[Question #4980] Testing Concern

24 months ago
I had unprotected vaginal sex with a Man maybe once or twice in one night.  That is it, after that I did not have any kinda sexual contact with him again. 

Since the unprotected Vaginal sex I had 3 HIV and full STD tests to ensure I didn’t get anything from this encounter. I was tested for HIV at 3days , 34days , and 46days from the incident, (34days  test was quick finger prick) all the test taken were 4th Generation combo test, results negative. I was recently informed that the man I had sex with might have been in jail at some point before I met him, this scares me because that is considered a high risk. The man claimed when I was with him that he is clean because he was tested three month prior to meeting me but I don’t know if I should believe this. I have had symptoms that have included small swollen lymph node behind my neck which could be caused by stress due to guilt and worry. Not sure ! Went away within a week or two.  It’s been almost a year since this incident has occurred, what kinda symptoms should I look out for to indicate that maybe more testing is needed to confirm my status. I don’t want to infect anyone ! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum and thanks for your confidence in our services. Sorry for the slightly longer than usual delay in responding.

The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. When testing is done sufficiently long after the last possible exposure -- e.g. 6 weeks for the antigen-antibody (4th generation, "combo") test -- the results always are 100% conclusive and overrule all other considerations, such as exposure history and symptoms. Even if your partner were known to have HIV, or if your symptom swere typical for HIV (which they are not), the test results rule. For sure you do not have HIV.

Stress won't cause lymph node enlargement, but it certainly could affect self examination and perception that something is wrong. In any case, for sure HIV isn't the cause. And don't worry about what symptoms to be on the alert for. As just explained, any symptoms you may have now or develop in the future cannot possibly be due to HIV (assuming no new potential exposures to the virus).

So all is well in regard to HIV -- No worries!

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

HHH, MD
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24 months ago

Thank you very much for answering my question. 


Just to confirm if I took a 4th Generation HIV combo test at 46days, results negative. This test is considered conclusive for HIV 1 & 2 because it was taken past 42days from the time of the last sexual encounter. No matter the risk level it is considered conclusive, symptoms do not matter because they would not be caused by HIV. 


I am only overly concern because I want to have children and this stupid act happen at a time in which I split from my regular partner. I want to get back together with my regular partner but I would not want to risk his health because of my momentary lapse in judgement. 

I assume It is  okay to resume normal sexual activity with a regular partner in the future with no fear of transmitting anything to them. 


I am curious regarding HIV testing and have a few additional unusual questions. 


  1. Why do you think so many places are not in agreement with considering a 4th Generation HIV combo test taken after 42days conclusive? Is it because they are trying to account for individuals that do not remember their exact last sexual encounter or is it because they are trying ensure they are accounting for anyone that might be taking Immune suppressant therapy (possible last stages of cancer) ? 


  1. I read that before advice was given that a 4th Generation HIV combo test was considered to be conclusive anytime after 30days and this same advise is still being given by others such as Medhelp site. Why did the advise change from 30days to 42days for the test to be considered conclusive? I saw that on one of the previous posts on this site their was mention of an article published that caused for change but I do not fully understand how this study was conducted to conclude that the time frame needed to be changed. Can you provide an explanation, please. I am just concerned that the time frame of assessment could later change again which could mean my negative test at 46days could no longer considered conclusive. 


  1. If an individual is HIV positive, how long could they possibly go on without being aware ? Meaning can they live for years without treatment ? I have a friend who told me she had an uncle that lived with HIV for upto 17 yrs without medicine, I don’t believe this. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
I confirm that your 4th gen test at 46 days was conclusive. It is impossible you have HIV, assuming no more recent exposure.

1) Good question. There probably are several reasons. Some are simply naive, not aware of the performance of the AgAb (4th gen) HIV tests. For 20+ years, 3 months was the standard with older tests, and some agencies or providers simply haven't changed. Others intentionally take a hyper-conservative stance for legal reasons, sometimes with their attorneys' conservative advice. But the science is clear:  6 weeks or more is conclusive.

2) Four weeks is almost always conclusive and that's what we said on this forum until about a year and a half ago. At that time, a careful review was published that showed that very rare cases that take 6 weeks, at which time we altered our advice.

3) If by "without being aware" means because of symptoms, it could be many years. I doubt your friend is lying:  a small proportion of people with HIV (probably 2-5%) are "elite controllers" whose immune systems keep the virus in check for long times. While 17 years without serious health problems is rare, it certainly can happen. But without anti-HIV drugs, the large majority of infected people are quite ill and many die within 10-15 years.

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24 months ago
I understand this will be my final question and my thread will be closed. Thank you for all your help an assistance. Going forward I will try not to allow my anxiety to get the best of me. 

So based on your previous responses. To recap one last time. If I took a HIV  1/2 4th Gen combo test at 46days- results negative and I had also taken one at 34days - results negative I can be assured I did not get HIV from this encounter which was 46days prior to the last test. As long as I did not have any other risky encounters other than the one mentioned I should remain negative for HIV. I can safely have sex in the future with a regular partner that is STD free without worrying that I will pass on anything to them. I could consider my HIV test at 46days to be conclusive and proof that I am HIV negative no matter what ever  symptoms my mind attempts to connect to this encounter.  

If I decided to take another test in the future and had no other encounter I would only be ensure of another negative results, which would not be  necessary. 

Like to also mention I was tested for all other STDs at 46days out and at 55days out negative. HIV was my concern. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
All those statements are absolutely correct. You definitely cn move on without worry about it. Also glad to hear your other STD tests were negative. 

I'm glad the discussion has been helpful. Best wishes.
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