[Question #7212] HIV exposure worry, 5 negative tests

6 months ago
Hi,

Thank you for taking the time to read my question.
The exposure: 25th of January - Receptive anal sex with transgender escort. Protected of course but the condom was changed half way through and I believe this may have been because of a break (I dont know this for sure) The escort claimed it was changed for another reason.
I fixated on the risk of exposure to HIV albeit a possible temporary exposure probably less than a minute with no ejaculation from the escort.
The tests;
Day 10: Cepheid Xpert HIV-1 qual (I think this is a 90 minute rapid PCR type test)
Day 23: Repeated test above.
Day 28: 4th Generation lab test
Day 75: 4th Generation lab test
Day 95: 4th Generation lab tests, with supplementary testing for Hepatitis and Syphillis.
(All negative results)

Symptoms:
Upper body rash that lasted about a week around day 80 but this could have been a reaction to local anesthetic at the dentist or even heat rash.

from day 15 until even now, sweating alot at night, feeling hot and bothered and exhaustion (I have mostly attributed this to the anxiety related to the event) I have a body temperature probe that often reads fever like temperature on my legs 38c and above and this has been common for many months especially at night. Forehead temperature checks almost always normal range however...So my questions,
1)Are the symptoms outlined above anything to worry about, given their timeline?
2) Given 5 tests looking hiv, what are the chances an infection could have remained undetected. Given the series of tests and their accuracy, I believe the rapid PCR tests were around 90% accurate at day 10 and 98% at day 23. I also believe the accuracy of the 4th gen tests were 95% at day 28 and over 99% at day 75 and day 95. Would almost
3) Is it safe to resume having unprotected sex with my long term partner.
4) Would further tests in the future be completely pointless?
5) Given the history outlined above am I HIV negative and can I now move on with my life?
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago

Welcome to our Forum and thanks for your questions.  I'll be glad to comment.  Congratulations on your commitment to condom-protected, safe sex.  At the same time, I can understand how the changing of a condom in the midst of your  encounter would raise concerns.  Before I address your specific questions however let me remind you that while rates of HIV tend to be higher amongst transgender persons, the majority are not HIV infected.  Further, even if your partner had untreated HIV, over 99% of exposures will NOT lead to infection.  The good news is that your test results now conclusively prove that you were not infected by this exposure.  With these general comments, let me address your specific questions:

1)Are the symptoms outlined above anything to worry about, given their timeline?

Your symptoms are non-specific and, based on your multiple negative test results, I am confident that they are not due to HIV acquired in the exposure you describe.


 2) Given 5 tests looking hiv, what are the chances an infection could have remained undetected. Given the series of tests and their accuracy, I believe the rapid PCR tests were around 90% accurate at day 10 and 98% at day 23. I also believe the accuracy of the 4th gen tests were 95% at day 28 and over 99% at day 75 and day 95. Would almost

Your test results are absolutely conclusive.  The sensitivity of 4th generation tests at better than you think, at any time more than 42 days after exposure 4th generation tests in persons who have not taken anti-HIV medications are entirely conclusive.  Believe your test results.  


 3) Is it safe to resume having unprotected sex with my long term partner.

Yes


 4) Would further tests in the future be completely pointless?

Further testing related to the exposure you describe would be a waste of time and money.


 5) Given the history outlined above am I HIV negative and can I now move on with my life?

Yes.


I hope these comments are helpful to you.  EWH

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6 months ago
Thank you Dr Hook, your reply is most re assuring, and I really appreciate your non judgemental and professional response. 

I suspect one of the biggest reasons people like myself go on to fear the infection and doubt the results is the lack of post test counselling for those that test negative.  

I wish I had consulted earlier in this process. I am ready to move forward with my life. I estimate the chance I am infected to be 1 in a million or perhaps even greater.  I will ask no further questions and only thank you for your time.

Kind regards

Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Thank you for your thanks. I’m glad that my comments were helpful to you. Take care. EWH---