[Question #949] possible

50 months ago
Dr Hook I saw you on an hiv blog and really hope you can answer  a few questions to help with my anxiety.  I am 38 years old and 10 weeks ago I made a huge mistake.  I am married and had a one time encounter with a girl I had met.  We had protected vaginal and anal sex, the condoms did not break, but she performed unprotected oral sex on me.  I feel like god is going to punish me for what I did. 
At 10 days I had a full STD testing done including a HIV 4th generation blood test, everything came back negative.
Then at 5 weeks I repeated all the same tests including the 4th generation blood test, again all came back negative
At 7 weeks I did an oraquick saliva test which came back negative.
And then yesterday 10 weeks I did another oraquick saliva test, which again cam back negative. 
Can you please tell me what you think the chances of me testing positive in the future?  Are these test accurate at the stages I took them? 
I have no reason to believe there was anything wrong with the girl, I just have a tremendous amount of guilt and anxiety and feel like god is going to punish me with HIV.   That may sound stupid, but its how I feel.

I have also had no symptoms of anything in these past 10 weeks, I have not had a cold or anything.

I greatly appreciate your answers, and the entries you wrote on the blog.  I also live in New Hampshire where the HIV rate is very low and I know the girl was not a drug user.

Thank you again so much  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome to the forum and thanks for your question. Dr. Hook and I take questions randomly, without regard to requests for either of us. We have been close colleagues for 3 decades and our views and advice almost never are different, even if our writing styles differ.

While I understand your anxieties, you have overreacted in your multiple HIV tests. It is never necessary to have any further testing after a negative 4th generation (antigen-antibody) HIV test done 4 weeks or more after the last exposure. All your tests after the one at 5 weeks were superfluous. Equally important, the chance you were infected with HIV or any STD was zero for all practical purposes. The odds are your partner wasn't infected; and properly used condoms reduce any risk by 90-100%, depending on the specific HIV. (It's 100% for HIV.) Oral sex is low risk for all STDs, even unprotected -- and zero for HIV. And the non-HIV STD tests also are highly reliable. With all those results plus lack of symptoms, you can be sure you have no infection from that event.

My final advice is to encourage you to separate your obvious anxiety and guilt over a sexual decision you regret from your fears about infection. They aren't the same. Deal with the former as you need to, but you can move on with absolutely no concerns about the latter.

I hope this has been helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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50 months ago
Thank you so much for the answer, I wish all my anxiety went away but it has not.  I am not doubting your answer, but was curious as to why the place I got the testing done and most websites I visited and read say to be conclusive the 4th generation test should be done at 12 weeks.  Do they recommend retesting at 12 weeks mostly for profits?  Or is it possible the results will change after 5?  And is the oraquick test reliable at 10 weeks?  Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
The discrepancies bewteen advice on this forum and official advice about times to reliable HIV test results have been addressed many times on the forum. For a quite detailed discussion, see question 868. Here are some excerpts:

The best available data often are buried in the studies done by test manufacturers prior to FDA approval and don't necessarily see the light of day in scholoarly publications. But even these data are not precise. Scientifically rigorous research to determine exact window periods is essentially impossible from practical, ethical, and cost perspectives. 

[Therefore, our] window period advice is based primiarly on biological principles.... We have good data on time after exposure when HIV antigen or RNA are detectable, and when measurable antibodies appear. On this basis, the 4th generation tests are virtually always positive within 4 weeks and remain positive thereafter for the life of the infected person. It is also the case that there are few if any published case reports of people with negative test results at 4+ weeks who were later found to have HIV; and all the HIV/AIDS experts we know also say they have never seen this in any of their patients. The same sorts of considerations apply to combinations of tests, such as when an RNA test is done at say 2 weeks and a standalone antibody test is done at 4 weeks.

On the other hand, some experts and agencies are uncomfortable standing only on these biological principles and hold out for more definitive data, without which they take consiervative stances. Often there also is a tendency to not change previous guidelines unless and until new data conclusively prove that information was wrong, which explains why 3 months remains a commonly accepted standard, based on older standalone antibody tests. And health departments and other governmental agencies also tend to take conservative stances, preferring to err on the side of longer advice about window periods. CDC is in this category.

I hope that helps. 
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