I'm working on moving on from this HIV scare.  I am feeling somewhat better, but now I find myself nitpicking the 4th Generation blood drawn test that I had on 5/13.  I spoke with the health center nurse a couple of days ago that took my blood test.  He called to confirm that I was also negative for Syphillis, Hep B & C.  When we were reviewing everything, I again asked to confirm the HIV test that I took was indeed 4th generation.  He confirmed that, but said that it was "without reflex".  Unfortunately I am now Googling trying to figure out what that exactly means.  

From what I can tell, if I was reactive to either ab or ag, the reflex would have then tested further without having to do more blood draws.  However, what I am also reading is that when both the ag and ab are negative, the reflex would have then checked for RNA presence.  Again, I'm not speaking too intelligently, just searching for answers.  It appears that the 4th generation tests are pretty standard to come with reflex.  I don't understand why mine was not and what's most disturbing is that I am now disappointed that the test was not as accurate/thorough as what I should have gotten.  Can you advise on this?

Today I am now at week 9 post exposure - out of fear that my 4th generation test wasn't as thorough as it should have been, I took another Oraquick test.  It was negative.  I seem to be getting stuck back in the negative cycle that I was trying to pull out of.  

Thanks in advance for any detail on the 4th generation tests.  Again, I know that my exposure didn't even warrant testing, but testing seems to be the only peace that I can find at the moment.  I was really hoping that the 4th generation that I took on the 13th (at day 55) was good enough to close the book on this.  

The words "without reflex" have nothing to do with test reliability. "Reflex" means that if positive, a confirmatory test is automatic. With a negative result, no reflex testing is done. In other words, even if "with reflex" had been requested, no additional testing would have been done. Accordingly, your worry -- that "the test was not as accurate/thorough as what I should have gotten" -- is entirely unjustified.

Again, I know I'm nitpicking, but your words/expertise are reassuring.  When I received the brief oral sex - it was painful.  It was in an awkward position, done quickly, etc.  Soon after I had issues with painful urination, groin, all over.  When I went to Med Express for STD testing, the doctor said that it could have been prostatitis.  He put me on Doxycycline Hyclate for 20 days.  It didn't really do anything to help and I still had issues, so I went to a urologist who said I had pelvic floor/pain dysfunction.  They were correct.  With several weeks of physical therapy I was almost 100% better with the urination, pelvic pain. 

My question is - if the fellatio I received from the girl caused pain would that raise any eyebrows as to HIV transmission?  I can clearly correlate having the pelvic dysfunction to that encounter.  I didn't know if having urination issues after oral would be a sign of HIV transmission.  

It's been a rough 2 months.  I had the pelvic pain issue right after the encounter.  I've had white tongue, now I'm taking an antifungal to take care of that.  My stomach is  uneasy.  My doctor said that the 3 weeks of Doxy could have ultimately caused the oral thrush and upset gut but that's just a theory.  Could also be stress/anxiety related.  

I've never had issues like this in my life and it all happened after the oral sex encounter.  If I had no symptoms, it would be much easier to trust things and walk away.  Sorry for the long winded diatribe.  

Many thanks again!

I can't second guess your doctor, but I doubt I would have prescribed doxycycline in the situation described. But in any case, pain during fellatio shouldn't have any effect on risk of catching HIV if exposed. But i agree it could cause the stomach upset you report. It also could have caused the white coated tongue. Coated tongue can be due to a yeast/fungal infection, which can be triggered by antibiotics like doxycycline. However, most coated tongue are not caused by yeast at all, and I doubt the treatment you're taking will help it. (It's a physiologic reaction to all sorts of minor conditions, ranging from oral hygiene issues to common colds. It does not suggest HIV.) Further, HIV is almost absent in typical seuxally active young women in North America; it is very unlikely your partner has HIV. 

As for the Doxycycline, you seem to have called that correctly - the MedExpress doctor gave me the prescription for 3 weeks in anticipation that I might have contracted an STD or was dealing with Prostatitis.  I was having painful urination when I saw him a week after the encounter so I am assuming he made an educated guess on going with an antibiotic.  Turns out, I didn't need it at all, and most likely that is what has hurt my gut microbiome and possibly caused the white tongue.  I haven't verified that with my doctor but it seems to be the most rational explanation for now.  

Also, you are correct in that the anti-fungal that my doctor prescribed has not worked with the white tongue.  When you mentioned that it could be due to a physiologic reaction - does that mean that my phobia/fear/anxiety is driving my body to show these odd symptoms?  I know our topic here is HIV risk assessment, but just curious about your experience in dealing with people that are suffering with high anxiety with something like this.

Lastly - when discussing all of this with my doctor, he did not think it was medically necessary to do another test.  I see on other med help forums, etc. that their recommendation after a risk event is 6 weeks ab/ag test, followed by a 12 week confirmatory test with the same type of test.  As for risk, I know my situation was essentially low/no risk.  I've now tested negative with Oraquick at 6 weeks, 7 weeks (twice during that week), 8 weeks and 9 weeks.  The 55 day mark (1 day shy of 8 weeks) also had a 4th generation venous blood draw, which too was negative.  Is there any other guidance that you can offer on this on how to let it go?  I'm now on week 10 and the thought of going through another Oraquick test is exhausting or would another 4th generation blood test at 10 weeks solidify things more?

Thank you again for your input and expertise  -  your guidance is helping more than you know!

I doubt psychological factors can cause coated tongue. It's more related to physiologic things -- which might include altered bacterial balance due to an antibiotic. It's exceedingly common with all sorts of trivial or unimportant health problems. In itself, it should never be a serious concern.

Your doctor and I agree that there is no need for additional HIV testing. 12 weeks is old news for final HIV testing, going back to older tests now used infrequently. Trust me on this:  there has never been a confirmed case of HIV that wasn't detected by the AgAb (4th gen) tests within 6 weeks. That many websites and agencies take an overly conservative stance (staying with 12 weeks) reflects either just not getting around to changing, or legal advice. The only exception to the 6 week time is when anti-HIV drugs are being taken (pre- or post-exposure prophylaxis), which can delay positive results if the drugs don't work.

Oraquick misses up to 5% of HIV infections, no matter now long you wait. It's the least reliable of all available HIV tests and always the wrong test to check for HIV after any particular exposure.

It is 100% certain you do not have HIV. Don't overthink it, and stop searching online about it. 

That completes the two follow-up exchanges included with each question and so ends this thread. It should be your last one about HIV testing, OK? I do hope the two discussions put things to rest for you. Best wishes and stay safe.