[Question #3777] Hiv Window Period

32 months ago

Dear Doctors:

Thank you for the invaluable service you provide here...

Exposure History - I performed unprotected oral sex on a woman of unknown status. Female in her late 40s; South Florida region; bar pickup at a hotel lounge. Performed oral sex on her for abut 5 minutes or so but thought better of the encounter and decided to leave her room. I literally never took my shoes off. Would have also had genital-hand contact with her prior to oral sex.

Symptoms: Exactly 14 days after encounter developed fever, GI upset, swollen glands. Fever resolved after about 24 hours but anxiety took strong hold after that. Have continued to have periodic GI upset as well as nausea, lightheadedness, etc. Did not develop sore throat or rash.

Tests: Ordered online through STD service. Venous blood samples given at Labcorp. 4th generation tests at 31, 40 and 52 days. All non-reactive.

Was feeling pretty good about things but have been reading lately about the window period for HIV 2. I know that the subtype is exceedingly rare in the US but you know how the anxiety goes...

I'm in a new relationship and my partner just tested negative on an Oraquick home test. It's been several months she has had sex with another partner so I feel pretty confident about her result. We have started engaging in unprotected sex based on the results of my last HIV test. Questions:

1. Would my test at 52 days be sufficient time to exclude HIV 2 or do I need to retest at 12 weeks?

2. Can I continue to engage in unprotected sex with my current partner? I should add that I had a standard STD Panel earlier this year before the Florida encounter with everything negative. My new partner is also planning on having a full STD panel but realistically, HIV is my primary concern. I just want to do everything possible to avoid exposing my new partner to any risk.

Thanks.

Edward W. Hook M.D.

32 months ago

Welcome to the Forum. I happened to be on the site when your question "hit" so you are getting a reply far sooner than is typical. I hope that I will be able to convince you that your did not acquire HIV from the encounter that you describe and that there is virtually no risk at all for HIV-2 from the encounter you describe. First the HIV-2 issue, In the first 30 years of the HIV epidemic in the United States, there were only 166 cases of HIV-2 that occurred out of the 1,400,000 cases of HIV diagnosed in the U.S. The vast majority of these infections occurred in persons from, or who traveled to West Africa. Realistically, HIV-2 is not a concern from the exposure you have described. In addition, in terms of risk for infection even if your partner did have HIV (which is unlikely), cunnilingus is a biologically inefficient means of STI and HIV transmission. I have never seen or heard of a case of HIV acquired from performance of oral sex on a woman. Your combination HIV antigen/antibody tests (4th generation) are definitive as well and confirm that you did not acquire HIV-1 or HIV-2 from the exposure you have described. Thus, the answers to your questions are:

1. No need for further testing. Your test results exclude HIV-1 and HIV-2.

2. Presuming you did not get any other STI from the encounter you describe, I would not worry about having unprotected sex with your partner.

I suspect that the sore throat you mention was co-incidence and unrelated to the oral sex encounter you describe above.

I hope this information is helpful EWH

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32 months ago

Doctor Hook:

Thank you for your quick reply and advice. I'm a divorced father of three and the incident I described was very out of character for me so your reassurance on the testing I've had is much appreciated. Like many of those worried who read through the various questions on the forum, it sometimes makes a big difference to hear the answer directly from you or Dr. Handsfield even if the question has essentially been answered before. Please keep up the great work you're doing. It is a wonderful public health resource.

Edward W. Hook M.D.

32 months ago

Thanks for your thanks. It means a lot. EWH---