I hope all is well. I’m back with a follow-up question around a more recent encounter. I admit that I have a lot of anxiety around HIV specifically, and I’ve been seeking counseling regarding it, while abstaining from sex to completely eliminate my risk. However, I struggle with risk assessments because I get caught up in the weeds of low vs. no vs. theoretical risk. 

Since my last test, taking place 43.5 days after the fingering with cut event, I assume my status is negative. 

On August 19th, I had met a friend of mine, who was drunk. She ended up kissing me and we made out for about 20 minutes. That was the extent of the encounter. However, two things raised the alarm bells for me. My friend tested negative on June 12th. But between our encounter and six weeks before that test, she’s had 18 encounters with 6 different partners, with inconsistent condom usage. That seemed very promiscuous and was a red flag for me. I also noticed the next day a small cut in my mount, potentially induced by the kissing episode, which in my head increases my risk.  

Given my friendship relationship with the person, I was able to convince her to get a lab-based AgAb. She did one 4 days after the encounter and one 19 days (9/7) after the encounter (the latter covers all the exposure before our encounter besides one that occurred 31 days (8/6) before the test so still within the window period)

My questions are the following:

1- what is the risk associated with deep kissing? How does that scale with presence of cuts? To be honest I never tasted blood but CDC claims kissing to carry some level of risk

2- can someone be infectious for HIV and not be picked up by an AgAb? I’m trying to see if the most recent test my friend had would clear me for sure from any risk

3- what and when would you recommend me in terms of testing? I appreciate an honest response as if you were advising yourself or a close relative.

Thank you very much doctors 

You seem to fear your partner could have HIV despite her negative test. That result 19 days after your encounter proves she could not have transmitted HIV to you. The time to positive testing (up to 6 weeks for the AgAb tests) is not the same as testing that proves non-infectiousness. At 19 days, with the negative antigen component of the AgAb test, it is clear she could not have had transmissible HIV at the time of the encounter.

2. No. See comments above.

3. I recommend against any further testing. There is no possibility you caught HIV. However, you are free to have an AgAb test 6 weeks after the kissing event, if you need the negative result to allow you to move on without worry. But truly there is no need and you should go on with your life as if nothing happened:  in regard to HIV risk, nothing did.

Just remember this, so you will not need to post any more questions about zero risk events like fingering and kissing:  If you do not have vaginal or anal intercourse with an infected person, you will never catch HIV. Even oral sex is risk free. Don't worry about other details, like whether or not your partner might be infected, cuts on the finger, or other factors. If no intercourse, there is no risk of sexual acquisition of HIV. Got it?

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

HHH, MD

Thank you very much for your prompt and well written response. I wanted to write to you as I feel like I have some strange symptoms that are making me anxious. As of 37 days post exposure, I'm starting to feel fatigued, with a runny nose, cough and a scratchy throat. I tested for COVID-19 twice and it came back negative. I know these symptoms seem to be on the late end, but is there a chance they could be due to a somewhat late HIV seroconversion? I take daily temperature measures and I have not had any fever or rashes associated with these symptoms.

The other follow-up was regarding the infectiousness of my partner. Even if I had a risky exposure with her (say anal intercourse unprotected), would you be confident that a negative AgAb at 19 days after exposure rules out the possibility of being infected by her? I ask because the girl is refusing to test conclusively after her last exposure prior to me due to "lack of time", so I have scheduled my own test with planned parenthood the morning of the 42nd day hoping for a conclusive answer and an end to this story. I'm a bit worried that it might be coming back positive for some reason or that I'd be the first person to get HIV from a kissing incident.

Finally, regarding your last comment on future questions, my question is: if I do not engage in any sexual penetrative or oral activity, and I don't inject intravenous drugs, should I be confident that I would never contract HIV no ifs and buts (including things like barbershop clippers, cuts during casual contacts or sports)?

Thank you so much for addressing my questions and I promise I would refrain from asking further repetitive questions in new threads.

Your "If I do not engage" statement is correct.

Thanks for your understanding about repetitive questions. You have one more follow-up comment in this thread, if you would like to post your negative 42 day result.

You were right once again. I tested at the 42 day morning with rapid finger prick AgAb at PlannedParenthood and it came back negative. I went ahead and confirmed that at 48 days with a lab-based AgAb that also came back negative. I did it to settle the 45 vs 42 day debate. So, I think that should be conclusive with respect to the kissing incident altogether?

The strange thing, however, my symptoms have persisted (mainly the runny nose and itchiness of the roof of the throat, which I think is due to some sort of allergies, and the constant sleepiness which I can't really justify). I'm pretty sure, given my testing history, these symptoms have nothing to do with HIV but I wanted to confirm. 

I didn't have any other sexual encounter ever since the kissing incident (not even kissing, oral, or hand to genital) and I don't use any drugs (Injection-based included), so there isn't another risk that could warrant any further testing. The only doubt I have is that I got cut by the clippers (not razor, and it's more of skin irritation rather an actual cut but I wasn't able to check if they had any blood on them) of a barber in downtown Manhattan about 15 days ago, and I was worried that it could pose a risk, given the timing of onset of symptoms. But, once again, I wouldn't think that's a risk for HIV to my best knowledge, not even theoretically as I haven't seen anything about such thing even on the conservative CDC website. I just want to defer to your medical experience in assessing such risk, and whether, given the symptoms you'd recommend testing again.

Thank you Doctor and I wish all the best in your future endeavors.

Of course I would not recommend testing again for HIV. If you have any doubt about your risks, I suggest you go back and re-read your discussion with Dr. Hook as well as my replies above in this thread. (Carefully re-read every word!) I'm otherwise not going to comment on your own statements that suggest you understand that the events you mention are zero risk -- at least you understand intellectually, even if you're not quite there in your subjective/emotional belief. I'm not going to repeat what we have already said.

And by the way, there is no "debate" about testing at 45 versus 42 days. To my knowledge, nobody in the world has ever been reported to have tested negative at 42 days and then positive at 45 (not counting perhaps a few people who took anti-HIV drugs after exposure).

That concludes this thread. As you likely know, repeat questions on the same topic are strongly discouraged; this being your second along these, it should be your last -- unless and until you have a known high risk exposure like unprotected sex with a high risk partner, shared drug injection equipment, and so on. Thank you for your understanding. Also thanks for you kinds words and best wishes. Same to you!