[Question #4962] HIV Testing Guidelines

27 months ago
Hello Doctor, While having unprotected veginal sex with a girl (24, college going girl that I met at a bar), I had a cut on my foreskin of the penis. Neither me nor the girl had ejaculation and I repeatedly asked her if I need to be tested and she said that  she is clean and as long as I am clean there is nothing to worry about. However, about 3.5 weeks after this encounter, I had developed a sore throat which lasted for about a week. I didn't observe any fever or swollen lymph nodes. How ever my mouth and body were dry, headaches for weeks (probably anxiety), I started observing half and half nails. I was anxious and terrified and took 4th Gen DUO at Labcorp at 25, 29, 32, 44 and 52 days after exposure. I have also taken HIV RNA at 36 days post exposure. All the results are negative. I recently saw blood in my stool couple of times due to  few anal fissures. My Doctor, said the chances are minimal and all this is mostly my anxiety.
1. Are my results conclusive? Do you suggest any further test for HIV in future?
2. Do I need to re test after 90 days(Everyone including CDC suggests to take confirmatory test at 90 days)?
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome to our Forum.  I'll provide more details in a moment but the bottom line here is that the encounter that you have described las low risk for acquisition of HIV and the testing that you have done as absolutely proven that you did not acquire HIV from that encounter.  To elaborate:
1.  This was a low risk event.  HIV is rare in heterosexual women.  Further, even if she was infected, the chance of infection from an encounter of this sort is less than 1 infection in 1200 sex acts.  That you experienced an abrasion during sex does not change this.
2.  Your test results prove that you were not infected.  4th generation DUO tests provide conclusive results at any time more than 6 weeks (42 days) after an encounter.  Thus, your test results were definitive when you tested at both 44 and 52 days.  In addition, Your 36 day RNA test was also definitive.
3.  Your symptoms.  While a sore throat may be a sign of recently acquired HIV, when persons are symptomatic, they typically have high fever, severe muscle and joint aches as well as a sore throat.  In symptomatic persons, if the HIV test is negative, then the symptoms are not due to HIV.

1.  Your results are conclusive.  There is no need for additional testing.
2. The 90 day recommendation is out of date and more recent CDC guidelines do NOT recommend a 90 day test.

I hope that this comment is helpful.  EWH
27 months ago
Thank you Dr. Hook for the fast response. My test at 32 days after exposure was a complete screen for all the STD's. During this test my RPR was reactive, but confirmation test for TP-PA, TP - Specific EIA were non reactive and RPR ratio was 1:2. So Doctor said it was false positive and asked for a retest after 2 weeks. So when I took the test at 52 days after exposure the result was same: RPR was reactive, but confirmation test for TP-PA, TP - Specific EIA were non reactive and RPR ratio was 1:2. So Dr. suggested to go for TP-PA in future and avoid RPR as my body was repetitively reactive for RPR.  But when I look online I see acute HIV infection can cause repetitive reactive RPR. Then I start to wonder if these tests are conclusive, but my Doctor says they are conclusive. As you mention I do remember when I first got sore throat, I also had white tongue, dry eyes and slight muscle pains(Can be due to exercising as well). I am in two minds, should I trust my tests or symptoms. Logic says chances of HIV infection is very very less but the symptoms exist. My Doctor thinks most of these symptoms are caused by anxiety and lack of sleep. More recently since my last two days I had weird bowel movements (Not Diarrhea).

1. Do you still think this is low risk scenario and I don't have HIV? (When I had a cut on my foreskin I was on antibiotics for 10 days and the injury cured in 3 weeks). Don't you think I might have had more probability of acquiring infection due to the cut?
2. Why is my RPR reactive repeatedly? Does that mean anything in terms of HIV?
3. I have also been seeing my finger nails color change. Top half is pink and bottom half is white. Some say it may be anemia, lupus or HIV, but my Doctor said he doesn't know how to diagnose this and assured me its nothing to do with infectious disease. Do you agree with him?

The only positive things going towards me are negative tests and the probability of an infection in a girl going university and living in Seattle is pretty minimal. 

Apologies for the long post.

Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
You are overthinking this.  It was my research that showed that persons with HIV have a somewhat increased rate of false positive RPRs over 20 years ago.  Nonetheless most persons with false positive RPRs are like you and do not have HIV.  

As I explained above, when symptoms and tests differe, the tests should always be believed as symptoms have many, many possible cuases, some of which you have already acknowledged.  

1.I am confident you  did not get HIV from the encounter of concern.  You have proved this with two different types of tests.
2.  False positive RPR tests are chance events, reflecting human variability, nothing more.
3.  I do agree with your doctor .  If you are concerned about this, I suggest you see a dermatologist.

Please believe your tests and do not let the combination of your guilt and anxiety over a casual sexual encounter, combined with being mislead by the internet worry you.  You do not have HIV from this encounter.  EWH
27 months ago
Thank you Dr. Hook for the response. 

I just have couple of questions to reduce my anxiety.

1. Do you see in rare cases a 35 day RNA negative/ 51 day 4th Generation Negative turn positive later? I was said that HIV RNA is conclusive at 28 days and 4th generation test is conclusive at 42 days. Is it true? Is HIV RNA the most accurate test out there? Do I need to retest? I am definitely HIV negative?

2. Do you still consider my encounter low risk, doesn't a cut significantly increases a chance of HIV infection although as per stats there are only 1200 people living with HIV in all Seattle (That number is significantly lower for college goers)?

3. Do HIV symptoms start even after 8 weeks after exposure? I am asking this because, I am so nervous that I am checking my temperature about 10 times a day, looking for any rashes on my body. I am starting a therapy on suggestion of my Doctor as I am afraid of sex altogether.

Thank you Dr. Hook for your patience and swift replies. Really grateful

Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Straight to your followup questions.

1.  The 4th generation, combination HIV antigen antibody is the gold standard for testing worldwide.  Results are definitive at 6 weeks (42 days). The RNA test is nearly as reliable and would certainly be considered definitive at 35 days.  With both tests there is simply no realistic chance that a person has HIV
2.  Yes, I do consider it very low risk.  Further remember that most persons with HIV in Seattle are men with other men as sex partners and about half of those are non-infectious because they are on effective therapy for their HIV.
3.  You are getting. Carried away.  If you had acquired HIV the symptoms of the ARS would be obvious and would not require checking for them.  Further. The ARS would not occur after 8 weeks.

I urge you to put your concerns aside and move forward.  As this is my 3rd response as part of this thread, the thread will be closed without further responses shortly.  Take care and please don't worry.  EWH