[Question #8277] Confused on how to move forward

46 months ago

Doctors,

I am a middle aged man (48). On July 26, 2021. I had vaginal sex with a women. A condom was used. During the sexual act I became flaccid. The condom slid down but it appeared to always cover the head of my penis. I eventually ejaculated. I did ask if she had been hiv tested and her response was she was because of work (negative). I dont know if that is true.

I didnt think much about this until I decided to get back with my long term girlfriend.

Since this exposure I have had sores in my mouth, coatings, and a bout of thrush. All of this has been seen by my dentist and oral surgeon.

I have been tested using the alere hiv 1/2 antibody antigen rapid test at 6 days, 29 days, 49 days, 57 days, 63 days (post exposure). All were negative.

On day 64 I got another thrush sore. This scared me. I went yet again for a another alere hiv 1/2 antibody antigen rapid test on day 65. The results were negative even though the test didnt totally clear of the buffer fluid. (this also scared me) The counselor said it was negative.

FYI- I was diagnosed with hpv several years ago but havnt had an outbreak in a long time.

Questions:

1. Did I put myself at risk?

2. When is the typical time frame for ARS?

3. Is nine weeks and a day (64 days) to late ?

4. How long do you have to wait after symptoms to prove they were not caused by ARS for HIV 1?

5. How long do you have to wait after symptoms to prove they were not caused by ARS for HIV 2 since the test only looks for HIV 2 antibodies?

6. Since I had thrush on day 64 would my day 65 test have been positive even if it was HIV 2?

7. Do I need another test to be sure?

8. When from a time standpoint can HIV 2 be ruled out?

9. When can I sleep unprotected with my girlfriend?

10. Lastly, if I continue to have mouth problems (sores thrush) do I need to keep testing? (I think this is why people keep getting tested because there symptoms keep coming back)

Thanks,

Edward W. Hook M.D.

46 months ago

Welcome back to our firm. Several of these questions closely resemble questions that you ask of me in your final follow up about a month ago. Condom protected sex sex sex and even when a man loses his direction, as long as the head of the penis is covered, there is no appreciable risk for STI’s such as gonorrhea or chlamydia or for HIV of any sort..I’ll go straight to your questions:

1. Please see my comment above. There is no appreciable risk from the exposure you described.

2. The ARS typically occurs 2 to 3 weeks following an exposure. The mouth sores you describe are not suggestive of the IRS and the ARS would not occur nine weeks following an exposure.

3. See above

4. When symptoms are due to recently acquired HIV, combination HIV antigen/antibody (fourth generation) tests are invariably positive.

5. Same response. Please review our previous exchange. There are fewer than 50 cases of HIV-2 which occurred in the United States each year and have those, virtually all are due to contact with a person who has traveled or is from west Africa or India. Nothing you have said suggests need to be concerned about HIV-2

6. Yes, if your thrush was related to HIV your test would have been positive. Thrush is a sign of well-established HIV. Please remember, most people with thrush do not have HIV

7. There is no medical or scientific reason for additional testing. You’re 49 day, 53 day, and 69 day tests are each conclusive both for HIV-1 and HIV-2.

8. As I said above, HIV-2 has been ruled out conclusively.

9. Nothing about the exposure you described, nor your symptoms suggest any need to avoid unprotected sexual contact with your regular partner.

10. Your oral symptoms sound like aphous ulcers. The cause of aphous ulcers it is unknown but they are not a sign of HIV. I would encourage you to discuss this problem with your regular healthcare provider.

I hope the information I have provided is helpful to you and will allow you to move forward from your continuing concerns over your misstep. EWH

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46 months ago

Dr. Hook,

Thank you so much for your response. One thing you misunderstood in my post was that my last HIV test was at 65 days post exposure (not 68).

1. Day 64 (post exposure) I had a sore (maybe thrush). Day 65 I tested HIV 1/2 antigen / antibody negative. Would that have confirmed the thrush sore was not ARS resulting from either Hiv 1 or 2?

2. As I said Day 64 (post exposure) I had a sore (maybe thrush). Day 70 I went for one more alere hiv 1/2 antibody / antigen rapid. I tested negative. Would that have confirmed the thrush sore was not ARS resulting from either HIV 1 or 2?

3. Did I need hepatitis testing from this exposure?

4. I tested hepatitis c (HCV ) negative 57 days post exposure with a rapid test. I read other responses that said HCV testing at 6 weeks post exposure was conclusive. Can I assume my test was conclusive?

5. I read long ago that if you get HCV during your exposure or have HCV it could affect test results. I searched the forum and found responses that said it does NOT affect antibody or antigen tests? Please confirm.

6. In the future if I get more mouth sores, coatings, or thrush does that mean I should test again for HIV or should I assume it is the result of something else?

7. Can I stop HIV testing and resume unprotected sex with my partner immediately?

Thanks you for your time

Edward W. Hook M.D.

46 months ago

You continue to worry far more than you should. There is absolutely no difference In the accuracy of HIV test whatsoever between 65 and 68 days. Both are entirely conclusive.

1. If this was thrush, and thrush would not be present for only a day or two, thrush is a finding associated with advanced HIV, not recently acquired infection. Further, your test results at day 65, as I’ve said before repeatedly, are conclusive and should be believed. But for HIV-1 and HIV-2.

2. Correct, you are sore was not related to HIV-1 or HIV-2. As already discussed, the ARS would not occur beyond 30 days, much less at 60-70.

3. No

4. Hepatitis see is virtually never transmitted through heterosexual contact. Furthermore, like hepatitis B, use a condom for vaginal sex would be protective if this were even a possibility. Finally, your results and 57 days are conclusive.

5. The idea that acquisition of hepatitis C, or coexistence hepatitis C would interfere with the accuracy of HIV testing is an urban myth. Forget about it.

6. Please, please, please accept your HIV test results. You did not acquire HIV from the encounter that you have described. Should you acquire mouth sores in the future look for another cause.

7. This is another repetitive questions. Your HIV test results were conclusive several tests ago. There is no reason for you to abstain from the unprotected sexual contact with your regular partner.

I hope that these responses which, in large part, serve to only reinforce the answers I have already given, will provide you with the reassurance you need to accept your test results and move forward without continuing concern. EWH

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