[Question #3500] HIV testing and transmission

35 months ago
Hi I am asking a question on behalf of  my friend who is very anxious about HIV testing and transmission.  About 5 weeks ago, he had sex with a sex worker in Amsterdam. It was protected oral sex and brief 20 seconds protected vaginal sex. Once he was done, the sex worker took the condom off and he is unsure if it broke or not. 
He got a test done at 16 days which was negative and is waiting on a test on 28 days. His questions are
1.what are the risks of transmissions of HIV from the sex workers assuming she has HIV?
2. How accurate are the results at 16 days and 28 days?  They are saying that to get conclusive results you have to wait for 3 months. They use a 4th generation testing here. Here is the website for all the tests that are used in Canada, which says the results are conclusive up to 6 weeks. http://www.catie.ca/en/fact-sheets/testing/hiv-testing-technologies
3. he is paranoid is wondering what are the chances of transmitting anything to his regular partner via kissing, bleeding gums, touching etc . 
4. if the results are conclusive at 28 days can he have unprotected sex with his regular partner?

Can you please help answering these questions and recommend what testing is required and should he wait for 3 months to get conclusive results. 

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum. I have to say this exposure event and test sequence sound very much like the ones you described on your own behalf in a separate thread 10 days ago. Whether it's you or truly a friend, I would encourage you to re-read Dr. Hook's replies in your other thread. The answers are there, either directly or by implication from Dr. Hook's comments.

1) As discussed last time, it is unlikely the Amsterdam sex worker had HIV or other active STDs. There has never been a scientifically validated oral to penile transmission, even without a condom; and condoms also are, of course, highly reliable in preventing transmission by vagiinal sex. All things considered, I would put your (or your friend's) risk of HIV from this event at under 1 in a million, even if the sex worker had HIV.

2) Three months is outdated for the antigen-antibody (4th generation) HIV blood tests; it never takes that long. The results are 80-90% reliable at 16 days and around 98-99% at 4 weeks. On this forum, we agree with your Canadian resource about conclusive results any time 6 or more weeks after exposure.

3) Someone without HIV cannot transmit it to anyone else. Even if infected, HIV is never transmitted by touching, kissing, bleeding gums, etc. Only by unprotected sex (or injection drug use with needle sharing).

4) He or you can have unprotected with his/your partner right now. Certainly you or he should feel free to do so following a negative test result at 28 days.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago
Thank you for the reply Dr. The question is truly for my friend and we were both in similar situations but he is more anxious than I am and couldn't bring himself to ask the questions. 

He is still unsure why certain Doctors (GPs) and nurses here in Canada recommend retesting at 3 months.? And is willing to believe the 3 month window is conclusive  and not that at 4 or 6 weeks that it is conclusive as they may not be 100 percent . Why is there such a misinformation within the health care professional for the testing windows? 

He wants guarantees that he won't be transmit a infection to his partner. I don't know how to give him this guarantee. I hoping you can speak to that a little and what you have seen in your experience. 

He is asking me questions like he a pimple that was bleeding on his head and his partner was touching him and he could infected her through that. Is this even possible? I don't believe so, but I don't know how to make him understand this. I don't think the hiv virus last that long after coming in contact with air.  Could you please comment on this?

So what do you think his plan of action should be? As he wants to go back to his normal life without being worried that he will infect his partner. 

Should he get retested at 6 weeks or 28 days is conclusive? Or should he wait till 3 months? I don't think his anxiety will make him last that long without ruining his life. 

Sorry to ask these repetitive questions but I'm hoping you can answer these and provide some peace of mind for him. 

Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Canada is not unique; physicians all over the world, and even entire health departments, continue to cite 3 months as conclusive. I'm not entirely sure why. Part of it is that 3 mo. was recommended for 10-15 years and breaking habits is hard. Some are not aware of the differences in evolving test technologies, not understanding that AgAb tests become positive sooner. Other times it's conservatism, i.e. better to err on the side of testing later than necessary than too early. Or legalistic, CYA in case someone complains or sues. However, the data are unequivocal that 4 weeks usually is conclusive and 6 weeks always is.

Probably nobody in the world ever caught HIV by contact of blood or sexual fluids with pimples. For doctors, even a slice with a scalpel contaminated with wet HIV infected blood usually doesn't transmit the virus.

I cannot tell your friend when to be tested. But if somehow I were in his shoes, I would have a single test at 6 weeks and rely on the negative result. If he just can't stand the wait, he could seek out a clinic to have an HIV RNA/DNA test around 2 weeks after exposure, plus an AgAb test at 4 weeks. That combination would be 100% conclusive.

In the meantime, tell your friend to grow up and think objectively. If he's old enough to be having sex, he's mature enough to have the responsibility for cool, objective, non-panicked thinking about all this. If he just can't pull it together without "ruining his life", he needs professional mental health counseling. I suggest it from compassion, not criticism.
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35 months ago
Thank you for your response. I am hoping this will be the last question I ask for him regarding this. He is finally agreed to get some help through therapist. But for some reason, he keeps going back on the 3 month waiting period and is having a hard time be physical with his partners as he is worried he will pass something on to her. 

Anyway, his question today was about Syphilis,  How long does he have to wait to get a conclusive result from the test? The tests he has done and will do at the  6 weeks mark, also tests for it. Is the window period long enough to get a conclusive result at 4 weeks and 6 weeks? Or does he have to  wait for 3 months to get conclusive results? He hasn't had any symptoms or was wondering what would be some early symptoms that he would have?

I know these are repetitive questions, I really appreciate you answering these for him.  Hopefully this would be the last one questions and his therapist would help him get over his anxiety. 
thank you, 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I can't help that your "friend" continues to be concerned in spite of all this reasoned, science based reassuranc; and of course he is free to be tested again at 3 months or whenever he wants.

The main initial symptom of syphilis is a sore (called a "chancre") at the site of inoculation, typically showing up 10-20 days after exposure. If he has no such sore by that time, on a body part that contacted the sex worker (unprotected), then he can be confident he did not acquire syphilis. Syphilis blood tests are conclusive at 6 weeks and beyond. 

That's two replies to follow-up questions, our standard limit, and so this thread is done. Please note the forum does not permit repeated questions on the same topic or exposure. This your second, including the one your own behalf and this one for your friend. It will have to be your last question on your joint adventures in the Amsterdam red light district; future new questions about this/these exposure(s), testing, and your (or your friend's) fears about HIV or other STDs will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.  


I hope the conversations have been helpful. Best wishes to both of you, and stay safe. 



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