[Question #6858] Hiv Risk and Testing

12 months ago
Hello, doctors, I am a 30 year old Turkish male married.  About 55 days ago, I had a sexual relationship with the escort from Uzbekistan in Turkey. İts a big mistake for me. For I was married, I had a great cooking and started using antidepressants.  My relationship was without condom oral sex and I had vaginal sex with condom.  And I was drunk.  The escort said to me “ım clear” and did not want me to use condom but I did not accept her and used condom.  But during sex, the woman took off the condom and I stopped.  I put on the same condom again.  Meanwhile condom may have been reversed.(turned over, inside out).  I don't remember this clearly.  The possibility that it may have been a Sexual Fluid transition drives me crazy.  And my symptoms;  
1-I have been stressed since the day of the incident and my diarrhea.
  2-Mild muscle pain in the legs and arms for 2 days after about 2 weeks 
3- Sore throat that lasts for 3-4 days after about 1 month 
4-Dry skin and rash in my abdominal area, No fever.  
On the 7th, 22nd and 42nd days of the incident, I had a Hiv test and the result was negative.  My wife says that 10 days ago, her head and teeth ached, 3 days ago, aphta in her mouth, and I am very afraid to infect her.  I think the HIV tests are the 4th generation.  Can I trust these tests , do ı need another test and if these are 3rd generation, what is my risk of HIV?  And my last question is, if there was a small amount of fluid passing through the condom, this would prolong the test times.  Please help!Thanks.
12 months ago
Firstl ım sorry for my english. I used google translate. Some translations are wrong. I want to fix it. “ I had a great cooking and started using antidepressants.  ” is very pointless. I felt regret and meant I started using antidepresant .And The word escort I mentioned in my story meant sex worker.
Sorry for word corrections. Thanks Dr. Handsfield and Dr. Hook. Im waiting your advice
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Greetings. Welcome to the forum; thanks for your confidence in our services. (Google translate is good, but not perfect!) 

The important part of your question is your test results. The HIV antigen-antibody (AgAb, "4th generation") tests are always 100% concluisve 6 weeks or more after infection. Your negative test at 42 days shows you do not have HIV, (The 7 day result was meaningless. The 22 day result was about 80% reliable. The 42 day result is 100%.) 

Your test results overrule everything else. Probably your escort partner didn't have HIV, but even if she did, you didn't catch it. Your symptoms are not typical for a new HIV infection, and neither are your wife's symptoms. But even if they were, the test result still rules. If the 42 test was third generation, not fourth, it's still 96-98% reliable.

The amount of virus exposure has no effect on time to conclusive testing. Exposure to a small versus large amount of infected vaginal fluid makes no difference.

So all is well. You do not have HIV and could not have infected your wife.

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

12 months ago
Thanks for your answer Dr.Handsfield.

There are a few other questions that I constantly look for and have in mind.  I would be very happy if you answer.

1- When does acute infection begin and can symptoms be related to ARS after 6 weeks?  2-If I had an unprotected risky relationship with a hiv positive woman and had a negative result on Day 42 with a 4th Generation test, would this result be considered 100%?  
3- I was vaccinated with Hepatitis-B vaccine just before my 42nd Day test, and does this vaccina and cortisone drugs affect the drug test result?  
4-hpv-hsv-gonorrhea-ebv-cmv hepatitis-c and similar viruses affect the test functional?  5-Many doctors say that the tests will be finalized after the 12th week.  Can I get your feedback on this topic.  In your studies, did you encounter the 4th Generation tests and the 42th Day negative case that turned positive after the result. 
6-Do I need to retest after my 42nd day negative test and can I do condomless sex with my wife?
7-In the test I was 15 days after hepatitis B vaccine, I was found to be immune to hepatitis-B.  Is this fact that there is no delay in antibody formation in my body?

I hope you answer my questions without getting bored:)

Thank you very much Dr.Handsfield.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
1) When initial HIV infection causes symptoms, it's called acute retroviral syndrome. ARS symptoms usually begin 1-2 weeks after exposure, rarely as long as 3 weeks, never longer. New symptoms at 6 weeks are not ARS. But it wouldn't matter:  your test results prove your symptoms are not caused by HIV or ARS.

2,6) Your 42 day negative result is conclusive, as discussed above, and it is entirely safe to have sex with your wife. You cannot give her an infection you don't have!

3,4,7) No vaccines, medicines, illnesses, or other infections of any kind have any effect on HIV test results. That includes hepatitis B vaccine. Cortisone also has no effect; that's an urban myth, especially with the AgAb (4th generation) blood tests. (The only exception is when people take anti-HIV drugs as prophylaxis that fails. In that case, testing must be done several weeks after completing treatment.)

5) 12 weeks is old news, going back to first and second generation tests, now rarely used. It's 6 weeks for AgAb and ~8 weeks for third generation antibody-only tests. I have never seen or heard of any case of HIV with negative AgAb at 6 weeks who turned out to have HIV. Except following attempted HIV prophylaxis, this has never been known to occur.

Stop overthinking all this. There is nothing else that will come to mind that would possibly change my opinion or advice. You don't have HIV. Do your best to stop worrying and move on with your life!
12 months ago
 Thank you very much for your advice, Dr. Handfield.  You really would have removed a lot of worries about HIV.  Finally, I want to ask a few questions. 
1- Today is the 57th day of my risky relationship.  And my throat has been sore for 2 days and this has stressed me.(difficult swallowing) (I have smoked a lot now, maybe for this reason) And there were very small wounds on my wife's feet and on the kneecap.  Can we say that these are not definitely related to Hiv and ARS? 
2- When should I be tested for other sexually transmitted diseases? (Syphilis, Cylamidia, Hepatitis, etc.) Can even an advanced syphilis be cured?
3-In general, do all of the symptoms of ARS occur at the same time, or a sore throat first, a skin rash after 1 week after a sore throat and maybe 2 weeks later  headache etc.  Can you tell me how the symptoms of ARS progress and how long it lasts? 
2- The second window duration is mentioned about Hiv on the Internet, is that real? 
4- After my 42nd day negative test, I will not be tested again, are we sure about this?  

This was my last question right, thank you very much for your services and advice. 

 I hope the Covid-19 outbreak ends as soon as possible, and valuable doctors like you can work in better conditions.

  Thanks for everything.  I am very lucky to have found you.
12 months ago
I'm so sorry I forgot to ask, doctor.  Which sexual disease can be related to aphtha problem in my mouth other than HIV?  Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
1,3) Your test results prove HIV is not the cause of your sore throat or any of these symptoms; and that no symptoms you ever have in the future can be due to HIV from the exposure you are worried about. Therefore the details of the symptoms and their timing don't matter.

2) All those STDs can have valid testing now, if you wish. It's optional -- since a condom was used, the chance of any STD is very low. If you decide to do it, have a blood test for syphilis and a urine test for chlamydia and gonorrhea. I recommend against testing for anything else:  the chance of any other STD (herpes, viral hepatitis, etc) is zero for all practical purposes from this sort of exposure. For sure don't test for herpes:  the tests are not perfect and the results often are misleading.

4) Correct, no worries and no need for any more HIV tests.

5) No STD is a likely cause of apthous ulcers of the mouth.

That completes the two follow-up questions and replies included with each original question and so ends this thread. Thanks for the thanks; I'm glad to have helped. Best wishes and stay safe.