[Question #63] Follow up question for Dr HHH please

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104 months ago

hi Dr Handsfield

I have a follow up question regarding my exposure that I discussed with Dr Hook 3 days ago it was question# 59.

I am from Sydney Australia

in short I had a high risk exposure it was unprotected vaginal sex for 1 minute and I did ejaculate in her with a swinger in group sex party and she is am very much sure HIV positive.

I had no major symptoms (no fever, rash or sore throat) was tested twice with duo test Abbotts Architect ag/ab 12 days and 31 days past exposure and both were negative.

I had gone through medhelp and found that 28 days duo is conclusive so was happy with my results but on 35 day I started  getting Oral thrush. as I already explained Dr Hook that am not sure whether it was thrush or something else had thick white lines on both sides of tongue and on inner cheeks with 1 ulcers each on both sides, those lines on cheeks spread later throughout inner cheeks , Dr hook said its not Thrush. I never had this before as far as I am aware of and just to add I was fasting during that time so wasn't drinking water for the entire day. I believe I had no lesions except thick white lining with ulcers as said above. This wasn't painful at all and it went away by its own in 3-4 weeks time.

this is freeking me out as I read that ARS symptoms goes by its own and Oral Thrush is one of the symptoms of ARS in few cases.

my problem is I got this Thrush after the negative test, wouldn't have worried if I got this before test.

now its week 9 and I'm having cold basically stuffy nose and blocked nose with mild headache since 3-4 days.

I am worried not thinking whether it late sero conversion or may be HIV 2.

the lady I had sex with was having sex with a black African guy and it was unprotected as well so am now worried whether she had HIV2 and may be this thrush is caused by this virus.

Dr Hook assured me that I am 100% HIV negative and should believe my results and move on but this thrush is keep on beeping my mind thinking may be HIV2 is the caused of this. cause duo test detects antigens of only HIV1.

Can you please answer this questions

1. Dr Hook already said its not thrush would like to know your opinion and whether or not this is the case related to HIV

2. does my test  covers symptoms which come later I mean as I said took 2nd test on 32nd day but thrush on 35 day, do you still say that the test proves no HIV though thrush came after the test.

3. Does ARS thrush goes by its own

4. Should I worry about HIV2

5. Dr Hook said when duo test are improperly performed then those results are not accurate and can be false negative, how can I make sure that my results were properly performed, I know Australia has best health care system but my anxiety is bringing these questions.

6.. Do you still advise to move on and forget about this incident

7. Is common cold ARS symptom

8. Can I be 100% sure that I am HIV negative

9. why is it very hard for me to forget this incident, I am trying to believe my results but again thrush thing is not letting me.

10. Is Isolated thrush ARS or have you ever come across patient who was HIV positive and had isolated thrush as ARS symptom

please give me some hope of life I am newly married and want to have family this incident making me insane.

thanks Dr

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H. Hunter Handsfield, MD
104 months ago
I'm sorry to see how much difficulty you're having understanding or accepting the reasoned, science-based reassurance Dr. Hook has given -- and probably your own doctor(s) as well. As Dr. Hook said, our perspectives and advice never differ from one another, which is why we answer questions interchangeably without regard to requests for either of us. That's certainly the case here. I reviewed your exchange with Dr. Hook and agree exactly with all he said. Accordingly, my replies are succinct.

The overriding principle is that HIV blood tests, done sufficiently long after the last possible exposure (28 days for your tests), always overrule symptoms and exposure history. It doesn't matter how high the risk at the time (yours was low), what symptoms you have had (in fact they are not very suspicious for ARS), or anything else. Once positive, HIV tests are positive for life, including if and when new symptoms appear. Therefore, thrush or not, whether thrush or other ARS symptoms clear up on their own, whether new symptoms arise, and whether cold symptoms could be ARS all are irrelevant in light of your test results, which prove you did not catch HIV. No worries about HIV2, which is covered by the tests you had, not to mention being virtually absent outside east-central Africa.

Those comments directly or indirectly answer most your questions. Briefly on others:  5) Dr. Hook didn't say that; you reported Dr. Cummings' comment about false negative 4th generation tests. But I agree with Dr. Hook. Mistaken performance of the test is far to rare to worry about, and I've personally never heard of it happening. Questions 6 and 9 raise an obvious psychological issue. If you remain concenred after all this, you may need professional counseling to deal with it. I suggest it from compassion, not criticism. 

Let's dispense with further questions that re-ask the ones already answered by me or Dr. Hook. Thanks, regards, best wishes, and in the future, stay safe!

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104 months ago

Thanks for your reply Dr HHH I really appreciate your feedback,

please clarify on few more things,

when I asked Dr Cummings this was the answer I got, ( the one in red is his reply)

"Have you ever seen or heard of anyone who was tested negative in 4 weeks with 4th gen duo test and later positive- yes of course - but not from the same event"

so I am not sure what he meant by "not same event"

Also you said my exposure was low risk can you please explain me why as the women is VERY Promiscuous who always have unprotected sex with countless men

can you also please tell me how soon Viral antigen (p24) is formed in blood stream once infected

also doctor here said conclusive result is 3 months so he is not in agreement with you or Dr Hook, he said 4 weeks test is short cut

I read on Dr Tan's website that Hep c will delay HIV window period, in my STD screening they did Hep A and B but not C, should I be worried if no why?

Also would Syphilis results be conclusive in 32 days post exposure.

any suggestions for me to forget about this incident as I am trying my best but wasn't able to.

also did any of your patients or online forum people ever came back to you saying their results came back positive later ( am sorry if this is a repetitive question)

thanks DR I will leave this behind once I have honest answers for above

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H. Hunter Handsfield, MD
104 months ago
1) I cannot interpret Dr. Cummings' comments, but this makes no difference in your risk anyway.

2) As Dr. Hook explained, your swinger partner probably gets tested regularly and participates with partners who also are tested. The vast majority of even the most sexually active heterosexuals in the US do not have HIV. And when a woman has HIV, the average transmission risk by unprotected vaginal sex is only once for ever 1,000-2,000 exposures. Therefore, most heterosexual exposures, even with high risk individuals, are low risk for HIV transmission.

3) p24 antigen typically appears around 10-14 days after infection.

4) I don't know what "doctor here" you are referring to. But 3 months is old news, going back to older antibody tests no longer in use. The current antibody-only tests are always conclusive within 6-8 weeks, and the combo test (p24/antibody) at 4 weeks.

5) Hepatitis C is not heterosexually transmitted, despite what you have read. The only proved sexual transmission is in gay men with potentially traumatic (bloody) anal sex practices. There was no need to test you for it. And as discussed already, it doesn't have any effect on HIV test results anyway, especially with the combo test.

6) 32 days is a bit soon for syphilis testing. Six weeks is recommended. However, your risk of syphilis was just about as low as for HIV, so testing is optional. Anyway, it's up to you.

7) Re-read previous replies about moving on. Your'e really beyond the deep end of irrationality on this. Like many such persons, factual reassurance isn't going to help you; there will always be a "yes but" or "what if" question. See my comments above about professional counseling. This is an emotional problem, not a medical one.
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104 months ago
Thanks Dr I really appreciate your reply, i know you will close this thread after this but before that can I please have some clarification on few things.

Regarding p24 antigen does it mean if infected duo test will pickup antigen beyond 14 days

You said my test covered HIV2 as well can you explain how as I read p24 antigen is HIV1 only 

also can you pls answer this question did any of your patients or online forum people ever came back to you saying their results came back positive later.

I am definately going to move on after this...

Thanks Dr for your reassurance much relaxed now
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H. Hunter Handsfield, MD
104 months ago
These questions also are essentially irrelevant. I think I see signs of internet searching that finds information you don't completely understand or misinterpret in ways that serve to inflame your fears.

1) You apparently do not understand how the duo test works. p24 antigen appears early in HIV infection (usually within 10-14 days, sometimes as long as 3+ weeks). Then antibody comes along, clearing HIV from the blood. For a while both p24 and antibody are present. So it doesn't matter if p24 goes away in a couple of weeks. It usually doesn't clear that fast, but if it does, it is only because antibody has been produced. In all persons infected with HIV more than 4 weeks, one or the other is present in the blood and the duo test is positive for the rest of the person's life.

2) The antibody component of the duo test covers HIV2.

3) Whether or not I have seen such a patient is irrelevant. It happens I have not, but so what? It doesn't alter your risk. Rare events happen, whether or not I have experienced them. If I have cared for someone struck by lightning, does it change the odds you will be struck?

I'm glad you feel you'll be able to move on. I hope so, and that this discussion and the one with Dr. Hook help you do that. But re-read my advice about counseling if you find yourself continuing to worry. Good luck and stay safe. And for goodness' sake stop searching the web about all this!