I wanted to inquire about your expert opinion around recent exposures and the effectiveness of condom protected sex. My wedding got called off eventually and there were a lot of unfortunate events in the aftermath of my PEP episode. I had 8+ therapy sessions but still feel anxious despite reassurance and adhering to therapist recommendations. 

I made the decision to fully abstain from sexual relations until I succeed in managing my excessive anxiety around low/no-risk events. I do want to seek your opinion on testing to make sure I'm in the 100% clear.

In March, I had some protected vaginal encounter with other college students, where I fully and hopefully correctly used condoms (no obvious breaks, and I know this because of prior experience). 

Partner A: 19yr old straight female, goes to an elite school, I seem to be her 3rd partner overall.

Partner B: 22yr old bi-female, first year PhD student at an elite school, I seem to be her 4-5th male partner overall, is educated around STDs.

I had two exposures with partner A, one with partner B, and used condoms for all sexual acts (no oral at all), even replacing the condom as soon as ejaculation happens. No unprotected sex has taken place. I have done a round of testing (to be honest, it was more around the PEP event), by taking a PCR RNA and an AgAb lab-based. Both came back negative. This testing round would be 30 days after exposure 1 with partner A, 19 days after the only exposure with partner B. I also had a very brief exposure after testing with Partner A again (04/08), where a condom was used but penetration was under one minute long, with the ejaculate all in the condom.

a) Is my testing conclusive enough around the protected encounters as well?

b) Can people get HIV despite condom usage? I keep seeing 70% efficacy on the web, "virtually" 0 risk, 0 for all practical purposes here, but is it really 0? If it's not, why is it advertised that condoms are protective?

c) what further testing do you recommend?

Apologies for re-asking this question. please, forgive me. I'm really having excessive anxiety and can't even pinpoint its source.

You once again describe partners at no realistic risk of HIV, plus proper and consistent condom use, which would prevent HIV even if one of them has it. 

a,c) It was a waste of money, and probably emotional energy, for you to be tested at all after any of these events. And you apparently ignored all you were told about test timing in your previous threads. If you need negative testing to move on (which is a psychological issue, not a medical/risk one), then you need an AgAb test 6 weeks after the last time you had sex with either partner. Do not have a PCR test, which is pointless if AgAb testing is done.

b) CAN people get HIV despite proper condom use? Probably, but only because there have been lapses in proper use that people may not realize or recall. But you need to be very careful searching these things online (and probably shouldn't do it at all, given that most anxious persons get more worried not less, being drawn to statements and studies that inflame their worries, missing the reassuring parts). For any particular exposure, condom protection is very much better than 70%, probably 99 or 99.9%. As for why an imperfect prevention would be advised as protective, why not for goodness sake? People die in auto wrecks despite using seatbelts, and from home fires despite smoke alarms. No safety device is 100% effective, but of course that doesn't mean those devices -- including condoms -- should not be vigorously promoted. I suppose it is possible somebody somewhere posted a figure of 70% effectiveness of condoms against HIV, but I would bet that comes from people with HIV who SAY they always used condoms for potentially risky events but did not.

d) I think this question refers back to the previously discussed exposure. I have nothing more to say about it. You know (intellectually) that you didn't catch HIV. That you're having trouble accepting this (psychologically) isn't something I can help.

HHH, MD

First of all, thank you for your response and for bearing with me. I hope you are not seeing any ill-intent in my additional posts. I don't mean any inconvenience for you and I hope you believe I'm seeking all the help I could to cope and move forward.

Few follow-ups for your responses:

a,c) I understand that further testing seems to be more for psychological security rather anything else. I also realize that 6 weeks are needed to establish conclusive results. However, do you think a PCR RNA was conclusive enough at 30 days and 18 days following protected encounters? Or, does the AgAb remains to be the only way to conclusively determine HIV status? 

b) I know researching things can be confusing. I do have research background myself, though not in medicine, so I tend to read journal publications rather than random facts on the internet. The paper I was referencing: (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003255/abstract and https://www.sciencedirect.com/science/article/abs/pii/S0277953696002584). I was honestly very shocked because 80% seemed too low of a figure, and in contradiction to my prior sexual education that assumes condoms to be fully protective unless broken and not used for full duration of sex. I know studies have limitations around self-reported usage of protection, but in your experience in practice and in research, have you seen anyone seroconvert for HIV despite properly using a condom that did not break? Your figure of 99% protection is very reassuring and puts my risk at around 3 out of 250 million (assuming 1 in 1000 hiv prevalence, which I think is probably even lower). But to be honest, inconsistency in information across doctors and medical researchers really amplifies my anxiety

d) Closing the file on this one. That being said, if you happen to be aware of any useful resources (though not your specialty), when it comes to anxious persons you've seen before, I would definitely be appreciative of any input. I have really been working hard to manage my anxiety so hoping for a happy ending soon.

a,c) The results you have had are probably 100% conclusive; I am unaware of anyone infected with HIV who had negative PCR results at these times and turned out to have HIV after all. On the other hand, all experts recognize the very small theoretical possibility of false negative PCR and would advise an AgAb test in addition, at 6+ weeks after the last possible exposure. Indeed, most of us would recommend only the AgAb test and skip PCR entirely. 

b) I am unaware anyone who acquired HIV despite proper condom use without breakage. But rare things happen. I've also never cared for a patient struck by lightning, butof course that has no bearing on your risk of being struck. That said, consider three factors that argue that you will never get HIV:  you obviously choose partners at little or no risk; even unprotected (no condom) vaginal sex with an infected female partner has only 1 chance in 2,500 of HIV transmission; and condoms work. It's fair to assume that in these circumstances, nobody in the world has ever acquired HIV, and you won't be the first.

d) Sorry -- I'm not a psychologist and have no expertise in anxiety management, and certainly do not keep up with any professional resources. We view our role on the forum as providing facts and science (despite how uncertain these sometimes can be); the rest is up to the user him/herself. Thanks for your understanding.

I wanted to update you with my test results. I got tested with AgAb test at 41 days after that last condom protected encounter and it came back negative. I messed up the count on the days, as I planned for 45 days, but can 41 days in my case be considered conclusive?

I also wanted to consult you about another encounter, Happy to open up another question if you don't want to address it here. The premise is that I engaged in an oral / hand-genital contact with a new heterosexual woman(also selected to be on the low risk end, as she says she doesn't engage in penetrative sex with anyone for religious reasons). There was a moment of frottage, where I suspected that penetration could have happened. To be fair, I didn't feel anything and the woman confirmed that no penetration occurred as she was just "grinding" on the base, but I'd rather be safe than sorry and cover all basis. I spoke candidly about my anxiety, my partner reassured me she was negative as of a February and went for an AgAb 18 days after our encounter and she sent me her negative results. Is her testing negative 18 days later eliminate any risk of HIV, say if penetration did occur accidently?

She also tested for other STIs and were all negative besides Syphillis which came back initially reactive but negative on the confirmatory. She says this is due to overlap with covid antibodies according to her doctor. Granted, I don't worry about syphillis as it's curable, but could this impact the conclusiveness of her HIV results?

Thank you for the help again doctor. I'm happy to say that being more open and direct about my previous anxieties with new partners has helped me manage a lot better and hopefully I can continue move forward in the right direction.

It is time for you to stop checking with us about each and every new sexual exposure you have. In your several discussions we have given all the information you need to judge the safety and risks. You have also been advised about the forum policy that we do not accept repeated anxiety-driven questions on the same topic. Any more questions along these lines will be deleted without reply, and without refund of the testing fee. I do hope this and the previous discussions have been helpful, but we are not a psychological support resource. Best wishes and thank you for your understanding.