[Question #6011] Need for Second HIV Test?

18 months ago
Last month, I had two high-risk sexual encounters involving insertive anal sex one after the other. I topped two guys of unknown status for no more than 30 seconds each, but wasn't aware that no semen or blood exchange is required for transmission from the receptive partner to the insertive one; mere exposure to the mucous membrane in the rectum is enough to transmit the virus through the urethra if the receptive partner isn't undetectable. I'm not on PrEP because I'm normally not sexually active. These two encounters are the first time I've put myself at risk. I went to the city STI clinic 12 days after the possible exposures. The rapid antibody test was predictably negative and what they call the AHI test (which they said looks directly for the virus, though I know not by which precise method) requiring blood to be drawn also came back negative. Do I need to return to the clinic for another antibody test at the six-week post-exposure mark to follow up or can I accept that I don't have HIV? Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your question.

The HIV test results you have had are highly reassuring -- it is very unlikely you acquired HIV during the sexual exposures 12 days previously. The antibody test doesn't mean much; 12 days is too soon. "AHI" is not a commonly used test name. Probably it means "acute HIV infection" test, and that it was an test for HIV RNA in your blood -- i.e. a test for the virus itself, as the clinic explained to you. About 90% of newly infected people would have positive RNA tests at 12 days. However, for conclusive results you will require additional antibody or combo antigen-antibody (AgAb, "duo", "4th generation") blood test. If such a test is negative at 6 weeks, it will confirm you did not catch HIV.

Have you also been tested for other STDs? It would make sense to have a urine test for gonorrhea and chlamydia, and a syphilis blood test after 6 weeks. Also, if the anal sex events were not anonymous, i.e. know who your partners were and can contact them, you might do that and ask about their HIV/STD status, or suggest they be tested. 

I hope you have learned a lesson about HIV transmission and sexual safety. Please use condoms in the future! Also, you should routinely discuss HIV status with any and all male partners before having sex with them -- and avoid unprotected sex unless you know for sure they are uninfected (or if they have HIV, that they are on effective anti-HIV treatment).

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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18 months ago
Hi Dr. Handsfield, 

Thank you for the clarification. I did get tested for chlamydia, syphilis, and gonorrhoea, including with throat and rectal swabs. All of those came back negative too. I do know one of the guys and believe his claim to be HIV-negative and on PrEP. Unfortunately, the other guy my friends and I don't know and cannot contact. I do regret my actions for obvious reasons. I'll return to the clinic at the six-week mark for an antibody test and take things from there.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
OK. Gon/Chl testing is valid at 12 days, but the negative syphilis test only shows you didn't have it before the new sexual exposure. You'll need another syphlilis test at 6 weeks.---
18 months ago
I forgot to mention that I happened to restart doxycycline hyclate (100 mg twice daily) for an unrelated condition (acne) a couple of days after the exposures. I've taken it consistently since that time. I'm not sure if that would have eliminated any syphilis had it been contracted, but I can request a retest for it along with the HIV. New York City's Department of Public Health's sexual health clinics have a rule that visits are only permitted every 90 days, but hopefully if I explain my situation to them, they'll make an exception.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Yes, doxycycline would have prevented syphilis from taking hold, or would cure an infection already acquired. There is now no point in being tested for syphilis.

I doubt the NYC health dept STD clinic rules are all that rigid. They will know and understand that you need another HIV test sooner than 90 days.

That completes the two follow-up questions and replies included with each question and so end this thread. I hope the discussion has been useful.

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