Over 5 months ago I had unprotected sex with a female (I’m a male). While I do not know her status regarding HIV, I wanted to take no risks and tested religiously.  7.5 weeks out I went and got rapid finger prick anti body test done and then 14 weeks out I did the same test and it was negative. 

4 months out I did a 4th generation AG/AB test with reflex and that was negative as well. And then roughly 5 months out I did a 5th generation AG/AB test and that was negative too. Multiple doctors have told me that I am fine and I am suffering from extreme anxiety. Further testing will only heighten my anxiety but I know it’s going to be negative. 

My questions are as follows: 

Are my 4th and 5th generation tests, which were negative and done at 4 and 5 months out, conclusive to rule out any chance of infection? 

Was my 5th generation test not needed and what are the particular window periods on these tests?

Can I finally move on and enter a monogamous relationship and not worry at all about having this STD? 

I can definitely confirm that your test results are conclusive and you needn't be worried. I'll start by pointing out that heterosexually transmitted HIV is much rarer than you might think from media attention and health education advice. Even among the most sexually active women in industrialized countries, in most instances the odds they have HIV is under 1 chance in a thousand. And when a woman has HIV, the average transmission risk to a male partner by unprotected vaginal sex is once for every 2,500 exposures. These statistics calculate to a risk you were infected of somewhere around 1 chance in 2.5 million. To your specific questions:  

The "5th generation" terminology is marketing hype by the test manufacturer. It's a minor variation of the 4th generation (AgAb) tests. In any case, your negative results prove you weren't infected. Your finger prick test might have been either an antibody test (3rd generation) or AgAb (4th generation). At 7 weeks was conclusive or very nearly so. All tests you had after the 14 week fingerstick were superfluous. The AgAb tests are 98-099% conclusive by 4 weeks and 1000% at 6 weeks. In other words, any time after your second test, you could have entered a monogamous relationship without worry about infecting your partner with HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

First off, it was 3 unprotected encounters with the last one being over 5 months ago. Not sure how this affects the odds.

I will also say that I most likely was testing out of fear because I always thought it would show up out of nowhere. I don’t think that is how this virus works. From my understanding, HIV after a certain amount of time will let you know it’s in your body. It doesn’t randomly appear.

Does testing at 3 months give 100 percent accuracy per CDC. Why does some information suggest testing at 6 months? 

I noticed on another reply you did that you debunked the delayed seroconversion myth as far as the AG/AB test was concerned. I thought that was interesting and perhaps a tactic that some testing places use to get people to come back and test. 

The figures I gave about are what CDC advises:  100% accuracy of the AgAb tests by 6 weeks (actually 45 days, per CDC) -- not 3 months. Anyone (or any agency) advising 3 months or 6 months just hasn't updated their older advice, or they do not understand the performance of the AgAb tests.

I doubt any testing services have any marketing strategies intended to induce over testing. There's not that much profit in the HIV tests.

When I said that the virus appears out of nowhere, I meant that it is undetectable. But like you said, the virus or any virus will let you know it’s there. 

Additionally, yes, I am aware that testing is the only way to rule infection. Previously, I would have thought you would see symptoms until I actually did research. 

I will for sure use this website and speak to you or other experts if I have any other questions in the future. Definitely will not reference Dr. Google as it nearly killed me with bad information!

Finally, you are wise to not rely automatically on google or various websites. But not all information on the internet is bad. For the most part you'll get accurate information from sites run by professional medical or public health organizations (e.g. med schools, major medical centers, CDC, and other public health agencies); and sites that are professionally moderated (like this one). The American Sexual Health Association -- the sponsor of this forum -- is highly reliable in regard to HIV and all STIs. However, definitely avoid sites run by and for people with particular problems, such as those by and for people with HIV, herpes, HPV, etc; or non-moderated health info sites like Reddit. Anybody can write anything they want on the internet!

You're of course welcome to return to this forum as well. However, not for confirmation of what should be obvious from this discussion. For example, if you have a new exposure you're worried about, the advice about HIV testing and timing of a test will be exactly as discussed above, no matter the details of the exposure. But if something enitrely new arises, we'd love to hear from you.

That completes the two follow-up exchanges included with each question and so ends this thread. Best wishes and stay safe -- both sexually and against COVID.