Dear Dr H. Hunter Handsfield

I  will keep it brief. I am 23 female in London. 70 days ago, I performed oral sex on a black male(met in a bar)without condom and he ejaculated in my mouth. He also gave me oral sex and licked my anal. We then had vaginal sex with condom for about 5 minutes and continued with anal sex with the same condom for another 5-10 minutes. The bad thing happened: the condom broke and I don't know when. He ejaculated in my anal again and we found the condom was broken. He was pretty relaxed about it and I was a bit drunk so I didn't worry until a few days. I can't contact him now because I don’t have his number. He mentioned he is from Dubai and is traveling around Europe.

Symptoms: 2 lymph nodes on my neck. sore throat that comes and goes(and is still) white tongue

I had the following negative tests:

A rapid HIV test at day 28(finger blood)

4^th generation HIV tests at day 28, 42, and 59. The first one was done at a GUM clinic and the other two were done at two different private clinics. They all sent my venous sample to a lab for testing.

The last clinic told me that I am in the clear because the window period is 45 days. However, I think my exposure is very high risk so I can’t calm down and have been searching on the internet and your forum.

I have the following questions:

1. About HIV-2. Do these tests detect HIV-2 for 100%? I find that recently BHIVA published a separate guide on HIV-2: https://www.bhiva.org/file/615ee3de98539/BHIVA-guidelines-for-the-management-of-HIV-2.pdf which says that the window period is still 90 days because there is no antigen.(page 16)

I would really appreciate it if you could take a quick look at that page 16. Do I need to take a test at 90 days? What’s your suggestion?

2. Do I need PCR testing now? I see you suggest PCR test for high-risk exposure

3. Should I test for HCV? If so, what tests? There are HCV PCR, HCV Ab and HCV Ag…

4. What else should I do?

Thank you so much for your help!

Welcome to our forum and thanks for your questions. I’ll be glad to comment. Before I do let’s face your encounter in context.  You are concerned about your exposures although you do not know that your partner was infected with HIV of any sort. Your highest risk exposures for acquisition of infection if your partner did happen to have HIV were the unprotected vaginal and anal sex which occurred when the condom broke. Please remember that it is statistically unlikely that your partner had HIV of any sort and that even if he did your risk for infection if you happen to have untreated HIV infection is less than 1/2 of 1%. With that background---

Apologies I accidentally hit submit before I could complete my response.  I noticed well that you have tested for HIV using highly reliable fourth generation HIV antigen/antibody tests 28, 42, and 59 days following your exposure.  On  to your questions:---

Thanks for your reply, Dr. Hook.

Yes, I had negative tests for gonorrhoea, chlamydia, and syphilis at 42 days and the clinic told me these are conclusive. Do you agree?

I am actually in a relationship. This is the first time I have had this kind of behavior and guilty takes over me. I have been abstinent all this time(My partner is not in London). But I can’t hold any longer to not telling him and not having sex with him. So just to confirm:

1. My latest test at 59 days was done outside of the 8 weeks(56 days) mark you mentioned, so I 100% don’t have HIV(1 and 2) and will not put my partner at risk by resuming unprotected sex with him? No need for any further testing?

2. I just need a bit more reassurance to move forward because I can’t stop worrying about my symptoms. I read a similar statement in other threads but just want to confirm with you that this is still true: with my negative fourth-generation test result at day 59, no symptoms I have now or ever have in the future can be due to HIV(1 and 2), assuming no new exposures. So I don’t need to pay attention to potential future symptoms. Do you agree?

Again, thank you for your help Dr. Hook.

Thanks for the additional information. This is very helpful. Indeed, your results for the more common STI’s are absolutely conclusive. Believe the results. There is no further testing needed.  Regarding your specific follow-up questions:---