[Question #3868] need clarity of testing

34 months ago
I will try and keep things concise.  Thank you ahead of time for your service to educate and make others feel more at ease.My risk:  April 25th I saw a Ukrainian sex worker.  She gave me unprotected oral for about 10 minutes and I applied a condom and had vaginal intercourse with her for about 30 seconds (lol).  I know oral sex is not an HIV risk but there are other STD risks.   What bothers me is as soon as I ejaculated into the condom I immediately lost the erection I had   and cannot remember how loose the condom was after removal.  It was kind of just sitting on top, loosely, but not removed.  It's this unsure memory that led me to getting tested.  I have had zero other exposures of any kind.  I Think the sex was fully protected by the end when she removed herself off my penis I was already soft and I'm not sure about the stability of the condom.  I've had zero symptomHere are my questions/statements:  If you could reply.  1.  I'm on assignment for work.  I do not have access to any labs or Dr offices for any type of HIV bloodwork, but there's a walgreens.  I bought 2 Oraquick oral swab tests.  I used one on Monday June 11th ( Just shy of 7 weeks) and the other today (7 and 1/2 weeks) post exposure.  Both negative with a clear line next to the C and nothing by the T.  Are these to be believed?2.  3 weeks post exposure I was very sick for a fever for about a week.  101-102 range for 2 or 3 days, and low grade for a few more.  No other symptoms except a bruised rib and a lot of dry coughing.  The Oraquick tests would have turned positive if this sickness was ARS, correct?  The tests were done 3 - 4 weeks post sickness.3.  could you explain your change of heart on the Oraquick?  Your older posts here and on Medhelp state it's very reliable at the 3 month mark, and depending on exposure even a little before.  It seems now you have a dislike for it.  Does it not work in your eyes?  This makes me nervous as its the only test I have available for the next month or so.  
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the Forum and thanks for your questions.  Congratulations on your commitment to safe sex as well.  When persons lose their erections while still inside a partner's vagina, as well as when the penis comes out of the condom as the penis is removed from the vagina following sex, the condom has still done its job and the user is protected.  Thus, even if the CSW you were with had HIV, your risk for infection was virtually zero.  In answer to your specific questions:

1.  As a test for HIV antibodies the Oraquick test is not as quickly conclusive as currently available combination antigen/antibody tests and due to the technology used for the assay, it may take a little longer to become positive than other more recently developed antibody only tests.  By 6+ weeks well over 80% of recent infections would be detected and after 8 weeks that figure is over the 90-95% range.  Recent data suggests a very small number of infected persons may take up to 12 weeks for Oraqucik tests to become positive. 

2.  If your flu-like illness had been due to HIV, your Orakqiuick test several weeks would have been positive.  The ARS is a sign that anti-HIV antibodies are being
formed and antibody detection tests are reliable positive just a few days after the beginning of ARS symptoms.. 

3.  Our "change of heart" on Oraquick reflects new data that small numbers of persons may not be positive until 12weeks after infection as well as the fact that newer tests have gotten better.  The Oraquick is the same test that it has always been and is a good test, its just that there are now better tests.

In the situation you described, I would be confident that you have not gotten HIV.  Personally, I see no need for further testing related to the exposure you have described although that, of course, is up to you. I hope these comments are helpful.  EWH
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34 months ago
Thank you for your answer.  

1.  Dr. HHH says recently that with some people an Oraquick will not turn positive no matter how often they test.  Am I understanding that correctly?  is that a flaw with the test?

2.  I would think that with every couple of weeks that I test and get a negative, my odds of staying negative out to the conclusive zone at around 10-12 weeks would get higher and higher.  Would you agree?  

3.  If I take a 3rd Oraquick (and the last one available at the Walgreens that I already purchased) at around 9 or 10 weeks, would that be considered conclusive?  Or would the problems of the test apply to myself as well?

Thank you, and will save my final response for the future should I need it.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
No test is perfect.  After 12 weeks the accuracy of the Oraquick test is slightly less than other laboratory based tests.  In the largest studies the Oraquick mists up to 1 in 12 infections while other, lab based antibody only tests missed about 1 in 20.  HOWEVER, when considering your likelihood of infection, remember that your rlikelyhood of having HIV is determined by much more than the test performance.  Factors besides test performance include:
1.  The likelihood that your partner had HIV (certainly less than 10%_
2.  The chance of infection IF the  encounter was unprotected (about 1 in 1000-2000)
3.  The effect of the condom - more than 99% effective, even though you lost your erection
4.  Your test was negative.

When you consider all of these (not to mention that your Oraquick was negative not once but twice, therefore increasing the chance of accuracy), your statistical risk of infection is less than on in 10 million (conservatively) which statistically is effectively zero,  If this is not sufficient, then rather than doing more OraQuick tests, arrange to be tested by a combination HIV antigen/antibody test.  The negative result that I am confident you will get then becomes less than 1 in 100 million. 

As for your specific questions:
1.  See above.
2.  Yes but again, how sure do you really need to be.  I think you are worrying far too much
3.  I considered your earlier results conclusive.  The person you need to convince is yourself. I'm not trying to be argumentative here.  NO test is 100% accurate.  Your results are effectively zero.  When it comes to the statistics, perhaps a useful perspective is to appreciate that you are 100 times more likely to be struck by lightening than to have gotten HIV from the encounter you have described.  EWH
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34 months ago
Dr,

I'm now 66 days post expure (a little over 9 weeks).  Since this is my final reply I just a few final questions before I go.

1.  If I use another oraquick today, would it be considered that I am HIV negative?  If negative, that would be 3 negative Oraquick tests at 6 1/2 weeks and 7 and 1/2 weeks, and about 9 and 1/2 weeks.  Or do you think I need a bloodtest when I get back to my home area?

2.  In mid may as I mentioned I got very sick.  I am now a little sick again.  sore throat, runny nose, and a cough that's sometimes productive and sometimes not.  You previously said my 2 earlier Oraquicks would have been positive if this was ARS considering the timing of the tests.  This new cold doesn't sound suspicious?

3.  considering that yourself and Dr HHH say sometimes people never turn positive on Oraquick, even after 12 weeks.   Does that mean between week 9 (now) and 12 weeks I could still seroconvert?

4.  For Gonorrea/Herpes/Chlamydia other STDs...is it safe to assume since I never had discharge or discomfort I am probably in the clear?  Since it's been over 2 months, if I had any of those STI's, would they have cleared on their own, even if I was asymptomatic?

Sorry if I sound paranoid to what you deem was a no risk event.  Just want to put this 2 month nightmare behind me.
34 months ago
Question 2 pertains on the suspicion of a possibly compromised immune system, since I've been getting sick often lately.  Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
1.    This question is a bit repetitive. The exposure you described was essentially no risk from the starting point.  If you took another OraQuick test today I am confident it would be negative. Three negative OraQuick  tests is strong evidence that you do not have HIV. That does not change my qualifications regarding or quick performance. 
2.   Cough and runny nose are not signs of HIV. As I said before if you had HIV and ear symptoms were due to HIV the test would be positive. I am not worried that you have HIV. 
3.  Taking all of the information that you have provided into account as well as your test results I am confident that you will not serconvert. You are being paranoid. 
4.   Most chlamydia infections in men are asymptomatic. Gonorrhea can occasionally be asymptomatic. Nothing in your history suggests any reason to worry about herpes.  While your likelihood of having one of these infections is very very low, given  your level of anxiety the simplest thing for you to do is to have a urine test for gonorrhea and chlamydia. There is no need for a herpes blood test. 

 As you note this is my third reply to your questions. Therefore as per Forum guidelines this thread will be closed shortly. I should also warn you that further repetitive, anxiety driven questions may not be answered. Take care, please don't worry.  EWH
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