[Question #819] Oraquck in-home after 21 weeks

89 months ago
I am straight white male in my mid-20s and have been obsessing over my HIV status for months. I read and read about it online over and over again and I get constant anxiety. 

Now to my background and question: 

I was tested with a standard blood test in November 2014. It was negative for HIV. However, I tested positive for HSV-1 genital via a swab of my penis. I have had no recurring outbreak. I had unprotected sex before and after this date (November 2014). All vaginal intercourse. (All before Jan 31)

My last possible exposure was July 23, 2015. (I had no sex between Jan 31 and July 23.) On that July 23, 2015, I was having protected sex and my condom broke at the base. The tip of my penis was still covered. I was having vaginal intercourse. I had a fever for one day (I think) and a cough for a week, a month after the that last possible exposure (July 23, 2015). 

I took an Oraquick in-home test  (oral fluids) on December 20, 2015 or about 5 months (21 weeks) after the last possible exposure (July 23, 2015). Two of my friends watched me as I did it. And they made sure I followed the instructions. It was negative. Clear line on the C. No line next to the H. Not even a faint one. 

Just to be thorough: In early May 2016, I got a fever for one night -- it was very weird to me.  

I have no symptoms right now. 

I want to ask: 

Is my single oraquick in home test result conclusive? Do I have HIV? 

If it is conclusive, why are there so many oraquick studies that show that the test gives false negatives? This is what is making me doubt my test. 
H. Hunter Handsfield, MD
89 months ago
Welcome to the forum and thanks for your question. I happened to log in within minutes of you posting it -- most users should not expect nearly real time replies.

The oral fluids test picks up virtually all infections after 3 months. Although false negatives occasionally occur, the test is not the only evidence against you having HIV. You had an extremely low risk exposure (protected vaginal sex with a partner statistically unlikely to have HIV) and, despite what you think you have learned in your online searching, no symptoms that suggest HIV. Let's put some numbers to it: Average chance any particular sexually active woman in the US has HIV, around 1 in a thousand. Transmission risk if she were infected, roughly 1 in a thousand. Condom protection somewhere around 99%, i.e. a 1% risk remaining despite condom use. Accordingly, the odds you caught HIV were rougly 0.001 x 0.001 x 0.01 = 0.00000001. That's one chance in 100 million, and that's even before you were tested. If we now assume a 5% chance of the test missing an infection, the odds you have HIV decline even further, to 1 chance in 2 billion. (If I have my decimal places right. Even if I'm tenfold off, I hope you'll agree it doesn't matter.

In other words, zero.

FYI, HSV1, even when genital and not oral, does not increase HIV risk if exposed. Only HSV2 does that.

I hope this helps you get beyond your obsessive worry about this. Of course if you like, you could have a test that never gives false negative results, such as an antigen/antibody (duo, combo) test. If you do so, it will be negative.

Best wishes--  HHH, MD

89 months ago
Wow, I guess I'm pretty lucky for the response time. 

Thank you for your answer! Just as a follow up: 

Are you assuming the sex I had on July 23, 2015 was protected because the condom only ripped at the base? Or is is that when you start with a condom on HIV risk is 1%

Just to shut my worrying mind up, can you comment on the nonprotected exposures I had around the November test? 

Thanks again!! 
H. Hunter Handsfield, MD
89 months ago
With apology, I wasn't really focused on the unprotected exposures. But from my reply above, you will understand there was little risk; that the overwhelming evidence remains that you don't have HIV (well under 1 chance in many million) -- zero chance for practical purposes. HIV protection is considered complete if the head of the penis is covered, so that also makes no  difference in my assessment.

So all is well and you should move on without worry. But see my last comment above about considering a top of the line test instead of less reliable rapid testing. It's up to you. If you do it, you can count on a negative result.

89 months ago
This is has to be my anxiety but all I'm getting from the combination of your two replies is that my oraquick test isnt very much reliable. Is it really ONLY 95% accurate after 3 months? What causes it to miss infections? 

Also I has no idea condom protected sex was only 99 percent effective. Is that really the case?

I like the way you run odds. I've read it on your old medhelp posts thousands of times but I feel our exchange has just increased the odds of infection in my head by decreasing the reliability of my OQ test and condom protection. 

I sincerely mean no offense and I sincerely appreciate your help. But can I trust my current result? I feel too much anxiety even approaching a doctor and asking for another test. 
89 months ago
To add: Is oraquick after 3 months any less reliable than a standard blood test? 
H. Hunter Handsfield, MD
89 months ago
You misunderstood my reply entirely. The oral fluids test is very good by the standards of diagnostic testing in general, just not quite as good as other avaiable tests for HIV infection. It is somewhat less reliable than all blood tests, which is clear in my comments above (or should be). It is not and never has been the best test to prove for sure someone doesn't have HIV. That's why I suggested you consider having a blood test as well.

It is difficult to put meaningful numbers to condom efficacy. For any single exposure, a carefully applied, properly used condom that doesn't break can be considered 100% protective against HIV acquisiton by vaginal or anal sex, especially for the insertive (male) partner. However, condoms often are not used perfectly and sometimes they break. Therefore, people who rely on condoms as their main prevention strategy probably have about a 90% reduction in HIV risk. (Same for conception:  overall only 90% reduced pregnancy risk, taking into account human error and other failures.) I used 99% as a rough example for the purpose of the calculation. Don't hang your hat on it. And don't worry about it -- if you plug 90% into my analysis, i.e. using 0.1 instead of 0.01, you'll see that the risk you were infected remains extremely low.

It is nonsense that this exchange should have increased the odds you have HIV. That's silly. You can still trust that you do not have HIV. Why are you having so much trouble just accepting the reasoned, science-based reassurance I have given you, as almost all people would in this situation. You're really working hard to prove to me and to yourself that you really were at risk and that your fears are justified. They are not. But this isn't a debate. I suggest you re-read my replies and concentrate on them, then move on with your life. 

That completes the two follow-up replies included with each question, and so ends this thread. Take care and stay safe.