[Question #8547] Follow up on question "[8524]: Hiv test results"

42 months ago

Hello Doctor,

I am following up from a previous question as I still had some doubts. As I just wanted to be certain of testing after the window period I went to test at 47th day after exposure and as expected the results were negative for Ag/Ab test. I was satisfied since this is after the window period of the test and since you mentioned it was conclusive. I was just going through the paper you mentioned in the previous answer: https://pubmed.ncbi.nlm.nih.gov/29140890/

There is a paragraph in the end in section titled "Testing after an exposure event":

"Follow-up testing should occur 4 to 6 weeks and 3 months after baseline, with additional testing at 6 months if the exposure event resulted in hepatitis C virus infection. These recommended time points reflect expert opinion rather than a strict adherence to window period durations. If the patient tests negative at the end of the window period (Table 1), one can be very confident that he or she did not acquire HIV from the exposure."

After reading this I was wondering if my results are conclusive or should I test again after 3 months to get final result. Also the infection with Hepatitis C is something I have no idea about the probability of that. I just wanted your expert opinion on this.

Thanks again

Edward W. Hook M.D.

42 months ago

Welcome back to the forum. As I presume you know, Dr. Handsfield and I share the forum based on our experience of having worked together for nearly 40 years. Over the years we have been in total agreement regarding the facts of our recommendations. I have reviewed your earlier interaction with Dr. Handsfield and agree with all that he said. The exposure you described was essentially a no risk event, both for HIV and for hepatitis C which is virtually never transmitted through vaginal intercourse.

The recommendation for additional testing at three and/or six months is overly conservative. We have never seen or heard of a person who was not already taking anti--HIV medications who took longer than six weeks for their test to become positive. In fact over 98% of persons develop positive tests within four weeks of exposure. As Dr. Handsfield explained, in your case the testing using both PCR on two occasions as well as multiple fourth-generation, combination HIV antigen/antibody test provides absolutely conclusive results. Further testing regarding the encounter you described in your original post would be a waste of time and resources. You did not acquire HIV in that encounter!. I hope this information is helpful to you and Will’ are used to move forward without continuing concerns. EWH

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42 months ago

Thanks Doctor for the reply, it is really helpful. I am trying my best to move forward. Some days I have questions and doubts and I feel better to get more knowledge from experts like you and Doctor Hunter than suppress them, even though I have confidence in my results. This is also helping build my knowledge on these topics for future. I had a couple of further questions:

1. Since both you and Doctor Hunter described the event as essentially a no risk event so just wanted to understand the rationale behind that. Since almost all STI virus particles are 10 or more times smaller than the pore size of a lambskin condom wouldn't this be considered the same as an unprotected vaginal sex exposure.

2. I am also worried about having contracted GHSV2 and/or syphillis. I haven't had any common symptoms so far related to these. I only got tested for these once which was 12 days since exposure but I think it was too soon. Could you share when should I test next for these to get conclusive results. I am now at 7+ weeks since exposure.

Edward W. Hook M.D.

42 months ago

1. As Dr. Handsfield has already described, Theoretical poor size arguments aside, lambskin condoms provide partial protection. You can debate this all that you want. Remember however that even with no protection whatsoever, if your partner had HIV (you don’t know this) your risk of infection from a single encounter it would be less than one infection for every 2000 acts of intercourse. You’re negative tests prove that you were not infected. It’s time for you to get over this.

2. You have had no clinical episode to suggest either of these diseases. I am not going to re-state the issues related to partial protection resulting from the use of Lance Lamb skin condoms, nor am I going to talk about risk other than to remind you, once again, that even if your partner happened to be infected, most single exposures do not lead to infection. I fear that you were going down a “what if” rabbit hole driven by your guilt over the encounter you’ve described. You really need to move on.

EWH

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42 months ago

Thanks Doctor for the reply and my intention was not to debate. I am trying my best to move on and working with a therapist. I have moved on from the HIV scare mostly and want to rule out all other infections which are more transmissible and have larger testing windows. Can you please suggest if I want to have conclusive results for HSV2 and Syphillis when should I go for conclusive results. Since my lab does RPR test for Syphillis I wanted to know more about its testing window and best time for the reliable and accurate results.

Thanks

Edward W. Hook M.D.

42 months ago

I am sorry you continue to worry and hope that your work with your therapist will help. Please remember that your lambskin condoms provided considerably more protection against bacteria such as syphilis then it theoretically did to HIV. Had you asked whether you should test for herpes my recommendation would have been no. Blood test for herpes are plagued with falsely positive results and take up to six months to provide “conclusive” results. Even then, currently available blood test for herpes detect only 90% of infections. In answer to your follow-up questions:

Official recommendations regarding window periods for conclusive test results for syphilis tend to be very conservative. Most typically when persons acquire syphilis they will experience a lesion at the site of exposure within three weeks of the encounter and blood tests will be positive within 30 days. The official recommendation for conclusive testing following exposure to an infected partner with Syphilis is 90 days. Please see my comments above regarding blood test for herpes.

EWH

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