[Question #6276] HIV concern

69 months ago

Hi Doctor,

I need your advise on one of the exposures I had.

On 12^th October I went and saw a CSW IN Australia. I didn’t do anything risky and had protected vaginal sex with her for 2 minutes. I used a condom from the start and didn’t break at all. After I came, I saw the condom was intact although not sure there was some blood on my public area and the top of condom may be because she might be finishing a period etc..

I got a bit scared but condom didn’t break. All my cum was on top intact inside it.

Now I went and did an HIV test.

21 days after exposure – HIV AG/AB negative (Dorevitch pathology Siemens advia centaur combo)

31 days HIV combo serum ( Melbourne pathology) Negative again.

I just wanted to ask should I move on or go do another one?

H. Hunter Handsfield, MD

69 months ago

Welcome to the forum. Thank you for your confidence in our services.

Your question really includes the answer: "I didn't do anything risky". From your description, I agree: condoms work. In addition, the large majority of CSWs in Australia do have HIV.

As for your two HIV AgAb test results, they are highly reassuring but not yet conclusive. These tests detect 90-95% of infections by 21 days and 98-99% at 31 days. For truly 100% conclusive result, have another test 6 weeks or more after the exposure. You definitely can expect another negative result.

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

HHH, MD

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69 months ago

Hi Doctor,

Thanks to you .... I have more questions.

Your words around testing made me a bit more anxious. Over years you gave advise on fourth generation been conclusive at 4 weeks.

Does it mean all those people that moved on from 4 weeks over the freedomhealth, medhelp forum and yours were wrong?

I called Melbourne sexual center and spoke to a nurse she said you dint need a test in the first place. I am getting confused now as well. I had protected sex and my condom didn't break and plus two tests i did are from different labs around 31 days.

Can you please advise me what i should do ?

Should i do a six weeks test ? Those two negative test plus condom protection ?

Please advise what will u do in the scenario.

Also, there is a lot of info about testing and 3 months ? why is that so ?

Please let me follow up again..

H. Hunter Handsfield, MD

69 months ago

My words about testing were reassuring: almost certainly you do not have HIV. I agree you did not need testing in the first place. However, having started down the testing path, I assumed you would want to have a test that is conclusive. But it's up to you -- have another test or not, I don't care. If you do it 6 weeks or more after the last possible exposure, the result will also be negative.

You are correct that for many years we advised 4 weeks as conclusive for the AgAb (4th generation) HIV tests. However, about 1 ½ yr ago it became apparent that on rare occastions it takes 6 weeks. At that time we modified our advice, which has consistently said 6 weeks since then.

Advice about 3 months used to apply to some of the earlier HIV blood tests, no longer in use. In addition, some clinics and online resources still recommend 3 months, usually just being extra careful. However, the science is clear: the AgAb tests always are conclusive after 6 weeks.

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69 months ago

Thank you so much doctor.

I just wanted to ask you the two tests I had 21 and 31 days are very assuring after protected sex. I am sure the condom didn’t break and I am circumcised too.

How you evaluate my risk after been protected and those two hiv tests at different labs both fourth generation?

Have you seen a 31 days turn positive at 6? Please confirm with Doctor hook too.

Also, can you please comment on what’s the CDC window period in USA? I read 45 days but nowhere on internet I see 45 days. Can you please elaborate what is official?

Also, this is what Melbourne sexual center says on their website. You can quote this for worried other people too.

Your HIV test today tells us about your exposure to HIV up and until 6 weeks ago. It does NOT tell us about any possible HIV exposures in the last 6 weeks. This 6 week period is called the window period.

If you have been at risk of HIV in the last 6 weeks, you will need a repeat test at a later date.
A risk or exposure is a time that you have had sex without a condom or had blood-to-blood contact with someone else.

Type of HIV testing

Melbourne Pathology will perform a HIV antibody test. These antibodies take up to 6 weeks to develop.

Also, please leave my reply follow up open so I can do a test and let you know at 6 weeks .. Thanks again.

H. Hunter Handsfield, MD

69 months ago

This forum uses the same review as CDC in advising times to reliable testing, which listed 45 days. We round that down to 6 weeks; there is no significant difference.

Neither Dr. Hook nor I have ever been aware of anyone negative at 4 weeks (or 30 days) who later had a positive result at 6 weeks. It's very rare.

In your opening question, you yourself described your exposures as non risky and I agreed. Given the exposure plus the test results so far, the chance you have HIV is probably under 1 in a billion, probably zero. If you have another test, it iwll also be negative.

That conpletes the two follow-up comments and replies included with each question and so ends this discussion. Do your best to move on wihtout worry. I hope the discussion has been helpful.

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