[Question #6908] Follow up on Question #6889

9 months ago
Dear Dr.Handsfield,
Thank you for your guidance and reassurance in the last interaction. I am sorry to be back, but I have a couple of questions and would appreciate your guidance.
The knowledge that my last partner is indeed HIV positive was quite a shock for me as you can imagine.

To the questions:
1) I had 4th gen Lab tests at 32,35,41,47 days following the last encounter. Does the knowledge that my last partner was HIV positive change your opinion that my tests are conclusive? what are the chance future tests might turn positive.
2) This was a fully protected encounter, I was insertive for 2 minutes, then removed my condom (Durex extra safe) and washed my hand and finished by masturbating my self. I do know the condom was intact when I removed it, and I used plenty of water based lube. Can this be considered a fully safe sex, since I don't recall fluid exchange between us, no oral or kissing.
3) given the above, and to be on the safe side, would you recommend additional testing (PCR) or other tests?
4) Since he never knew he was HIV positive, so wasn't on medication, does that mean I was at increased risk?

Finally, would you say I am in the clear for sure and dodged the bullet?

Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

Welcome back to the Forum and thanks for your question.  On this occasion I happened to pick up your question and will be answering.  FYI, Dr. Handsfield and I have worked together for more than 35 years and while our verbal styles differ, we never disagree in our assessments.  In addition we have answered literally tens of thousands of questions on this and other forums and are in agreement on those as well.

In preparing to answer your question, I reviewed your earlier interchange with Dr. Handsfield and completely agree with all that he said.  In addition, while it is unfortunate that your partner has turned out to have untreated HIV, at least he can now seek therapy.  For you however, my assessment is the same and unchanged from the assessment that you received from Dr. Handsfield - you are in the clear and did not get HIV from the encounters that you described.  I realize just how unsettling it is to learn after the event that a partner had HIV but your test results are completely conclusive and you can be sure that you did not get HIV from the exposures you described.  Let me elaborate on the logic and why I am completely confident of this answer:

1.  Your encounters were condom protected.  Condoms are highly effective for reducing risk for HIV.

2.  Even when partners have HIV, the risk of acquiring infection from a single unprotected encounter are low- no more than 1 in 100.  Thus following a single encounter there is a 99% chance that you would not be infected.  Then, when you add use of a condom for sex, the risk is lower since condoms provide 99% protection from infection.  thus your mathematical risk for infection is 0.01 per sex act.  In other words, 9999 out of 10,000 condom protected sex acts with an infected partner will NOT become infected.

3.  Finally, currently available HIV tests are highly reliable and at any time more than 42 days are entirely conclusive.  Thus your 47 day test result entirely rules out the possibility that you acquired HIV.

Put another way, my answers to your questions are:

1.  There is no chance that future tests will turn positive for these encounters.

2. Yes, this was safe sex.

3.  The is absolutely no need for further testing related to this encounter.  Testing of any sort is a waste of time and money.

4.  See above.  Believe your results.

In conclusion, yes, you dodged the bullet and were not infected.  Please don't worry.  EWH

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9 months ago
Thank you Dr.Hook for taking the time to review the earlier interaction and your reassurance. A great weight has been removed from my chest in these tough times. 

Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
thanks for your thanks.  I'm please I could help.   EWH
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9 months ago
Dear Dr.Hook,

I have been getting night sweats recently and despite your reassurance, anxiety got the best of me. I took another Ag/Ab Lab test on the 53 day and it was negative. I am still having difficulty moving forward from the events, given the context it involved a positive partner. I just am trying to think through the whole issue.

1) If the condom was used properly, would it prevent infection? as the efficacy figures given on condoms make me unsettled. I do recognize there is always a possibility of condom failure, but in case there was no failure, can the protection be complete.
2) If I meet a female partner and decide to have a monogamous relation, are my tests thus far 100% conclusive? Would my specific context change your opinion given the last encounter was with a positive person.
9 months ago
3) BASSH recommend testing at 4 weeks and 8 weeks incase of high risk exposures. Would my exposure in your opinion fall under the high risk category requiring an 8th week test? and would you recommend it?
4)The CDC in its website says most but not all cases will be detected by 45 days for the Ag/Ab tests. Which cases  will not be detected by the 45 day?
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

I'm sorry to hear that you continue to worry and to attribute perceived symptoms as possible HIV.  Your multiple tests prove that these symptoms are not HIV.  In response to your specific questions:

1.  Yes, condoms are highly effective at preventing HIV acquisition.

2.  Believe your test results.  Entering into a new relationship will not put your partner at risk. Your tests prove that you do not have HIV from the encounter that you describe.

3.  Yes, this was a relatively high risk exposure however  your current results are conclusive and I see no need for further testing.

4.  The only cases not detected by 45 days are in persons who have taken anti-HIV medications in unsuccessful attempts to avoid HIV


Please believe your test results.  I know that a known exposure to HIV is disconcerting but your testing has proved that you were not infected.  You can and should move forward without concern. EWH

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9 months ago
Dear Dr.Hook,
Thank you once again. I have been reading your comments daily, in addition to Dr.HHH, and they were what kept me going on through this tough times.

I have some follow ups if you don't mind.

1) After reading most of the threads in the forum, I get the feeling that for certain high risk exposures like mine, you would not advise against additional testing/ multiple testing beyond the window period. So if the current window period is 45 days for Ag/Ab tests, would I be at fault for testing beyond this period? And till when should I test to get 100% certinaity. I say this because I also so see people testing way beyond any window period (months/years). Also Dr.HHH said I can take one additional test for reassurance, I didn't  have the chance to ask him as the thread was closed, but by what time would he recommend the test be?

2) I did not find threads relating to an exposure to a HIV positive person with a condom protection. So I figured my situation is unique a bit hence my additional questioning. I for sure won't have any anal(with female or male) CSW, but in your experience, when a situation like this happens (Condom protected with positive partner)  what course of testing would you recommend. I ask this because I did not consult an STD expert, I went through the tests alone and learned of the last partner positive result after my 47 day test result only. And would PEP be recommended in similar situations?

3) I do not know if he has HIV 1 or 2, nor his viral load, and don't think I can reach him, do these informations matter now? will my tests also cover HIV 2. He was from Thailand.

4)I took another Ab/Ag test at 59th day (8.4 weeks), which was negative thanks god, this time at a different lab which uses a different method (Combi Cobas vs Semience CHIV earlier). I did this to comply with BASHH guidelines for re-testing at 8 weeks, however I do understand also they are considering  updating their guidelines to the 45 day for Ag/Ab test in this consultation paper https://www.bhiva.org/file/5dfceab350819/HIV-Testing-Guidelines.pdf I know that you did not advise  additional testing, but can anything be missed with 6 tests and at different labs? I still am worried.

5) At this stage, does a PCR test matter, now its 60 days post last exposure? or I am already conclusivily in the clear.

Thanks again Doctor.
9 months ago
6) I do know that you did a lot of research on condom efficacy. Whats written in the web is a lot and I doubt I would be able to make full sense of it hence my question. If I wore the condom properly till the end, with enough lube, and insured that the lower part didn't enter their rectum/anus to avoid any fluids working itself up into the head of penis, would latex condoms prevent an infection? I do understand course that partner choice is the most important factor, but given this scenario is protection complete?

7) Would you advise me to take PreP. And when can I start taking it, given my situation regarding conclusive testing ? Noting this is my first MSM situation and last.
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

Thank you for the follow-up. As you know, we provide up to three responses to each question. This will be my 3rd response and thus following answering these questions it will be time to close the thread.  At that time I rust that you will be able to accept the results of your many tests and appreciate that despite the frightening circumstances of your exposure, you did not acquire HIV. 

As for your questions:

1.  Testing is a personal choice however there is no medical or scientific reason for continued testing beyond 45 days.

2.  Testing is carried out because of the possibility that a partner might have HIV and not know it.  That you know your partner has HIV naturally adds to your concern but it does not change the reliability of your tests.  You can have complete confidence in the result.  The use of PEP is likewise a personal decision but if you had asked my advice or if I were in a similar situation, I would not recommend PEP. Condoms work!

3. Your tests will cover HIV-2. HIV-2 is VERY rare but in the unlikely event that he has HIV-2 rather than HIV-1, you can be entirely confident in your test results.

4.  Once again, I urge you to believe your test results.

5.  You are conclusively negative and there is no need for a PCR test.

6.  You are correct, I have done considerable research on condoms.  Evaluation of condoms is challenging because of the need to rely on the observations of persons using them and their may be misperceptions. Even so, our research shows that condoms worn throughout a sexual encounter and which do not break reduce the already small chance of infection from a single exposure by more than 99%.  I encourage my patients to use them correctly and consistently.

7.  PrEP is also a personal choice.  For persons with multiple at risk partners, PrEP is very, very effective, reducing HIV acquisition rates to virtually zero in persons who take all of their medication as directed.  If you chose to take it, you can start at any time - your tests have already proven that you did not acquire HIV from the exposure you described.

I hope that the information I have provided has been helpful.  This thread will be closed shortly.,  Take care, please believe your test results and don't worry. EWH

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