[Question #693] Follow up

46 months ago
Dr,

Thanks again for all you guys do here.  I thought I still had one reply left from my previous question (#604) however I guess I waited too long.  Therefore I started a new question and  this will be my last.   I apologize in advance.  

Based off my exposure now 8 weeks ago you had said you didn't think I needed testing.  Just for my own assurance, I decided to do a rapid hiv finger prick test two days ago at a free testing site that offers free on the spot rapid testing.  It wasnt a doctor who performed the test and I'm unsure of which test was used.  All I know is it was an antibody test only and one of the finger prick ones where you sit there and wait for the lines to appear with results in 15 mins.  I am in the United States but I don't know if that tells you anything in regards to the test.    I was negative and this test was done at 7 weeks and 5 days from my exposure of protected vaginal sex and French kissing.  I was relieved.  The testing center informed me results weren't conclusive for 12 weeks before I went but I still wanted the test.  Yesterday following my negative test I noticed some pain in the very back of my right jaw area towards the ear and can feel a lymph node there.  I can only assume it's swollen because I can't feel it on the other side.  I've had no other symptoms in this 8 week span

My questions are simply this.  

1.   Is my rapid test accurate after 7 weeks and 5 days post exposure?  Am I truly negative even though it only tested for antibodies  and since it was only one test or do I need another?

2.  If you truly believe it is would you feel the same if my partner was confirmed positive?  (I do not know if she is or isn't)

Im only asking because I'm concerned with the node but don't wanna test more than necessary as I figure it will only feed the worry.  

And lastly 3.  Would someone take over 7 weeks to start having symptoms like lymph nodes the day after they tested negative.  Any info would be greatly appreciated.  And in terribly sorry 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome back. I scanned your recent discussion with Dr. Hook. Sorry you remain so concerned after such a low risk exposure. But I'll be happy answer these additional questions.

Let's do a simplistic back-of-the-envelope statistical analysis. Chance partner had HIV, maximum 1%. Average female to male transmission risk by unprotected vaginal sex, if the woman is infected, around 1 chance in 2,000 (but I'm going to use double that chance for calculation, i.e. 1 in a thousand). Condom effectiveness in prevention, if properly used and no visible breakage, probably 99% -- but here too we'll be conservative and say it was only 90% protective, i.e. a 10% chance of transmission. (I'm ignoring the oral sex event, since oral to penile HIV transmission has never been shown to happen and can be considered zero risk. Same for kissing.) The chance you caught HIV calculates as 0.01 x 0. 001 x 0.1 = 0.000001, or one in a million. If you use the more realistic statistics, it's at least 10 times lower, i.e. one chance in 10 million. (Your chance of winning a lotter jackpot is higher!)

1) The antibody-only blood tests, including the rapid ones, are very close to 100% reliable at 6 weeks or more after exposure. But let's say it's only 90% reliable. The negative result now drops the chance you have HIV to somewhere beteen one in 10 to 100 million.

2) If your partner were known to be HIV positive, it would change the first figure in my quick analysis from 0.01 to 1. We would still be talking about one chance in 100,000 to one in a million that you have HIV. In that event, I would understand if you would like to have yet another test at 3 months. But there's really no need.

3) New HIV symptoms cannot start later than about 2-3 weeks after exposure; and the first or only symptom of acute HIV would never be a single enlarged lymph node with no other symptoms. And HIV related nodes are painless.

Bottom line:  You really needn't worry about HIV. Don't mistake your apparent anxiety, regret, and perhaps guilt over a sexual decision you may regret with HIV risk from that event. They aren't the same. Deal with the former as you need to, but you truly can disregard the latter.

I hope this has helped. Best wishes--  HHH, MD

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46 months ago
Dr HHH, thank you for the swift response.  I can really only assume there's just one node as I refuse (for my sanity and the sake of your time) to probe around looking for more.  All I do know is I had protected sex (from start to end) with a woman I know has had a lot of partners (condom appeared to be intact from what I remember), an ER doctor that scared me to death by telling me I could have contracted it from kissing, and a node that I have never in my life noticed before.  I have noticed others below my jaw when I was sick with a viral infection but never one at the back of my jaw under my ear and a neg test at almost 7 weeks that was done by a place that probably wouldn't have even tested me had I told them it had only been almost 8 weeks.  Furthermore stories on the Internet of people saying when they had ARS they only remember a single large node and stories of people from the 07-08 time frame saying their first test after symptoms were negative but later positive  add to the worry that maybe my single test at 7.5 weeks could possibly produce a false neg as well.  The Internet can be a scary place and I just wanna know I'm okay and that I can have sex with my current partner.  I really do appreciate what you guys do and your patience.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for the clarifications. However, none of this information changes my opinions or advice -- except to advise you to stop your online searching about it. Like many anxious persons, you are being selectively drawn to information (often false or unsupported) that inflames your anxieties.

Thanks for the thanks about our services. Take care and stay safe.

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45 months ago
Dr,

It is my understanding that rapid antibody, finger prick tests in the United States are all 2nd generation tests ( I know it wasn't a fourth as it only tested antibodies) with that being said do you still consider my 7 week and 5 day test close to 100%?   I guess I just adon't understand the difference in test generations.  the CDC and all these sites say a test isn't conclusive until 12 weeks.  Therefore having an antibody test only,  makes it hard for me to accept an almost 8 week test I suppose.  I guess I'm just having a hard time understanding how to feel good about a test that isn't even the newest version of tests, meanwhile everything you read says 12 weeks.  Does that make sense?  Because this whole window period thing doesn't to me.  Regardless,  I in no way doubt your expert opinion.  I suppose I'm just trying to make it make sense to me so I can move on.  Im not convinced I have it doc.   Deep down I believe the advise you have given me, deep down I think I know any symptoms are probably anxiety driven and even want to believe my almost 8 weeks test.  It's just this little "what if".   Either way, this is my last question to this forum and  again I appreciate all you guys do.  Thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
First, some rapid tests are third generation. Second, CDC has always taken an especially conservative stance on time to definitive test results, and many testing centers echo the CDC on this, regardless of scientific evidence to the contrary. CDC doesn't even official say anything other than 3 months even for the 4th generation (antigen-antibody tests), which are conclusive any time 4 weeks or more after exposure. Even the second generation tests are almost always positive (95% of the time or more) after 5-6 weeks; i.e. it's the rare person in whom it takes longer. Finally and most important, you are obsessed with your test results, as if that's the only basis for the conclusion you don't have HIV. Not true; Dr. Hook's and my advice depends on all the available information, in addtion to testing. Re-read my "back of the envelope" calcuations above. Even if the test you had were "only" 95% reliable (I'm not saying that, just using the example), it would reduce your 1 in 10 million chance of having HIV to 1 chance in 200 million. That's zero for all practical purposes.

Window period is simply the time from catching HIV until test results are positive. Test generation refers to the biology of the test -- more advanced generally translates to more rigorous and more reliable, with shorter window periods.

You are of course free to have any additional testing you wish, it would make you feel better to have another negative result at CDC's official 3 month interval. Nobody is stopping you, and if it helps reassure you more effectively than my words, so be it. But that's not what we advise or do in my clinic, and certainly not what I would do if somehow I were in your circumstances.

So time to move on without worry. Best wishes and stay safe.


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