[Question #7120] Likelihood of HIV with 27-day negative Ag/Ab test?

7 months ago
I am a white American heterosexual male in my mid 40s and recently had unprotected vaginal sex with a white American heterosexual female former co-worker in her late 40s.  I tested negative for chlamydia, gonorrhea, syphilis, hepatitis B, and HIV at 27 days post-exposure.  Based on what I have googled, I have had none of the “typical” symptoms of any STD or HIV (fever, sore throat, flu-like other), though I’ve been anxious, and seem to notice any little bits and bobs.  I also had a candid talk with the female post-event, and she noted that she isn’t promiscuous, although I don’t think that she has had a recent HIV test, so her comments are anecdotal.

I was non-reactive on the 4th generation Ag/Ab (4th Generation wRfx to be precise) test at 27 days.  I realize that is one day short of the 28-day guideline, but for all intensive purposes, should I feel assured that I am HIV negative?
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Welcome to our forum and thanks for your question. I’ll be glad to comment.  Statistically, even before you tested, the encounter you describe was low risk. Your partner states that she does not have large numbers of partners and most people tell the truth.  Furthermore, epidemiologically, she is in a low risk group. STI’s had HIV are quite uncommon in women over the age of 30 or 35.  You’re testing adds further proof that you were not infected.  You’re testing for gonorrhea chlamydia are absolutely conclusive at this time. Syphilis would be extraordinarily rare in a Caucasian woman of this age and at this time your Syphilis test results are more than 99% conclusive. The same holds for your testing for both HIV and hepatitis B. For conclusive testing for HIV, syphilis, and hepatitis B you would need to retest at about six weeks. If I were you, given the situation that you describe at your current test results, I would not bother further testing and would be absolutely confident that I was not infected.

I hope this information is helpful to you. If any part of my comments are unclear or you have further questions please feel free to use your up to two follow up questions for clarification. Take care. EWH
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7 months ago
Thank you for the prompt and thoughtful response, Dr. Hook.  Two quick follow-ups:

1). Given what I have described (my test results, etc.), would you say that I would be okay to have committed, unprotected sex with a new partner (after she tests negative for STIs)?
2). If I did want to have absolute closure on this matter, given that it has been nearly two months since the encounter, could I simply confirm my negative HIV status with an OTC finger prick kit?  I’m trying to be mindful not to expose myself to COVID, so trying to make something work that could be done at home (finger prick, OraQuick, etc.).  If I’m being too cautious, and you think this step is unnecessary (I believe that’s your position), I will gladly exhale and move on with life.

Thanks again for your candid, qualified comments.  These situations create a lot of anxiety, especially for those of us who very rarely have a lapse in judgment.
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
I’m glad my comments were helpful.

1.  Based on your history and test results, I see no reason related to the encounter you describe to abstain from unprotected sex with future partners.

2.  Now, more than six weeks after your encounter of concern, a finger stick HIV test will be conclusive although as I mentioned above, I really see no need for it and were I you, I would be moving forward without concern.  EWH
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7 months ago
Thank you, Dr. Hook.  Your comments are incredibly reassuring and will allow me to confidently move on with life.
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Glad I could help.  Take care.   EWH---
7 months ago
Dr. Hook,

While you suggested it was unnecessary, I went ahead and got a confirmatory 4th gen test at day 61.  Results were non-reactive.  As is likely the case with others who post, my anxiety had gotten the best of me, even though the worst case was very remote.

Thanks again to you and your colleagues for hosting this forum.
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Thanks for the follow up.  We understand how anxiety producing these things can be.  I hope you will now be able to move forward without further concern.

As per Forum guidelines, this thread will not be closed.  Take care. EWH 
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