39 yo male from Poland.  About 9,5 weeks ago I went to a Strip Club in one of major cities in Poland and received a lap dance from a stripper. However I was heavily drunk during these event and sometimes I loose memory after getting drunk. It is likely that it was just the lap dance with me licking her nipples for a moment. However not sure 100% if anything more happend due to the drunk state.

Anyway ,47 days later I went to a local Anonymous HIV testing site and was offered lab test, though I chose finger stick rapid test just for antibody to HIV and after 10 minutes received negative result. I was advised that there is no data regarding antibody only test accuracy at this time (47 days) and should repeat at 3 months or have lab test which is certain at 6 weeks or beyond.

Now is 9,5 weeks after the strip club event and I do consider re-testing however wonder whether lab test or another rapid test for antibody.

Questions:

1. On the internet there are various numbers for accuracy of an antibody only  tests - are there any solid data that it is about 90 % accurate at 6 weeks? Expecialy as it was the rapid test which seems to be less sensitive and become positive later than lab based antibody test?

2. I consider also a self-test rapid antibody like INSTI or from some other company. However I am a bit afraid of a false positive result from the rapid finger stick tests. Is it much more common for the false positives to be present in rapid test vs lab tests?

3. Are rapid antybody test conclusive at 9,5 weeks or only at 12 weeks?

4. Have you ever experienced an antibody test turn positive being negative at 6 weeks?

Thank you

First, I would judge that there was little if any risk for HIV from your strip club visit. No sexual contact transmits the virus except unprotected vaginal or anal intercourse; even unprotected oral sex is zero risk, or close to it. From your description, it seems very unlikely that this happened, right? If somehow I were in your situation, I would not have been HIV tested at all. That said, I am happy to answer these questions. (Your sophisticated questions seem to imply you may have professional understanding of testing issues, yes?)

1. The more recent antibody-only HIV tests ("third generation") probably are more like 95-98% sensitive at 6 weeks; probably 90-95% for the older ("second generation") versions.

2. False positive results are more common with rapid than lab based tests, but still rare. (A few weeks ago I reviewed a paper submitted for publication in the journal Sexually Transmitted Diseases about mistakenly advising patients with positive rapid tests they are HIV infected, before considering risk level or waiting for confirmatory test results.) You should not hesitate to use a rapid test for this reason. Still, why not have a lab based test to be that much more confident in the result?

3. Nine weeks is fine; no need to wait until 12 weeks. In case you're interested in the available data, here is a link to the main analysis that the US Centers for Disease Control and Prevention use for advising about HIV test performance, and which is the main basis for our advice on this forum:  https://pubmed.ncbi.nlm.nih.gov/29140890/ 

4. No, I have not had this experience. But that's irrelevant anyway. Rare things happen. I have never had a patient struck by lightning, but obviously that has no bearing on the chance it will happen to you. No different for HIV testing, right?

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Actually I do prefer rapid tests, because I can't bear waiting a day for a lab test result.

As a 12 week passed since strip club incident I have done another fingerstick rapid test - self test done by myself. - https://simplitudebyme.com/

Result is negative.

My questions:

1.  Actually I followed instructions carefully and was to apply four drops into a testing device. I did so - however I wonder if  these kind of tests are foolproof? 

2. Should I repeat this test with another one like e.g. INSTI ?

3. Have you ever heard about rapid testing providing false results as a result of bad handling and/or bad test conducting?

Thx

2. At least INSTI is a well established test known to be accurate and reliable.

3. In general, the rapid tests are very good, even without careful adherence to the test methods. But here again, I suggest lab based testing.