Firstly, I wanna thank you for your great services in the field. I'm from Vietnam and here're my questions about my exposure and the test.

1. About the exposure: on Jan 10th, I had sex with a lady on Tinder, before we met, I asked her to test for HIV, and it was negative. The sex was with condom, and condom was intact after that, I checked with water, but there was one thing that very concerns me: I had a small cut at the base of my penis - next to the scrotum, where the condom didn't cover, and she was on her period, and that cut might get it and out of her vagina during the sex.

That scares me a lot because there's a chance she might be on her window period for HIV.

1a. What was my risk here? Is it high risk, low risk or no risk?

1b. Is there any record of someone get infected like my exposure based on your knowledge?

2. About testing window period in general. I tested negative on Jan 31st (yesterday - 21 days after the exposure). 

2a. I intended to bring her to have a PCR RNA test tomorrow (Feb 02nd - 23 days after exposure) and another 4th gen on Feb 07th (28 days after exposure). If both tests come back undetected/ negative, can I absolutely 100% sure she's not infected on the day of exposure (Jan 10th)? Or I need another 4th gen test of her at 6 weeks to absolutely confirm?

2b. Do I need to test myself on 28th days and 42 days as well with a 4th gen test if both of her tests come back negative to be sure? I had no other exposure, only this one.

  

1. There is zero chance of HIV in this situation. Her negative test is nearly 100% proof she isn't infected; statistically, the chance she is infected but blood test still negative (i.e. in the window period) is probably under one in many thousand. And even if she has HIV, condom protected vaginal sex is nearly 100% protective. Exposure of recent and healing cuts to infected fluids have never been known to result in HIV transmission. (The "water test" is nonsense. There is no such thing as microscopic leaks condoms that allow HIV or STI transmission; it's an urban myth. If a condom doesn't break wide open, protection is complete.) Those comments pretty well cover your speicif questions, but the answers are 1a zero risk, and 1b no:  I have never heard of anyone catching HIV in a scenario like you describe.

2. I would have recommended against HIV testing in this situation, and I certainly do not advise spending good money on an RNA test. However, if you insist, a negative result at 21 days will be nearly conclusive, at least 95%. And the combination of that result plus a negative AgAb (4th generation) blood test any time 4+ weeks after exposure will be 100%, without a 6 week test.

3. As just discussed, only the 28 days test is needed for 100% assurance.

But really, you're way more concerned and spending way more money and emotional energy on testing than indicated by this exposure. There is no chance you have HIV.

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

HHH, MD

I have more questions as follow:

4. About the PCR test, I have two questions:

4a. PCR-RNA/ PCR-DNA, or quant/ qual, do all of them have the same meanings at 23 days, in combination with AgAb at 28 days?

4b. I can see that there many types of PCR like 40 copies, 120 copies, 250 copies ..., again, do all of them have the same meanings at 23 days, in combination with AgAb at 28 days?

5. About external effects on test, I am taking Acyclovir (30 pills x 800mg) to treat my lips herpes, will the drugs affect any type and window period of each types of tests?

4c. Does the combination of PCR at 23 days + AgAb at 28 days conclusive for HIV-2 as well?

All PCR RNA tests for HIV probably are equally valid, i.e. negative results proving someone is not infected. Do not obsess over the detection levels (no. of RNA copies) determined when the tests were in development:  almost nobody with negative results at 23 days turns out to actually have HIV. There are no medical conditions or drugs, including acyclovir, that have any effect on reliability or timing of the HIV blood tests.

My last question relates to one of your answer and many others' concerns about HIV-2 testing.

6a. Is it true that the 4th gen test cannot test positive for HIV-2 P24 antigen?

6b. Many says that HIV-2 testing with 4th gen has a longer window period, is that true?

6c. In one of your answer on this website, "[Question #9357] Testing Post PEP. HIV 2 Scare", you stated that: "HIV2 has essentially been absent otherwise in the US. And anyway, the standard HIV AgAb tests are conclusive for HIV2 8 weeks or more after exposure, so your negative test results rule it out.", but here you told me that AgAb test at 6 weeks is necessary. So I just wanna ask is it really 6 weeks or 8 weeks with a 4th gen to absolutely rule out HIV-2.

Many thanks for your great support, Dr Handsfield. I wish you health.

6b. For that reason, only the antibody portion of the AgAb test detects HIIV2 infection, extending the test window to 8 weeks.

6c. 8 weeks for HIV2. But testing for HIV2 probably is unnecessary, because it is so rare.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.