect there is much you can do to get results more quickly and would suggest investigating through calling local public health authorities or perhaps local STI or HIV support groups. In the lab the test takes only a few hours.  Sometimes people ask clients to call at intervals longer than necessary to "be sure" they have results ready and available to give out.  Certainly this is worth exploring.  I know that 4th generation tests are now available throughout Canada. 

I remain confident that the exposure you describe did not lead to infection and that your condom has done it's job.  I'll leave the thread open in case there is another question which occurs to you in the near future.  You've doe things right- this will almost certainly turn out OK.  EWH.
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45 months ago
Hi Dr. Hook,

I called around and it seems it is approx 2 weeks to get results for the duo test here. I guess thats the one drawback with free healthcare here as things are slower being govt funded. Anyhow, one of the places i called was the Hassle Free Clinic in Toronto and he asked the reason i wanted to test and he said he's been involved in testing for over 10 years and has yet to see a positive test resulting from a broken condom only and a large majority of tests are for msm. So that was re-assuring which adds to what you told me as well.

So now i think i'll just test with the Insti rapid blood test. But just need some advice to see if i can start testing at 3 weeks even though a conclusive test may not be until 6 weeks.

Questions:

1. The Insti site states the following based on a faq on their site on whether their test detects early infection.

Yes. In commercial HIV seroconversion panels and low titer panels, INSTI® is equivalent to the most sensitive licensed or approved laboratory-based assays in early antibody detection. However, patients who may be in the “window period” of HIV infection may test Non-Reactive in the INSTI® test.

Based on this what are your thoughts if i test at 3 weeks detection % wise?

2. The centre for disease control in British Columbia stated the below. Is point 1 referring to 3rd generation tests which the Insti rapid test is?

Improvements in HIV test window periods
Recent improvements in HIV tests have significantly shortened the window periods of the tests (the time from infection to detection of HIV).[1] The average window periods for the following tests are:

• 20 to 22 days for third-generation enzyme immunoassay (EIA) tests, which detect HIV antibodies.
• 16 to 18 days for fourth-generation EIA tests, which detect p24 antigen and HIV antibodies.


Dr. Hook i just wanted to thank you again for helping answer my questions while i go through this stressful period. I will try to stay mellow in the meantime and will wait to test based on your responses.


Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
I wish I could give you the precise data that you are asking for but the data really are not all that good for test performance and the 2-4 week period.  The INSTI tests is among the most sensitive 3rd generation (antibody only) tests and by three weeks would detect somewhere in the neighborhood of 80% of recent infections.  A negative test at 3 weeks is quite likely to be true (this is mathematical consequence of the fact that such a small proportion of people who are tested turn out to be infected) .   Your statements 1 and 2 pretty much are saying the same thing.

Also glad to hear of what was said to you by the Toronto clinic. That is very much in line with my sense as well.

Hope these additional comments are helpful.  As you know, this is my 3rd response to your questions and thus the thread will e closed later today.  You may post more until it is but you will probably not get a reply.  Take care.  EWH .
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