This question is for Dr Hansfield

hi Dr's
I am from Sydney Australia Circumsied Male in mid 20's.
I had an exposure about 2 months ago, it was vaginal intercourse with a Swinger, I went to a group sex party (biggest mistake of my life).
I had condoms with me but I seriously dont remember if I had used one during the intercourse or may be I have used it but my axiety is saying I havent.
the women that I had sex with is been active swinger since 15 years or more and she organises group sex parties every month
and she prefers Bareback (condomless) sex always.
She sends all group members email invities and in that she mentions herself to be D&D free (drug and desease free) which is highyl unlikely or I can say
impossible as she does condomless sex with everyone over many years so how can she be HIV free.she must have had 1000's of partners.
I also had unprotected oral sex which I know is zero risk.

Now since then my life is like hell as I cant concentrate on anything except HIV.
I had tried contacting that women but wasnt able to so I called her husband who assured me that she is clean and I dont even need testing unless if I want
to do so, but I highly doubt on him, may be he is saying this to keep image of their community.

I had combo test 12 days after exposure which was negative doctor here told me that this doesnt include my recent exposure and asked me to repeat it at 6 weeks.
In the meanwhile I was going through some online research and found Medhelp and saw your's post and assesments which were very helpful.

there you said duo test is conclusive after 4 weeks without need of restest after that, so I went to a different clinic at 32nd day of my exposure
the test was Abbott Architect combo and the result was negative.

I was trying to get in touch with you but wasnt able to as Medhelp expert forum is closed.
so I went to freedomhealth hiv forum where Dr Jose and Dr Sean gives there expert advise, they are in UK.
I asked Dr Sean but his reply was not assuring he said did say that he thinks my result is conclusive but
when I asked him if he saw any cases of Duo test turning out positive after 28 days he said yes but not from same event as mine, does it matter what event it was?
I had other STD tests as well which were all Negative

I have few questions that I want clarity on

1. Lets assume I havent used condom and the women is HIV positive Would my negative Duo test be conclusive on 32nd day.
2. do you think I have to retest from medical or risk prospective
3. as Dr Sean from freedomhealth said that from different events or exposures duo test was false negative at 28 days in few cases, can this be possible in my case (though he said no to me in my case).
4. can I be 100% sure that I am HIV negative
5. the test I took was Abbott ARCHITECT Combo test, is it conclusive at 32nd day for both HIV 1&2
6. Will it be safe to have unprotected sex with my wife?
7. Nurse at the clinic said the 32 days is too early and the test might not pickup but I understand that the test will pick up antigens
which are produced after 10-16 days if infected is that correct?
8. When I discussed about duo test after 28 days with HIV specialist here he said shortcuts are not going to work in terms of HIV, is this a short cut?
9. On day 35 which is 3 days after my duo test I had oral thrush, acutally am not sure if its thrush had white lining on sides if tongue and inner cheeks
where tooth touches, does this sound like thrush? should I be worried for this?
10. on 8th week had Diarrhea for 2 days should be worried as I think its too late for ARS. I never had fever, rashes or sore throat.
11. can I leave this behind behind and move on with my life

thanks for your help

Welcome to our Forum. I will be answering your question today.  Dr. Handsfield and I answer questions interchangeably, depending on our availability,  We have worked together answering questions such as your for years and while our verbal styles may vary, we have never differed on our advice to patients or clients. 

The fact that your partner was a swinger does not mean she had HIV or any other STI.  In fact, swingers, like commercial sex workers, take care to be tested regularly and as a result, most swingers do not have STIs or HIV.  Further, both she and her husband told you she was not infected- most people do tell the truth when asked.  Finally, from a statistical perspective, it turns out that most unprotected exposures to not lead to transmission of infection and that while condoms are certainly the safest way to have sex with a new partner, acquisition of an STI (including HIV) from a partner who tells you they are not infected from a single sexual encounter is very, very rare.  In your own case, the fact that you were tested with a reliable, 4th generation test for HIV antigen and antibody 32 days after your exposure proves reliable proof that you were not infected and d o not need further testing or to be concerned any longer about the exposure you have describe. 

I have provided brief answers to your specific questions below:

1. Lets assume I havent used condom and the women is HIV positive Would my negative Duo test be conclusive on 32nd day. 

Yes
2. do you think I have to retest from medical or risk prospective. 

There is no need for further testing, for HIV or for other STIs.
3. as Dr Sean from freedomhealth said that from different events or exposures duo test was false negative at 28 days in few cases, can this be possible in my case (though he said no to me in my case).

There are rare cases in which improperly performed tests give false negative tests or in persons who were taking medicines to prevent HIV infection at the time of exposure (This is called PrEP).  These sorts of things were not part of your exposure.  You should believe your results.
4. can I be 100% sure that I am HIV negative

Asking the same question again and again will not change the answer.  Believe your test results.
5. the test I took was Abbott ARCHITECT Combo test, is it conclusive at 32nd day for both HIV 1&2

See above
6. Will it be safe to have unprotected sex with my wife?

Yes
7. Nurse at the clinic said the 32 days is too early and the test might not pickup but I understand that the test will pick up antigens
which are produced after 10-16 days if infected is that correct?

The nurse was incorrect.  Believe your test results
8. When I discussed about duo test after 28 days with HIV specialist here he said shortcuts are not going to work in terms of HIV, is this a short cut?

No.
9. On day 35 which is 3 days after my duo test I had oral thrush, acutally am not sure if its thrush had white lining on sides if tongue and inner cheeks
where tooth touches, does this sound like thrush? should I be worried for this?

This does not sound like thrush.  Thrush occurs on the roof of the mouth and the back of the throat.  What you describe is normal but you had not noticed it in the past.  If your smoke, this could make this occur more obviously as well. 
10. on 8th week had Diarrhea for 2 days should be worried as I think its too late for ARS. I never had fever, rashes or sore throat.

This was not ARS.  It would have occurred by 8 weeks.
11. can I leave this behind behind and move on with my life

YES.

Now that you have gotten the same information from me and from our colleagues at Freedom Health, it is time for you to relax, to stop testing and to move forward.  I hope this comment is helpful to you.  EWH

Thank you so much for your kind comments Dr Hook, can I please ask you few more questions after this I promise I will leave this behind and move on.

1. From statistical point is my risk same as 1 chance from 1000 vaginal exposures if she was hiv positive

2. You said my results are reliable should I take it as conclusive if yes why do you say reliable not conclusive ( I am sorry just wanted to clarify)

3. regarding Diarrhea I hope you meant "it wouldn't have occurred at 8 weeks"

4. can isolated Diarrhea on its own be ARS or will it comes with other symptoms ( am just curious to know this)

5. I also had severe back pain on weeks 7 which lasted for 2-3 days, should I be worried? Can back pain be ARS?

6. Regarding tongue white lining I don't smoke but I was fasting that time so wasn't drinking water can this happen because of dry mouth, I went to dentist she said may be because of fasting only.

7. sorry forgot to tell you that I also had 2 mouth ulcers on white lining of inner cheeks should I be worried? 

8. I always see people post where they get symptoms first and then they get tested but my concern is I got tested first and after that started getting symptoms like white lining on tongue and inner cheeks along with 2 mouth ulcers on that while line of cheeks and then weeks 7 back pain and week 8 diarrhea is this something to worry about or you still concludes my results to over rule these symptoms though they came after test
9. I understand that p24 protein is HIV 1 antigen do you know by any chance how less common is HIV 2 in Australia or in Sydney, my partner was white Australian

with all the above questions should I still believe my results and move on if yes I promise I will not worry about this anymore.

Thanks again for your help Dr Hook

Brief answers to your questions

1. From statistical point is my risk same as 1 chance from 1000 vaginal exposures if she was hiv positive. At most, probably less.

2. You said my results are reliable should I take it as conclusive if yes why do you say reliable not conclusive ( I am sorry just wanted to clarify).  What part of believe your test results was unclear?  If you want to hear the word conclusive, I will test you your test is conclusive.  It is!!  I will not repeat this again.

3. regarding Diarrhea I hope you meant "it wouldn't have occurred at 8 weeks" The symptoms of ARS typically occur well before 8 weeks following exposure.  Your 2 days of diarrhea does NOT suggest the ARS.

4. can isolated Diarrhea on its own be ARS or will it comes with other symptoms ( am just curious to know this) Isolated diarrhea is not the ARS.

5. I also had severe back pain on weeks 7 which lasted for 2-3 days, should I be worried? Can back pain be ARS?  NO!. 

6. Regarding tongue white lining I don't smoke but I was fasting that time so wasn't drinking water can this happen because of dry mouth, I went to dentist she said may be because of fasting only.  Fasting might well make the normal white areas in the mouth you describe appear more obvious. 

7. sorry forgot to tell you that I also had 2 mouth ulcers on white lining of inner cheeks should I be worried?  NO.

8. I always see people post where they get symptoms first and then they get tested but my concern is I got tested first and after that started getting symptoms like white lining on tongue and inner cheeks along with 2 mouth ulcers on that while line of cheeks and then weeks 7 back pain and week 8 diarrhea is this something to worry about or you still concludes my results to over rule these symptoms though they came after test.  See my reply to number 2 above.
9. I understand that p24 protein is HIV 1 antigen do you know by any chance how less common is HIV 2 in Australia or in Sydney, my partner was white Australianestions are, in large part repetitive and do not change the substance of my advice.  Your "few" questions are in excess of what we typically handle on this Forum.  HIV 2 is quite rare in Australia.  In fact, it is even rare in those parts of Africa where it is seen

Time for you to relax, stop worrying.  You did not get HIV from the exposure you have described.  EWH

Thanks again Dr Hook your comments were really assuring and I am relax now.

I am so sorry but last thing that I forgot to add in that group sex party there was a black African man and women, that man also had sex with the same women that I had and it was unprotected, should I still not worry of HIV 2 and move on with these results?

really sorry to ask this question again and thanks a lot for your help.

God bless you Sir

hi Dr Hook

could you please reply to my last question, am trying my best to move on but mouth whitening that I had is taking me back to HIV :( I'm getting in my mind that this may be was due to HIV 2. your reply is much appreciated

And lets assume it was oral thrush on day 35 would my 32 day test still be conclusive.

I am so sorry Dr to ask this question again am trying to move on but guilt and anxiety is not letting me move on, once I have answer for this I will definitely leave this behind

thanks again