[Question #5711] Testing Concern

20 months ago

Drs

As everyone says, thanks for your service.

 

I had 2 exposures I was mildly concerned about but I'm sure you would call them low risk, based on reading countless other entries. One involved no penetration of any kind but mutual mast. and exchange of body fluids, plus some guys from shaving pubic hair earlier. I was tested 35 days later and was negative and was mostly confident with that.

 

6 Months later, i had another exposure. No inter course but had a lot of naked frottage, grinding, and received lengthy oral (i'm male, these are females I should have mentioned). 6 Months after this exposure (which would be 12/13 months after the first exposure again) I tested again also negative.

 

Test results are from my dr, not the lab itself, and they don't say '4th gen' but they say 'HIV 1/2 - nonreactive'. Then it says underneath 'HIV p24 antigen - nonreactive). Anyway - my concern is that I've had some weird symptoms and looking back on the tests I have realized there was a long wait period. Test one, they drew the blood on december 23rd in the afternoon. The test was not resulted until December 27th, assuming there was a holiday break.

 

Test 2 is more concerning. Dr office drew blood Friday evening. My dr. initially told me he didnt think he could as he thought the nurse left for weekend but she was still there around 5pm. There's a sign at the office that says blood work must be done by 3:30 on Fridays. I didn't see this sign beforehand. Test was resulted on the following Monday. My dr's office is closed over the weekend. So my concern is that if the lab picked up at 3:30 and not again until Monday morning, my blood could have been sitting around at room temperature (or worse, the indoor heat in the winter) all weekend. So, assuming the worst in both cases if the blood was not stored properly, would the 3 and 5 day wait impact test results? Over the weekend I did an oraquick test that was negative as well, but I know that’s less reliable.

 

Can you let me know your thoughts? Should I test again?

20 months ago
Sorry - re-reading I meant to say 'plus some CUTS from shaving' not guys. This was strictly me (m) and F
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Welcome to the. Forum.  I'll be glad to comment.  Currently available tests for HIV are amongst the most reliable tests in all of medicine and are remarkably resilient.  Before I comment on what I believe are your specific questions, let me validate your assessment that the exposures you describe were not low, but no risk events.  HIV is NOT transmitted through mutual masturbation, even when partners get each others' genital secretions on one another.  Similarly there are no instances in which shaving, even with nicks to one another, has led to HIV transmission.

Regarding your specific questions, you should believe the results.  The mention of the p24 antigen result indicates that your first test included both tests for antibodies and antigen.  

Regarding the second event, my suspicion is that, if your specimen did not get to the lab they day it was taken, it was refrigerated.  Even if it was not however and was held at room temperature over the weekend, neither the HIV antigen, nor the antibodies would degrade in the blood specimen.  I would urge you to believe your test results.  I really see no scientific reason for you to repeat your tests for HIV.  Your exposures were no risk events and your tests prove that you were not nfected.

I hope my comments are helpful.  EWH
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20 months ago
Thank you for the prompt reply.

I won't get into symptoms because I know, even if I have symptoms which can line up with HIV, they aren't reliable. I've learned that.

Both tests were done by the same dr's office and thus I assume the same lab (I believe Englewood Hospital lab in NJ). I called the lab and they confirmed it was 4th gen but could not tell me manufacturer. Each FDA manufacturer lists different requirements (some say room temp is okay for 3 days, some 5, some only 24 hours). I assume that's a conservative approach based on your remarks?

The only thing about my second risk was a lot of grinding (her on top and her privates on my lower shaft, don't believe contact wiht the head and if so brief (1/2 seconds) and receipt of unprotected oral. I guess that's a higher risk exposure than the first (mutual mast with recent shaving abbrations?)

Last question, I guess out of paraoia...would the lab turn away a specimen if it was not collected the way they want? Would they know it was not refridgerated or would the test indicated such? 
20 months ago
I'll add some follow ups I thought of as well, if I can. There were 3 questions asked above, so I'll start on 4:

4. I mentioned I also did an oraquick, now over a year after the fact. Negative. How reliable is that?

5. Anxiety builds the more I think about it so I went a block away at work and got a rapid blood test done at an urgent care in NYC. It was a chembio SURECHECK hiv1/2 test, second generation as it only detects the later antibody not earlier. Anyway, that was negative as well just now. My stress is that my tech. punctured my finger then wiped the first bleed with an antiseptic wipe and then collected the 2nd bleed that came out. I'm worried that whatever chemical or alcohol is on the wipe she used could have interfered with the test. Is that warranted?

6. Generally curious and if it's inappropriate for this forum I apologize.  You read so much about possible cures or working towards a cure, do you see one on the horizon, say, in the next decade? 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
You are correct that the package insert information for different tests tends to be quite conservative.  These tests all perform pretty similarly.  Further, as you suggest, if the lab knowingly received a specimen which would not give a reliable result, they would not accept it.  

Regarding the "grinding" (medical term is frottage), the intensity, up to and including enough friction to cause minor abrasions, does not change my assessment.  No penetration, no risk.

4.  Oraquick is our least favorable test, particularly in any period less than 8-12 weeks after exposure.   there just are not as many antibodies in oral fluid as there are in serum/blood.  OTOH, in your case, when you combine the OraQuick results at 12 months with two other negative tests, I would bet my paycheck (and I'm not a better) that you do not have HIV.  BE confident in your multiple negative results following a no risk event.

5.  Sigh, you need to get a grip on yourself.  Stop testing- you are wasting your time and resources.  Any alcohol present would not change your antibody test results which, like your other results, is quite reliable.

6.  At the present while total control leading to a normal lifespan one infected is a reality, cure is still unclear and will be challenging.

Hope these comments are helpful.  EWH
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20 months ago
Alright. Thanks for your patience and reassurance.

I'll take advantage of my last follow-up. Perhaps it's anxiety driven and may be a bit repetitive, but want to make sure we're clear.

1. The second exposure, which is the 'grinding'...she was on top like at the base of my shaft. There was no penetration but perhaps there was quick contact with the head (she was trying to persuade me to 'put it in', but I refused with because we did not have protection). However, she wanted to and kept grabbing it, so there might have been slight contact but definitely no real penetration.  So, if any fluids got around the head but not via penetration, still no risk?

2. Let's assume because it's my greatest fear that this blood was left out and not treated correctly and it impacted the test. Would the chembio sure-check rapid test done at clinic yesterday (19 months after first exposure and 13 months after second) be conclusive by itself, even if the alcohol/chemical from the antiseptic wipe was mixed with my blood? I ask because while the test looks to be very reliable via studies it uses SO little blood that I'm worried even a little alcohol/chemical could interfere. I provided link to the SureCheck below. 

3. I have a toddler whom I'm very close with (of course who isn't) and she loves to share fruit like apples and nectarines with me and lately came down with a type of athletes foot fungus which is very rare in children so that's spiked anxiety. With this information, if answer to #2 is conclusive, are you still confident I don't need another test. I want to make sure nobody else is at risk.


Thanks very much Dr. I hope you and yours have a great second half of summer.
20 months ago
1a, the second exposure also included mutual mast and she gave me unprotected oral, for about 15 mins. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Your follow-up questions are a manifestation of your continued anxiety and are repetitive. My final responses will be brief. 

1.   Correct, no change in my assessment. No penetration, no risk. 
2.    Repetitive and I already answered. As I said any residual alcohol would not change the test accuracy. Believe your test results. 
3.   You have ready tested more than is necessary. No further testing is needed. Your toddler  is not at risk. 
1a.   Further repetition, no change in my assessment. No risk. 

 This response will complete this thread. As per forum guidelines you have received three responses to the questions You have asked. I hope my responses have been helpful. There will be no further answers. Please don't worry. EWH 


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