[Question #4647] Follow up question -hiv risk

26 months ago
Dear Doc,
I am asking a follow up question since my previous thread was closed. It is regarding same exposure and same concern . I had negative gonnerhea and chlymidia after a week of exposure . I also had negative hiv test based on duo ( antigen + antibody ) , which was rapid finger prick after 27 days of exposure. Based on my risk involved, can I stop being anxious and worried and resume unprotected sex with my partner? Knowing what you know , what would you have done where it to be you in my shoes ? Do I need another test?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back to the forum. Thanks for your continued confidence in our services. I happened to log in a couple of minutes after you posted your question:  most users should not expect nearly real-time replies.

I reviewed your discussion with Dr. Hook last momth and agree with his evaluation and advice. (Threads are closed after 28 days with no activity.)

Your gonorrhea ahd chlamydia test results are conclusive. Your HIV test is nearly but not quite conclusive:  the antigen-antiibdy (duo, 4th generation) HIV blood tests are nearly conclusive at the time you were tested (4 weeks), about 98-99% reliable, but 6 weeks is required for 100% conclusive results.

Do you "need" another HIV test? As Dr. Hook said, from a risk evaluation standpoint, you did not need testing at all. At this point, considering both the low risk of the exposure plus your current 98-99% reliable test result, the chance you have HIV is somewhere in the range of 1 in 250 million. That should be low enough that you can stop worrying and stop testing. But if you still believe you "need" a truly 100% conclusive test, have another AgAb test at 6+ weeks after the sexual exposure.

You don't mention testing for syphilis. The chance is also extremely low, but riskier than HIV. If you go ahead with another blood test at 6 weeks, I suggest including syphilis.

I hope these comments are helpful and reassuring. Let me know if anything isn't clear.

HHH, MD
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26 months ago
Thanks for the response doc . I haven’t had any visible sores or symptoms for syphillis , based on the 1 in 250 million chances and no sores or symptoms for syphills would it be ok to resume unprotected sex with my regular partner ? If by any chance you found yourself in my shoes what would you do ?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
My opinion is that although the chance of infection with either HIV or syphilis is not zero, it's low enough that you can safely resume unprotected sex with your partner. If I had been in your shoes, I would not have had any tests at all for any STD and I would never have stopped having unprotected sex with my wife. ---
26 months ago
Thanks for the response. I am just curious why window period has changed from 4 weeks to 6 weeks ? Is it to cover theoretical possibility? Have you ever come across 4 week negative turning positive after 4 weeks ? I will get tested again with syphillis. I am extremely worried and anxious and next few days waiting for the results will be tough.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
A little over a year ago, a research paper comprehensively reviewed the available data and concluded that in rare cases 6 weeks is required to achieve 100% conclusive results with the AgAb tests. The paper was accompanied by an editorial by investigators at CDC, endorsing the results. At that time, we revised our advice on this forum from 4 to 6 weeks.

That conlcudes the two follow-up comments and replies included with each question and so ends this thread. 

Really, stay mellow. In the 15 years I have been doing this and my previous online forum, with thousands of questions like yours, there has not yet been a single questioner who turned out to have caught HIV. Given your near zero risk, you certainly aren't going to be the first. If and when that finally happens, almost certainly it will be a genuine high risk exposure of the kind that regularly leads to HIV -- not the minor sort of exposure you had.

I do hope the disucssion has been helpful. 
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