[Question #7579] Has the PEP affected the BIOsure 2nd Generation fingerprick HIV test?

3 months ago
June 2020: I had a medium-high risk (can you please evaluate if this was as high a risk as I'm thinking) where I met a couple from Grindr, who after two days were both diagnosed with HIV and STDs. 

We had a threesome where I was masturbating one guy while his boyfriend was grinding against my naked uncircumcised head/penis (heavy pre-cum spilling throughout)

The guy grinding against my penis ejaculated onto my penis and was rubbing the cum on my head and foreskin, and the other guy ejaculated on my face and a good amount got into my hair, eye, and nose.

Out of fear, I didn't get tested and then in early December I had a needlestick injury (I'm a volunteer at a health centre) to a patient deemed low-risk through the questionnaire. I was advised PEP wasn't necessary, but I still went to the A&E to get it. Because of how busy the A&E was, the doctor didn't test me for HIV before giving me a one week prescription for PEP. I was only on PEP for 5 days (until I found out that patient's negative results for bloodborne viruses) and have been off it for 34 days now. 

January 17, 2021: I took a finger-prick 2nd generation Antibody-only test (BIOsure self test), and it read negative. (This is 200 days after the June exposure)

Would the 5-day PEP course I stopped 34 days ago, suppress the antibodies from my June exposure to give me a false negative on the BIOsure 2nd generation (only tests for IgG Antibodies) HIV test?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
Welcome to our forum. Thanks for your question. I’ll be glad to comment.  For future reference, should you have other partners who are known to be HIV infected,  ask if they are on therapy for their infections.  Persons on effective anti-HIV therapy are non- infectious to others.  Further, the exposure you describe was low risk.  Despite your exposure to their genital secretions, there was no penetration and even vigorous mutual masturbation and facial exposures have never been documented to lead to HIV infection.  

Your brief PEP course would have to risk on the results of your HIV antibody tests.  You can have complete confidence that your January 17 HIV antibody test ruled out any possibility that you were infected by your June encounter.

I hope my assurances are helpful.  Please don’t worry.  If you have any questions or need clarification, please feel free to use your up to two follow up questions for clarification.  EWH 
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3 months ago
Hi! I noticed there was a response that mentioned there was some software issues yesterday, so wanted to follow up to make sure this went though. Thank you! 
3 months ago
Dear Dr. Hook,

Thank you for your prompt response.

At the time of the sexual encounter they both said they were tested 1 month prior and were negative, I didn't think too much of it because I knew I wouldn't be having penetrative intercourse. 

That being said, the fact that their HIV is "new", combined with the STDs, and then adding that I have foreskin, wouldn't that be extremely high risk from a transmission point of view, due to their viral load and STD presence, combined with Langerhans cells in the foreskin, and the mucosal membrane exposure via eye/urethra?

With the risk of sounding patronising to someone of your experience, has no one truly ever been infected this way?

Also, (again, I sincerely apologise if I sound rude or patronising) why is the June exposure 100% ruled out despite the PEP if I've only taken a 2nd generation test that can only test for IgG.

I am having random pains throughout my body, sore joints, swollen lymph nodes and intermittent burning when peeing, however, I haven't ever noticed oozing/discharge. On closer inspection, I've noticed yellow dots on my Iacrimal caruncle (both eyes). Is it likely that I've been infected with an STI, and/or is this a common presentation of infection with Syphilis, Chlamydia, or Gonorrhea given that I was ejaculated in the eye, and head of penis and foreskin?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
While factors such as them having recently acquired HIV and the presence of your foreskin are associated with modestly increased risk for infection, in your case this did NOT translate to infection as shown by your conclusive test results.  Tests for HIV antibody (2nd generation tests) provide conclusive results at all times more than eight weeks after exposure.  Your results are negative.  You do not have HIV.  The intensity of exposure, the PEP do not change this.  If you remain worried, why not get tested, once, with a better test.

Your eye symptoms do not suggest other STIs.

Hope this helps. EWH 
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3 months ago
Thank you kindly, Dr. Hook!

1. Given my exposure and symptoms, do you think I've contracted an STD from this? I've never had symptoms such as these in the past?
2. Say I've contracted gonorrhea, chlamydia, AND syphilis, my negative result with the 2nd gen test won't change correct?
3. My fear is stemming from me thinking this is a false negative- do you think it's at all possible that this could be the case?
4. I have so much anxiety tied to testing, that it took me 6 months and so much support from a trusted friend to even do this fingerprick blood test. If I get tested again, with a 4th gen, there's no chance it would say I'm positive right?
5. Despite being older technology, can I trust that the second generation test is still accurate in my situation, and that I can finally breathe and try to move on knowing that I am 100% unequivocally and conclusively negative, even if I test positive for an STD such as syphilis? I read somewhere that up to 50% of those with syphilis had HIV and am kind of nervous that somehow that would "nullify" my HIV results, or make them less accurate?

With these questions answered, I sincerely thank you for your time, support, and care, and I hope I can begin to breathe from this point forward. Thank you kindly.
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
1.  No, I see no reason for concern about any STI.
2.  If you had contracted another STI, it would hand no impact on your HIV test.
3.  A false negative is most unlikely.  Sensing your concern about your test results, I would encourage you to retest with another test.  Despite you fear of testing, please remember that testing will not change whether or not you were infected.  Rather it will provide reliable results to quiet your lingering fears and provide you with important information to allow you to move forward without concern.
4.  See above. I am confident that you are not infected.
5. Yes, believe your results.  See my comments above.

While this concludes this thread, I will leave it open in case anything I said was unclear.  Take care.  Please don’t worry. EWH 
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3 months ago
Dear Dr. Hook,

Since I received my negative test, I have tried to accept your reassurance that my test truly was conclusive.

However, since the negative test, the dry-wheezing cough I've had since December has persisted, and now I have swollen lymph nodes in both armpits and one sore one in my groin.
I've also had diarrhoea and soreness above my ribcage/flanks of abdomen by spleen and liver, which feel like mini marbles either lymph nodes or fat accumulation?

Given these symptoms:

1. As the test had a visible control line- it obviously worked, so does that mean I am a late responder and therefore didn't have the required antibodies at 6 months?
2. Would my being overweight and autoimmune condition (IBS + mild psoriasis) prevent antibodies to be made, and delay seroconversion giving me a false negative?
3. Given my symptoms, do you think it's at all possible I have HIV?
4. Do you think I should retest?
5. After the fingerprick Clearview (biosure) IgG antibody-only test, I had taken the Pfizer Covid vaccine, would that affect anything from a rapid testing point of view if another test is warranted?

May I please pay in the same way as before so I may continue this conversation with you?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Thanks for sharing your results. They prove that your symptoms are NOT due to HIV.  In response to your final questions:

1.  The concept of a late responder is a myth which is based in internet misinformation.  If your symptoms were due to HIV, your test would be positive.

2.  No, IBS and psoriasis are syndromes due to excess immune response, not a lack of it.  Delayed seroconversion, as noted above, is an urban myth,

3.  No, see above.

4. There is no scientific reason for repeat testing related to the encounter of concern.

5.  The Pfizer COVID vaccine would not effect your test results in any way.

This completes this thread. There should be no reason for further questions.


Take care. EWH

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3 months ago
Dear Dr. Hook, 

I think there may have been a miscommunication or lack of understanding on my part. I'm confused as to why you've said "thanks for sharing your results" as I haven't been tested again since my one and only January 17th test with the 2nd gen Clearview fingerprick? Besides the lingering cough, all of the symptoms I mentioned (sore lymph nodes in groin, neck, and armpits + diarrhoea + pain in the abdomen by spleen/liver) started appearing AFTER my only negative test on January 17th. 

Therefore, with that confirmed, would you please be able to reaffirm forever and finally- 

1: Is testing (this would be my second test) warranted given the symptoms I've had after that sole negative test? 
2: Do you still think my symptoms are not HIV related? 
3: As the test couldn't detect any antibodies on January 17th, given I've had these symptoms after the negative test, would there be any change in HIV antibodies now than there were 2 weeks ago? 
4: Previously you had mentioned retesting for psychological reassurance, am I correct in saying that, despite these symptoms I'm experiencing, you are saying there would be no physical need for a re-test? I sincerely thank you SO much for your patience and kindness in responding to me and answering my questions. It will have definitely allayed my anxiety.
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Sorry.  I misread your comment.  That does not change my assessment.  Final answers:

1.  No

2. Correct, unlikely to be HIV

3.  No

4.  Correct, no need for repeat testing. 

End of thread.  EWH

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