[Question #5241] Please help! Dr Handsfield & Dr Hook

22 months ago

Dear Dr Handsfield & Dr Hook,

Last year December during my vacation in Manila. I had 3 vaginal protected exposure from CSW at a massage parlour -2018 December 11th, 13th & 30th. However, even though we used a condom on my last exposure back on the 30th, I wasn't really sure if the condom broke because I was intoxicated.  In the 3rd & 4th week of January 2019 I had a sore throat which went away quickly after a day after taking anti-biotics. It was followed up by a sinus infection, it felt like my whole head was burning and my right nostril was blocked. 

Fast forward last February when I came back in the UK. I had two test one was finger prick and venepuncture at 6 weeks 43  & 47 days post-exposure using 4th Generation ALERE COMBO from CityDoc Clinic in London both NEGATIVE including full STD panel for Hepa B & C Syphilis and Urine test for Trachomatis & Gonorrhoea which came out all NEGATIVE . I also did a follow up test for HIV again at 9.5weeks - 67days post exposure at Freedom Health Clinic London using venepuncture 4th Generation Laboratory Duo test at the Doctors Laboratory.

Here are my questions

1. Do I need further testing? Did I tested at the right time for HIV & Full std panel? I'm really confused which brand or laboratory clinic uses an accurate HIV tests. Is Alere 4th Generation Combo reliable? I tried to get information on my last test on what brand they are using but the doctor only said that they send my blood samplesat Doctor's Laboratory in London and it only took 4 hours to get my result. 

2. Is it true that unprotected vaginal sex from woman to man has low risk?

3. This is what really worries me a lot. I feel like my body hasn't produced anti-body enough yet, could it be that my body is having a delayed producing detectable HIV virus? Because I always go to the gym and take protein powder as my supplement. I feel like I have a strong immune system and my protein supplement is the cause why I haven't got enough detectable HIV virus yet.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum and thanks for your confidence in our services.

Quick answer:  for sure you didn't catch HIV and no more testing is needed. A couple of general comments:  indeed the risk of HIV from any one vaginal sex exposure is low, even with an infected partner; more info below. The current HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. The syphilis blood tests and urine gonorrhea/chlamydia tests also are pretty much foolproof and your results are relaible. Finally, Freedom Health is an excellent sexual health clinic:  their expertise is as good as ours on this forum, probably better in regard to HIV prevention and testing.

1) Don't obsess over the specific tests. All those you mention are highly reliable. The Alere 4th gen combo test is 100% conclusive 6 weeks or more after the last possible exposure. There are no ewxceptions.

2) The most respected and widely quoted estimates come from CDC, which calulates an average risk for the male partner from unprotected vaginal sex, if the woman has HIV, at 1 in 2,500. Sometimes higher (e.g. for recently acquired HIV) sometimes lower (e.g., longstanding asymptomatic infection), but that's the average when the infected person is not on HIV treatment. (In that case, transmission risk is zero.) In your situation, the risk is still lower because the exposures probabaly were condom protected. However, the level of risk at the time doesn't matter anymore:  no matter how high the risk at the time, your test results prove you didn't catch HIV.

3) There is no such thing as anyone not prodicing detectable antibody witin a few weeks. In addition, the 4th gen tests detect HIV antigen (i.e. the virus itself) in addition to antibody. If somehow antibody were not produced, the test would be even more strongly positive because of high antigen levels. This is why the 4th gen tests are always 100% conclusive. There are no drugs, diets, or supplements that have any effect on any of this. I'm glad to hear you have healthy habits, but they -- and your protein supplements -- make no difference at all.

So all is well. You can move on without further worrying and for sure with no more testing. If you ask these same questions of Freedom Health, they will agree -- you could even print out this thread as a framework for discussion.

I hope these comment are helpful. Let me know if anything isn't clear.

HHH, MD
---
---
21 months ago
Dear Dr  Handsfield,


Thank you so much Doctor Handsfield! It means the world to me coming those words from you! It worries me a lot because I did not had any major symptoms at all that causes me to worry that I might having a delayed case because my body hasn't produced enough virus yet, despite of my  6th & 9th week negative tests.  This event is really a life changing experience for me and will carry this lesson from now on. 

Again, thank you for your knowledge & patient consulting my case Doctor Handsfield! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
There is no such thing as a "delayed case". Symptoms are meaningless -- they are noticed by only about half of newly infected people. Among those with or without symptoms, there is no difference in antibody responses or time to positive blood tests. Everybody has a positive AgAb (4th generation) test, like Alere's, within 6 weeks. There are no exceptions.

But I'm glad the discussion has been helpful. Take care and stay safe.
---