[Question #3173] Follow up on [Question #3136] Semen Eye Exposure and scared

39 months ago

Hi Dr.,

I wanted to send and get some more advice from this exposure.

As I last said I am having a hard time with this and want to move on asap!

I mentioned before that with the TS escort we discussed HIV status and test, but I have some more information on that now. She sent her test results to me. It was actually done on the day of our encounter. It was a rapid test at a walk in clinic, it said it could of been a rapid blood or fluid test (I don't have those details).
She was very very adamant that she was negative and always uses protected. Which I think I should believe because we changed condoms a lot during the encounter and she seemed very knowledgeable on using condoms correctly.

I am split about this, because on one hand that means she is tested and was at least recently negative test, but on the other hand, if she was infected a few weeks before her test, then she would be in the window period and be more infectious.

Also, thinking back to the encounter, I can vividly remember her not wanting to have any oral contact at all without condoms on either one of us. And of course anal was protected.

I did last say that I was going to get a test at 27 days, but I couldn't wait and got one at 22 days. It was a 4th gen AG/AB test. Which was Negative.

I am scheduled tomorrow, which will be 27 days, to get another 4th gen test and also the HIV RNA Early detection test. As I said I want this past me as fast as possible.

What is your advice?

Have the test tomorrow? Don't test? Only get the 4th gen test?

If I do get both test, 4th gen and RNA, will that be conclusive evidence of no infection?

As always thank you!

39 months ago

I have decided to not get the HIV RNA test tomorrow. With the risk of a false positive, I don't think I could handle that.

H. Hunter Handsfield, MD

39 months ago

Welcome back. I'll be answering this one, but I reviewed your recent discussion with Dr. Hook. To be honest, most of you ask here was already answered by him, directly or indirectly. I would strongly reinforce his comment about your parter: people rarely lie about HIV status when asked directly, and I think you can rely 100% on your partner's believe that she doesn't have HIV. Yes, she could be in the window period, but the statistical likelihood of that is very low. And you had condom-protected sex!

Your new negative AgAb test at 22 days is around 90% conclusive. If we assume your exposure carried 1 chance in a million of HIV transmission (which I actually think it too high), then with this test your risk is now 1 in 10 million. That's zero for practical purposes. Believe it.

But assuming you go ahead with a final test, I recommend a) waiting until the 6 week mark, when an AgAb test will be 100% conclusive (as you already know, from what you said in your previous thread) and b) not having an RNA test.

OK? HHH, MD

---

39 months ago

Thank you Dr H.

My biggest issues is not getting off the internet and letting the reassurance from you both kick in.

I will do my best to hold off on testing until 42 days.

I do appreciate you saying that the exposure is probably more than 1 in a million. And with the test making it basically zero.

I know that symptoms are not something to rely on, but I have had a drainage, cough, and slight sore throat starting about 3 weeks after and diarrhea starting around the same time, but I do have a weak stomach and issues usually anyway. No Rash, No fever, or headache (other than in my eyes from reading on my phone too much)

H. Hunter Handsfield, MD

39 months ago

Testing always overrules symptoms. It isn't possible to have HIV symptoms with a negative blood test. In other words, even if your current result isn't quite conclusive on HIV diagnosis per se, it proves your symptoms are not due to HIV. And cough and nasal drainage are not acute HIV symptoms anyway.

I agree with your comments about online searching. Anxious persons often are drawn to things that inflame their fears, typically missing much reassuring information that is also available. Nate Silver, the statistician behind FiveThirtyEight.com, wrote a book about statistics in popular culture (The Signal and the Noise). in it he writes (approximate, from memory) "Give an anxious person a computer and an internet connection, and soon he'll be thinking his cold is the bubonic plague."

---

39 months ago

Hi Dr. H,

Update and hopefully closure!

As I said before, I got a 4th gen test done via Clinical Pathologies Lab 22 days after encounter, which was negative.

Based on our corresponding, you said the risk was at worst 1 in a million. I am assuming you calculated this by Odd of infection = .01, odds she had HIV =.01, and protection with condom = .01. That is 0.000001. Then with a test of 90% accuracy at 22 days, that put the risk at 1 in 10 million, which is essentially zero.

I did get the 4th gen test done via Quest Diagnostics on the 27th days after encounter. The results were negative, as I assume you already figured that :-).

Now, based on all the information from both you and Dr. Hook and assuming the same calculations of risk, chance she has hiv, and condom being used, and the theoretical risk to the eye being 1 in a million (0.000001) and now saying the test is at least 98% accurate on the 27th day (based on Dr. Hook's response). I can calculate the risk as 0.000001 x .02 = 0.00000002 = 1 in 50 million.

Should I still test after 6 weeks?

Can I safely put this behind me, move on with my life and not believe for a second that there is a chance I caught HIV from this event?

Thank you both again for all you do!

And if any of my math is wrong, or assumptions, please tell me!

H. Hunter Handsfield, MD

39 months ago

Your calculations are fine, as long as you understand that all the estimated proportions are just that, estimates. But even if you assume higher probabilities at each stage, the chance you have HIV will calculate as low enough to be considered zero.

Whether or not you "should" test at 6 weeks is entirely your decision, not one amenable to medical advice. If I had been in your situation, I wouldn't have been tested at all. But I'm not you, and you're the one who is obsessing about it! If you think you'll be able to go forward without worry based on the risk estimates and your current test result, that's fine. But my guess is that you're going to stew about it until you have a 100% conclusive test, regardless of the other elements of the risk calculation. If so, you'll probably need the negative result at 6 weeks to move on without worry.

That concludes the two follow-up replies included with each thread, which usually means closure. However, I'm going to leave this open for one more comment. If you decide to have a 6 week test, I suggest waiting until you have that result. In case you do so, I'll leave the thread open through the end of this month. But I won't have any further comments or advice unless and until you decide to get tested and let me know the result. OK?

---

38 months ago

Sorry Dr. Handsfield, but I do have a questions about timing for a conclusive result.

Looking at the CDC website I see that it says 45 days for the 4th gen test.
Do I need to wait until 45 days? or is 42 days 100% conclusive?

I am sorry about this follow up question, but it is weighing on me

H. Hunter Handsfield, MD

38 months ago

There is no statistical difference between 42 and 45 days. Dr. Hook and I are using exactly the same scientific report as the basis for our current advice. We simply round it to 6 weeks, i.e. 42 days.

But why does it "weigh" on you? If you'ree nervous about the shorter interval, get tested at 45+ days. It's only a 3 day difference.

That concludes this thread. Please do not be tempted to start a new thread about this exosure and your concerns about HIV. Repeated questions on the same topic are discouraged and in obviously anxiety-driven situations are deleted without reply (and without refund of the posting fee). Thanks for your understanding. I do hope this discussion has been helpful.

---