[Question #7361] HIV Risk & Oraquick Accuracy 6 1/2 weeks

5 months ago
Hello Dr. 

My question is related to a one time unprotected receptive vaginal sex exposure with a person whose status is unknown but part of a high risk group (AA Male). I have asked him to test but he refuses. Approximately 4 1/2 weeks after the encounter I started experiencing symptoms all of a sudden. The symptoms lasted for 4 days and included severe back and neck pain, a UTI, yeast infection, mild nausea and diarrhea (1 day) and my cycle was 4 days late (I think due to stress honestly). It has been almost 8 weeks now and I am fighting yet another yeast infection. No other symptoms. I tested with oraquick due to convenience at 45 days post exposure and the test was negative. My questions are below:

1. Are recurrent yeast infections a sign of acute HIV? I thought this was more so something that happens later on. 
2. Because I have asymptomatic HSV2, how much more likely am I to contract HIV during a one time vaginal exposure like the one I described? 
3. I know technology is forever changing and there are way better HIV testing available now. However, in your experience how confident can I be with the 6 1/2 week negative oraquick? 
4. Although there was no fever, sore throat, swollen glands (I think), rash, fatigue or night sweats, do the symptoms I describe sound consistent with HIV ARS?

Thank you in advance for your knowledge and honest feedback! :-)
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Welcome to the Forum.  Thanks for your question and your confidence in our service.  I’ll be glad to comment.  Before I address your specific questions let me provide a few statistics.  Fewer than 1 in 25 heterosexual black men have HIV.  Further if your partner did have untreated HIV, the likelihood of becoming infected is less than 1 in 1000.  In other words, chances are more tha 99.9% that you would not be infected.  Thus this was a statistically low risk event.  Further, your test results make infection unlikely.  Regarding your specific questions:

1.  Most yeast infections occur in persons who do not have HIV.  Further as you point out, when HIV causes increased rates of HIV, this is seen late in the course of infection, years after infection.

2.  If you have asymptomatic genital herpes, and your partner had untreated HIV ( unknown). Your risk for infection would increase about 3-fold but would still be substantially less than 1 in 300.

3.  Oraquick is our least favorite test and it’s results are not conclusive until at least 8 weeks after acquisition of infection.  That said, had your symptoms been due to HIV, your Oraquick would have also most certainly have been positive.  Your negative Oraquick is strong evidence that you were not infected.

4.  The symptoms you describe are not suggestive of recently acquired HIV.

Bottom line.  Your risk for infection from the encounter you describe is quite low and your test results are strong evidence that you were not infected.  If you remain concerned, a 4th generation, combination HIV antigen/antibody test will provide conclusive results.

I hope this information is helpful.  EWH 
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5 months ago
Thank you for responding so quickly.  So basically as it relates to #3...I can not be sure until at least 8 weeks if I'm using an Oraquick test... But you say that at 6 1/2 weeks there's a possibility that the test was accurate? Are there any statistics? Like at 6 1/2 weeks oraquick is 50% or 75% effective? Out of convenience I'm going to take another oraquick at 8 weeks and then the 4th generation blood test but I am here obviously looking for some reassurance. As you can imagine, like many others, I'm pretty scared. Additionally, do you believe that the absence of fever is strong evidence against an acute hiv infection or is it just the combination I described that doesn't sound like ars? Would 30 days be too late as far as the onset of symptoms or would 4 days be too short for the duration? I'm asking for my own education. Thanks again.:-)
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
The statistics are imprecise, particularly for Oraquick.  It is quite unlikely that you were infected but if you want a conclusive result, once again, I recommend a 4th generation test.

The absence of fever and a severe sore throat, both of which are typical of recently acquired HIV, are strong evidence that the symptoms you experienced were not due to HIV.  And yes, 4 days would be too soon and 30 days too long for symptoms to be suggestive of HIV.  EWH
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5 months ago
Hello Dr. Its the duration thats 4 days and the onset thats at 30 days. I believe you commented to the reverse. Either way, sounds like my poor little oraquick could have been hit or miss. Thank you for your professional opinion. I really appreciate it! 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Sorry for the misinterpretation.  30 days is too late for the onset of HIV-related symptoms.  Your Oraquick is reassuring, just not quite definitive at t his time.  EWH 
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5 months ago
Hi Dr. Hook,

I believe this is my last message  before this thread will be closed unless you wish to keep it open for my final results. I took the Oraquick today which is 8 weeks post exposure. The test was negative. I've also scheduled the 4th Gen blood test for next week. With my scenario, can I have a strong level of confidence that the blood test will be negative also? It's so nerve wrecking  waiting for those results. Thank you in advance for your knowledge. 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

I have complete confidence that your 4th generation test will be negative.  Please don't worry.

I'll keep the thread open so you can post your results.  I look forward to your good news.  EWH

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5 months ago
Hi Dr. Hook, 

Tomorrow is the day I'm supposed to give blood for the 4th gen test. I was feeling so confident after speaking/texting with you until I realized that what I thought was a yeast infection was actually the start of my 1st ever herpes outbreak. I've been asymptomatic for at least 8 years, never seen a blister/sore until now. In the meantime, I took another Oraquick 9 weeks post potential exposure - negative. Given this new information, is your advice still the same? In my mind, the only trigger for HSV2 has to be HIV. I know this is unreasonable but I hope you can see it from my point of view after 8 years with no symptoms... :-(
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Your outbreak is a coincidence.  I encourage you to have absolute confidence that your test tomorrow will be negative, completely proving that you did not acquire HIV.  I look forward to seeing you share the negative result later this week.  EWH
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4 months ago
NEGATIVE!!! Dr. Hook, thank you so much for your knowledge and for this platform. I am so grateful!! 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Glad to hear it and appreciative of your willingness to share your result.  Time to move forward without concern.  

We’ll close the thread now.  Take care.  Stay safe.  EWH
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