[Question #6769] Need for retesting? [MSM]

12 months ago
Hello Doctors, 
I wanted to ask a question about two past risks this year.  I am a MSM and have usually stick solely with oral sex.  However there were two risk this year [both at the end of January 2020]:
January 26,2020:  Met another male. I was receptive partner during anal, condom was used, no breaks, etc. No oral actually occurred during this event. I did ask HIV status, and he stated he was negative/tested just month before. He removed condom and ejaculated outside the body.
January 28, 2020: Met another male. He too stated he was negative/on PrEP. I again was receptive partner. I also performed oral on him as well. He is only a top.  During the anal sex, the condom tore [unknown to both of us].  I had used quite a bit of water based lubed so we had both not known.

Follow up:
I used an online resource [stdcheck.com] to test. They use Quest Diagnostics as their affiliate for testing.  I was tested on February 26,2020 with two different tests:   
1. The Aptima HIV Qual RNA test. Which came back "not detected".  
2. I also had them run a HIV Ab/Ag test as well that day. That test too was negative.
3.  5.5 weeks later I went and got a POC Rapid test [it was called the Alere Determine Ab/Ag test]: result was negative.
4. 6 weeks from last partner, I tested with my own PCP. On the medical portal I see the test was called Abbott Architect Ab/Ag test. The result was negative.  

Am I in the clear?  Do I need further retesting?  My more concern was the second partner when the condom broke. I never had any symptoms of ARS. I was also on an antibiotic [Doxycyline] just started days after second encounter due to upper respiratory infection for 10 days.  Should I get screened for bacterial infections? Would they have cleared from this antibiotic from the 10 days I was on it? [2x day/10 days]

Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Welcome back to the forum. However, I'm a bit puzzled you found it necessary. In your previous thread about 6 months ago, we discussed the time required to conclusive HIV testing. In addition, you describe partenrs ho seem very safe, and you generally use safe sex methods (congratulations for that wisdom). Condoms do break from time to time, usually can't be helped -- but your intent plus your care in selecting partners marks you as low risk for HIV.

Anyway, the answers to your questions should be obvious and probably you have predicted what I'll say. But here goes:

1) Negative RNA testing a month after the last possible exposure is virtually 100% reliable, all by itself, and...

2) ...the combination of that result with negative AgAb is truly 100% proof you were not infected. Accordingly,...

3) ...you didn't need any further testing, but this result also confirms you don't have HIV.  Finally,...

4) ...this also was unnecessary, but in any case the negative result also confirms you don't have HIV. You're definitely "in the clear". 

Doxycycline is 100% protective against syphilis and chlamydia, and would prevent some but not all gonorrhea cases. If you had urethral gonorrhea, you would have known it from the pus dripping from your painful penis. However, rectal and pharyngeal (throat) gonorrhea usually cause no symptoms, so for complete reassurance it would be reasonable for you to have throat and rectal swab testing for gonorrhea.

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

HHH, MD
---
12 months ago
Thanks for such a prompt response!     

 I actually did not ask for the 6 week HIV Architect HIV Ab/Ag test...I went to the PCP because I was having upper respiratory issues...and a fever.  She did not in any way state to me that she was testing me for HIV nor HepC [which both were negative] nor did I ask for the testing. 
 I came to realize that my medical info [that I could read online] stated my sexual orientation in my bio on their medical profile.[Did they profile me as a means of testing me?]     I am questioning their reasoning for testing me for HIV as I never stated any sexual risk in relation to the purpose of my appointment with her. In hindsight I now realize why she looked at me with caution when examining me and having her RNP drawing my blood.   

I too surmised that after 6 weeks, one of the 4 tests I now had taken would have became positive by now...had I had HIV.

Curious question related to current events:  Is there, or could there be a delay of HIV positivity due to the COVID 19 virus in regards to HIV?

Thanks for the reflective answer with detailed info.  I will get screened for anal bacterial std's in the near future.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Of course I can't comment on practices in your doctor's office, or assumptions they may have made about your sexual lifestyle and HIV risks. But I would suggest you raise it directly once you're in the office. There may well be an entirely appropriate explanation for her assumptions, behavior, etc. In any case, any person should be completely open with his or her doctor about all lifetyle issues that have a connection with health -- of which gender of partners is a biggie!

No infections, medications, or medical conditions are known to have any effect on reliability or timing of HIV test results (aside from profound immune deficiency when using older test technologies). Of course as yet there are no data in relation to COVID-19, but I know of no reason it would be the first exception to the rule.
---
---
12 months ago
For educational purposes [for any future user of this forum that views this post] would you believe a 6 week HIV ab/ag test result  conclusive [despite the risk: such as high risk or low risk?].     

 As a gay man, I know I am considered at more considerable risk for HIV.  
Does validation of results at 6 weeks confirm this ...despite the "level of risk"? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
"would you believe a 6 week HIV ab/ag test result  conclusive [despite the risk: such as high risk or low risk?]."  Yes.

The second question asks the same thing with different words. The answer also is the same.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope it won't be necessary for you to ask similar quesitons again:  the answers won't change! But I do hope this discussion has been helpful.
---