Post Encounter, Post Testing Assessment

[trellion]

I had a sexual encounter that I managed to work myself up over. I'm a male located in the USA, heterosexual, black, HSV 2. My partner was a black woman, also HSV 2, college educated professional who was quite adamant that her STD status prior to our encounter was across the board negative aside from HSV 2.

My encounter involved my performing unprotected cunnilingus and analingus on the woman as well as inserting my unprotected finger into her vagina and rectum. She performed unprotected fellatio on me, and penetrated my rectum with her unprotected finger. We also had protected vaginal intercourse, however the condom tore. I did not notice until withdrawing and the woman pointed it out to me.

I was initially not at all concerned about this encounter, but after some time the torn condom began to work on my nerves. My stress was enough that I didn't want to wait for six weeks, or eight weeks, or twelve weeks, or whatever the heck the HIV window period is. So I put down $200 and got an HIV DNA test with HIV Antibody. I took the HIV DNA with HIV Antibody test 30 days exactly after the encounter described above.

The results came back recently as follows:

HIV-1 Antibody, Confirmation Western Blot - Negative
HIV 1/O/2 Abs - Negative
HIV-1 DNA by PCR - Negative

I have two questions:

1. Can I take the results from the HIV DNA / HIV Antibody test described above as definitive that I am HIV Negative? I know that some people insist that an HIV DNA with Antibody is not an acceptable diagnostic and one must wait 3 months, or however long, following an encounter and take an antibody for definite status.

2. I'm also going to take an STD screening, partly from paranoia over the sexual experience I've described and partly because I'm in a new relationship and my girl and I want to be sure about STD status. Can you provide a time frame that would cover a window period following an encounter so that any STDs that are in place would be picked up through testing?

[Edward W Hook, MD]

Welcome to our Forum.  Any risk that you have for HIV (an what risk you have is small) is the result of your condom failure, something that happens about 1% of the time when condoms are use.  There is no risk for HIV from oral sex (giving or receiving, including analingus).  Further, your partner sounds to be rather low risk for HIV. That said, I understand your desire for testing and will be happy to address your questions regarding test performance.  

1. You are correct. We are not big fans of the PCR for HIV diagnosis.  Its performance for HIV diagnosis has not been well studied and there is concern about false positives which are more common in PCR tests than for other HIV (antibody) tests.  That said, the combination of a negative PCR test and a negative HIV antibody test at 4 weeks (30 days) is absolutely reliable evidence that you did not acquire HIV from the exposure you describe.
2. STD screening at this time will be highly reliable.  The major STDs you would be at risk for are chlamydia, gonorrhea an non-chlamydial NGU.  Testing at this time will be completely reliable.  The risk of syphilis is so low for you that a 30 day test will be reliable as well.  Obviously, there is no need for HSV testing.
Hope these comments are helpful to you.  EWH

[Edward W Hook, MD]

Gald to help.  Take care.  EWH

[trellion]

Indeed your reply is helpful, sir. Very much so. Thank you for your effort. I'm grateful.