[Question #5272] Hiv risk and testing

22 months ago
Brief synopsis of my exposure and my testing up to this point. 

Brief vaginal intercourse unprotected with csw.

Rna test 14 days: -ve 
Rna test 21 days: -ve 
Duo 4th gen 28 days: -ve 
Rna test 28 days: -ve 
Duo 4th gen 35 days: -ve

Since exposure ive had a root canal done. And I have been on 4 different antibiotics. Biccilin injection, azithromycin. (Given to me by clinic to combat other stds) amoxicillin and clindamycin. (For root canal) my questions are: 

1) can all of these antibiotics ive been on delay/impact tests taken? 

2) are my tests up to this point a good indication of a - status? 

3) can my root canal have delayed p24 from showing up on tests? 

4) at what day would my tests be considered conclusive?
22 months ago
Also to add to my exposure was anal frottage with balantis on my penis 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Greetings and thanks for your question. I happened to log in right after your second comment:  most users shouldn't expect nearly real-time replies!

First, you had a low risk exposure for HIV. The large majority of CSWs don't have HIV; and when a woman has it, the transmission risk for each epsiode of unprotected vaginal sex is around 1 chance in 2,500 (i.e. daily sex for months or years before infection becomes highly likely). Of course you should have used a condom, and I would hope you will do so for similar events from now on. But the chance you caught HIV this time is extremely low.

More to the point of your qeustion:  the combination of tests you had is 100% conclusive proof you did not catch HIV. It is not possible to be infected for 35 days and have negative RNA tests at 14-21 days and negative duo at 35 days.

To your specific querstions:

1) There are no medications of any kind that have any effect on the tests you had. (It sounds to me like you were greatly over-treated, based on the exposure! But the antibiotics had no effect on your HIV tests.)

2,4) See above. Your results already are conclusive. Older advice (e.g. waiting for 3 months) was valid for the older antibody-only HIV tests. It is outmoded for the duo test and the combination of duo plus RNA testing.

3) There are no medical conditions, and certainly not dental work, that delay or otherwise alter p24 testing or any other HIV test result. None. (Any stories to the contrary are urban myths, especially in the last 10 yearts when duo testing became the norm.)

As for your follow-up comment, anal frottage carries little or no risk for HIV, even if your partner had HIV. Balanitis would not increase the risk. In any case, your risk at the time of exposure doesn't matter:  no matter how high the risk at the time, your test results prove you weren't infected.

So no worries about HIV -- all is well and no more testing is needed.

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

HHH, MD
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22 months ago
Hey dr. Thank you very much for your reply. Super anxious about this whole event but your answer has calmed me down substantially.  I have one more test already paid for which I will take at day 42 and hopefully will put this behind me. The work you guys do on here and have done on medhelp is beyond amazing. Thank you again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Your 42 day test should be a duo, which will be negative. Don't waste money on another RNA test. Thanks for the kind words. I'm glad to have helped. That's why we're here.---
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22 months ago
One more question dr. And I'm sorry for being the anxious type. Would there be any medical circumstance that would interfere with the test? Crohns disease, uti, etc? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Re-read my replies to questions 1 and 3 above. There are NO medical circumstances that interfere with the reliability of the AgAb HIV tests. Don't overthink it. You're fine and are over-wrrying about a non-event in terms of HIV risk. Based on the exposure and test results so far, there is simply no realistic chance you have HIV and any further tesitng you do will be negative (assuming you don't have another, truly riskly exposure). Do your best to believe it, suck it up, and move on.

That concludes the two follow-up comments and replies included with each question, and so ends this thread. My final advice is to not confuse your anxieties over a sexual decision you apparently regret with infection consequence of that decision. They aren't the same. Deal with the former as you need to, but forget the latter. Not an issue!

I hope the discussion has been helpful.---