[Question #6784] HIV Testing Results / Exposure

13 months ago

Hello Doctors, I am a heterosexual Caucasian female. Around 9 weeks ago I had vaginal unprotected sex with a partner twice. Then about 10 days after that I met my current partner and also had unprotected vaginal sex with him. He got tested for everything a week after we met and after we had had sex several times, and he tested negative for everything. I recently learned that he cheated on me and gave me Chlamydia.  After that I freaked out and got tested for everything. I got a 4th Gen Antigen / Antibody test with reflex done at about 4 weeks post exposure and it came back negative. At about 5 weeks post exposure I took an HIV-1 RNA test and that came back negative as well. My Hep B, Hep C, and Syphilis test came back negative to. I was sick with cold about a month ago, sore throat, body ache, and a headache. I went to the doctor and my strep test came back negative so that scared me. I still have a swollen lymph node in my neck under my jaw that's going down and today my throat feels a little sore. I got my HIV-1 RNA test from STDcheck.com. I bought it online and went to LabCorp. So, my question is, can I consider my results from both tests conclusive? Or will I have to wait for the three-month window period to get tested again? There is a lot of confusing info online about window periods and when different types of tests are conclusive. Thank you!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome to the forum. Thanks for your confidence in our services.

Sorry to hear of your experiences, your chlamydial infection, and your HIV concerns. But your worries are over:  your tests are conclusive; you definitely do not have HIV. Here come the details:

Probably you were at lower risk of HIV than you might think. I have no knowledge of your two partners' sexual lifestyles, but if neither is bisexual or an injection drug user, the chance he had HIV is near zero, despite the chlamydia situation. Assuming not, in the 30+ years of the HIV/AIDS epidemic, I've never had a patient in circumstances like yours who acquired HIV. Don't get me wrong:  you were wise to be tested for HIV, which is advised for anyone with a new STD. But it would have been very surprising if you had had a positive result.

Your symptoms were nonspecific, meaning they did not point to any particular cause, i.e. they were consistent with many minor conditions, all far more common than HIV. Among other things, acute HIV doesn't cause "cold" symptoms like stuffy nose, sneezing, etc. That your strep test was negative shouldn't have been scary:  the large majority of people with such symptoms have neither strep nor HIV. 

Most important, your negative test results are 100% reliable. The negative AgAb test (4th gen) at 4 weeks was nearly conclusive, and that result plus the negative RNA test is absolute proof. These are among the most accurate diagnostic tests ever developed, for any medical condition, and the results overrule all other considerations. Now matter how high the risk of HIV at the time of exposure or how typical the symptoms, the test results prove the case. You don't need any further testing:  three months is old news, dating back to older HIV blood tests now rarely used.

So all is well in regard to HIV. Also good to hear of your negative results on other tests. Presumably you were treated for your chlmayidal infection, with eitiher doxycycline for 7 days or single dose azithromycin. Be aware that all persons with chlamydia should be retested after ~3 months. Treatment failure is uncommon, but does happen, especially with azithromycin; and statistically, anyone with chlamydia has an elevated risk of reinfection. Finally, both your partners should have been treated. IEven if you believe your second partner was the source of your infection, your seual history certainly is consistent with acquiring it from the first partner -- including the poissibility that you were the source of the second guy's infection. Because chlamydia can smolder for months without symptoms, t's often not possible to be certain about when and where any particular infection was acquired. So make sure both aprtenrs were treated (and preferably tested as well).

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

HHH, MD
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13 months ago
I have been treated for the Chlamydia and so has my partner and I have an appointment to go back and get tested again to make sure its gone. What also worried me was that the doctor who have me the HIV 4th gen test told me that I had to wait 6 months for it to be conclusive, that's why I got the RNA test to be sure. I didn't put it in my first comment because I ran out of room, but all four of my wisdom teeth are coming in at the same time which has also been giving me headaches and pain around my mouth, neck, and throat area. I was just very worried and I know someone who was recently diagnosed with HIV and I just wanted to be sure. I appreciate your time and thank you for putting my mind at ease! In the future though, I will be safer. It will save me a lot of worry and money to just use protection. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Thanks for the follow-up info. I considered adding a comment about condoms, but judged you to be intelligent and insightful -- and was right! Good plan.

I'm still not clear about whether both your partners have been treated. You can't safely assume the first wasn't infected, in addition to your current partner. Sorry if I misunderstood.

Your doctor is behind the times on the time required for concluisve HIV testing. It's not necessary to be tested as late as 6 months and never was. Some conservative providers and clinics gave such advice, but there's never been any scientific basis for it.
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13 months ago
I have notified my other partner, but I am unsure if he actually has been tested. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
He should be treated, even if his test is negative. Testing isn't perfect, and all partners of people with known chlamydia should be treated regardless of their test results. However, you've done your part:  assuming your relationship is over, this is now in his hands. 

That completes the two exchanges included with each initial question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe!
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