[Question #5549] Question concerning exposure and results and follow-up to question 5441

21 months ago
Dear Dr. HHH,EWH:Please refer 5441.For sake of continuity, it may help if Dr. HHH responded. More info:I forgot to add this.The next day after event mentioned, I may have sucked and suckled on the breasts of this woman for a few minutes (did not notice blood or milk) and also lip-lip kissed her with saliva and tongue involvement.Can’t recall any cuts or blood on either.I may have lightly fingered her.No other sexual contact on this day.So,that would make my AgAbduo test a 43 day Non-Reactive result and not a 44.5 day test as mentioned before. 
For the sake of analysis, please assume she is a highrisk person who is positive.I only menton as, while now in North America,she comes from India(moved here many years ago) where HIV2 is prevalent. I later learnt that she has very dubious practices and had not informed me earlier.
1.Is the 43 day AgAb test fully conclusive?Do any of your responses earlier change on account of 43 day with additional details (kissing sucking)?
2.I read in one of your responses to another question that the Ab portion of the duo test detects 100% of HIV 2 by 6 weeks, and so the duo test is fully reliable and conclusive for HIV 2 as it is for HIV 1 at 6 weeks or more.Does this still hold sir?
3. Does the validity, accuracy of AgAb (6 weeks conclusive) hold only in North America or does it apply to South East asia too?
4.Are window periods for duo test different for different types and levels of exposure?
5.However high the risk may be, if the person is negative at 6 weeks (42 days),he/she can be 100 percent certain that they are not infected?  And similarly, however miniscule the risk may be, a positive test would indicate infection that needs further corroboration for certainty?
6.Does the level of conclusiveness increase with time? Or >=42 days test are equally fully definitive and conclusive?
7.Would you recommend any additional testing?
8.Given the above details, what would you do ?
9.Do test results overrule any exposure history and symptoms?
Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome back, but I find it difficult to understand why you found it necessary. At least three times in your preivous thread I reassured you that your test results were conclusive. You also had an exposure that could not possiblly have transmitted HIV.  You're not going to be the first person in the world documented to have caught HIV from kissing or oral-breast contact. Since all these questions were answered directly, or the answers are obvious from my replies last time, you're basically asking if I might have changed my mind recently. I have not. To your specific questions:

1) Yes, still conclusive.
2) True, still holds.
3) Same test performance world wide.
4) No, window periods are independent of exposure type.
5) Yes.
6) 42d = 50d = 75d = 6 mo = forever
7)  You didn't need any testing at all, based on this exposure, and having had conclusive results, you certainly do not need more testing.
8) I would move on without worry. I would never have stopped having sex with my wife and would continue it now. You should do the same, if you have a regular partner. And I would not be continuing to ask these questions, having had the previous replies!
9) Yes, as I probably said last time.

Really, move on. You have had complete, science-based replies. Try to separate your apparent guilt or anxiety over a sexual decision you regret -- which didn't even include real sex! -- with infection consequences of the event. Deal with the former as you need to (counseling? discuss with wife/partner?) but forget the latter.

HHH, MD

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21 months ago
Thank you, Dr. HHH.  Sorry for having bothered.  Did not mean to and I did read your replies and tried to comprehend them.  But, my anxiety got the better of me.  I will try to separate guilt from consequences.

That said, as mentioned in 5441, I did have sex (you mentioned I didn't) somewhat with condom protected penetration where I knew it went in, but never felt it or enjoyed it as I was already nervous then and because the protection covered 3/4th of the shaft of private.  It did not last long at all but I do think, unfortunately, that I lost my virginity due to the brief insertions without any feeling or relief.

My apologies again.  Thank you for everything you do.   I wholeheartedly mean it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
No apology necessary, of course. And I’m sorry if my comments seemed insensitive; call it tough love. But condom protected sex is safe, no HIV risk — and of course whether or not you “felt it or enjoyed it” is irrelevant, i.e. no relationship to HIV risk. This is not a site for expression of sexual satisfaction or guilt — STD/HIV risk is the only relevant issue, as far as we are concerned. We do not moralize or judge! (Having said that, I’m sorry your first sexual experience wasn’t more rewarding.)---
21 months ago
Dear Dr. HHH: Thank you for the tough love.  Sometimes it is necessary. I appreciate it.  Also, my sincere apologies for coming across as passing  judgments. I had not meant to.

For my own edification, so that for exposures cited in questions 5441 and this,  I am able to reason out with the science based responses for similar exposures in the future , please indicate if I am  am understanding you correctly.
-For responses 3 and 4: The Duo test, its performance and window period are  standard and applicable world wide,  across geographies, across ethnicities and race, and irrespective of exposure level and exposure types.  Is this correct?
-Your Yes response for #5 below,  I should take as 'Yes and Yes' for both parts of the two part question.  Is that correct?
-For #6, your equality signs for 42=50=forever..., is meant to indicate that at 42 days the test results are fully and completely conclusive  and that conclusive results are final at 42 days and there is nothing more to be attained from further testing. Is this correct?
-The window period of 42 days applies to the  elapsed time since  last exposure..so, any older exposures  than the last exposure would be covered in the one duo test at 42 days (6 weeks) and no further tests are needed for older exposures unless there are new exposures since the last exposure.  Is this correct sir?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
These all are correct restatements of my advice and opintions.

That completes the two follow-ups and replies included with each question and so ends this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, and your fears about HIV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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