[Question #5327] TEST ANXIETY

21 months ago
Hello respected doctors, I’m a heterosexual male aged 21 in the USA. Recently I had sex with a girl from my university. We both go to the same school. She is 19. We used protection. But the condom broke and I ejacukated in her. Then I had a scare about STDs. So I got tested at labcorp for HIV PCR RNA at 13 days and it was negative. After that, I did a oraquick mouth swab at 20 and 33 days and it was negative. Still I had severe anxiety. So i went in for a 4th generation antigen/antibody test at labcorp at 37 days. The result was negative. Do I need further tests or am I done with this and should move on ? 

I asked her about STDs and she said she’s clean. I don’t think she has any chance of having a major STD like hiv but my mind keeps thinking she has it. Don’t know why. Please clarify my doubts doctors! 
21 months ago
Her ethnicity is Spanish/white. I’m indian. Just thought I would put this information in. 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the Forum.  I'll be glad to comment, as well as to provide a bit more information.  Information first:

1.  HIV is rare in women in the U.S. irrespective of race/ethnicity.  Your partner's statistical risk of being infected is substantially less than 1%
2.  HIV is not transmitted easily.  On average, if your partner was infected, your risk for acquisition of infection, on average would be less than 1 infection per 1200 exposures.
3.  Condoms remain the best means of prevention STI/HIV acquisition if exposed (not to mention pregnancy).  The do break however, about 1% of the time.

As for your test results, the combination of test results you report- a 4th generation test at 37 days and an HIV PCR at 13 days proves that you did not acquired HIV from this exposure.  Believe the results, they are conclusive, no further testing is needed.

Finally, a word about semantics.  Please reconsider use of the word "clean".  Persons with STIs or HIV are not dirty or unclean, just unlucky.

I hope these comments are helpful.  EWH
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21 months ago
Hello Doctor, Thanks for the reply. The reason I got tested for the RNA PCR is because around day 5-6 of exposure, I had a fever for an hour  just once.I also generally felt unwell due to anxiety.(No prolonged fever or rash or sore throat). Then I had joint pain in the legs. To make sure that these arent due to HIV, I got the Aptima RNA PCR at day 13, which was negative. The anxiety was still there, to make sure I did the oraquick and finally 4th gen duo at 37 days. Im now sure that my joint pains were not caused due to HIV. But is joint pain common as a symptom of HIV ? 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
This is repetitive.  It will not change my assessment or advice.  You did not get HIV.  Your brief fever and joint pains are not due to HIV.  Persons who have recently acquired HIV can have joint pains as part of the Acute Retroviral Syndrome but the joint pains are accompanied by other, simultaneousmsymtoms such as high fever and a severe sore throat.  If they were, both your PCR and your 4th generation tests would have been positive.  EWH---
21 months ago
Hello Doctor, I apologize for repeating the same thing over and over again. I just have a last question. I went to the cdc page and saw the window period of 4th gen tests especially the one I took ( Architect 4th gen combo). The 99th percentile was 41 days. My test was at 37 days. Do you think there is a statistical difference ? However I also read you saying in your previous posts that 99% of them get conclusive answers by 28 days using the 4th gen, but the cdc found some rare cases and extended it to 6 weeks though you and Dr.Handsfield haven't seen such cases. Is my understanding correct ? 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Your understanding is correct.  There is no meaningful difference between a 37 day test and a 42 day test for you, in part because you also have a negative HIV PCR at 13 days.  Be confident that you do not have HIV from the exposure you have described.

As you know, we provide up to three responses for each question.  this is my 3rd response, therefore this thread will be closed shortly without further responses.  Take care and please, please do not worry  EWH
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21 months ago
Hello Doctor, Thanks for your reply. I was supposed to go in tomorrow for the 4th gen test at 48 days before my trip out of country for a peace of mind. But as you said, it wont make any difference. I will just not go and i feel its a waste of money trying to find something I dont have. Thanks for your expertise!!