[Question #2325] Risk of HIV? Can you offer an opinion?

46 months ago
Hello there, 

Thank you for offering this service. I will attempt to be brief and spare unnecessary details. I am a 30 year-old female.  In late summer of 2016, in conjunction with my annual well-woman exam/pap, I requested a full STD screening, including HIV.  I am uncertain which type of HIV test was performed but it came back negative.  My next sexual encounter didn't occur until December of 2016 when I had a single sexual encounter with an acquaintance of mine . This encounter consisted of mutual  masterbation (fingering...ugh, sorry) and reciprocal oral sex. The fellatio was brief and he did not ejaculate. Everything I read after the fact indicated this was a no-risk event for HIV transmission even if he was infected, although likely that he was not (I outright asked and he does not participate in some of the higher risk factors for HIV (no drug use, no sex with men, etc)). Even so, being a bit of a hypochondriac about STDs in general, I decided to get re-tested. I ordered a 4th gen test from the website stdcheck.com and they indicated the test could detect laboratory evidence of HIV 2-3 weeks post exposure. I waited 22 days after the encounter in question and went for a lab draw. The results came back negative. I have had no sexual encounters since the one in December.  Fast forward 4 months and I get a yeast infection that  has persisted and won't respond to treatment with diflucan or terazol. My OBGYN does a susceptibility probe and discovers I don't have Candida Albicans but rather Candida Galbrata. She had never heard of this strain and had to Google a treatment option, which is Boric Acid suppositories. I came home and Googled this strain and everything I'm reading says that this strain is prevelant with over use of anti-fungals or HIV Infection. So, as you can likely surmise, I am terrified that I tested too soon with the 4th Gen (many websites say 28 days not 21 like std check) and that I might have contracted HIV somehow from this episode in December. 
46 months ago
I'm sorry, I accidentally sent this before I meant to. I simply wanted to ask specifically what you thought my risk of HIV infection was given this information and how accurate is a 4th gen test at 22 days? Thank you! 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome to the Forum.  I'll try to help, starting with congratulating you for getting periodic STD checks despite your relatively low risk status.  This will insure your sexual health.  There are really two questions here- how accurate was your HIV test and second, is Candida glabrata a sign of unusual vulnerability to infection.

First your test.  It is difficult to comment definitively on the accuracy of your 22 day test.   Tests using PCR to detect HIV RNA or DNA are highly reliable within two weeks of exposure, standard HIV antibody tests which are rarely used any longer would detect about 75% of recent infections at 22 days and for the most widely used, combination HIV antigen/antibody tests, over 90% of infections would be detectable at 22 days.  Remember however that when you consider the low likelihood that your partner had HIV (a fraction of 1%), the low probability of transmission of infection if he was (there is no risk from mutual masturbation and the risk for HIV from performing fellatio on an infected partner is less than 1 in 10,000), and the negative test, the likelihood that you acquired HIV is less than 1 in tens of millions (much lower than your risk of being struck by lightening).  From a scientific and statistical perspective, there is really no reason to worry or, in my opinion, any medical reason for further testing. 

As far as your candida glabrata infection is concerned, this is more bad luck than anything else.  Candida glabrata causes about 1 in 20 vaginal yeast infections and some are quite challenging to treat.  That you have candida glabrata is by no means suggestive of HIV.

I hope these comments are helpful.  EWH
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46 months ago
Thank you so much. This has put my mind at ease. I believe I am allowed a follow-up. I am quite nervous about the boric acid suppositories. In your clinic, have you prescribed them and if so, are they painful? Do they cause side effects I should be wary of...burning, discharge, etc.?  My doctor simply called in the compound and didn't really offer much beyond that. Thank you again!!
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
My own experience with boric acid is limited by, in generally, when it is used vaginally it is well tolerated, sometimes (but often not) causing mild local irritation or a watery discharge.   EWH
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