Semi unprotected sex

[questionfordoctor]

Hello Dr. Hook or Dr. Handsfield,
On Nov, 17th, I met another gay male for what intended to be protected sex. I had asked his HIV status, and stated he was HIV negative and tested in May 2013.  We did NOT engage in oral sex, but at the onset of the sexual encounter, as he was anticipating entering me (I am male), the condom broke and his head was exposed inside me for about 20-30 seconds. He pulled out, did not ejaculate (assuming only possible pre ejaculate would be possible), and no blood was visible.  There WAS water based lube involved, so my assumption was that the condom was not placed on him properly and perhaps had an air bubble at tip. I decided to end the evening after this incident. No ejaculation from either party.

I emailed him again 2 days later to reconfirm that he was HIV negative (out of mere anxiety). He emphatically stated “YES” (not in an abrasive way).  I tested at 5 weeks with the HIV ½  Clearview Complete rapid blood test and again  at 6 weeks with the Oraquick rapid blood finger test at Planned Parenthood (after reading some threads that a 6 week test would be more accurate…..95% I hope???).  Both tests came back negative.  

I have not had any “symptoms” to speak of [that relate to ARS]. No swollen lymph nodes, no fever, no rash etc.  

I intended to get retested again at 3 months but would be curious for what the likelihood that I could still be in a pre-seroconversion stage.  I do know that another person knows him well and stated that he is “negative” from the last time he spoke with him (nearly 2 years ago).  He does not do drugs and honestly does not seem the kind of guy that would "lie" (from instinct).    I am in the norm of using condoms for any kind of sex and had not had anal sex since last year and was tested routinely this year in June.  He was the only partner this year.  I can get a HIV Duo test which is about 2 hours away, but am wondering if it is worth it?   Thanks.

[Edward W Hook, MD]

As said before, you do not need a 3 month test, these results are reliable.  I urge you to believe them. EWH

[questionfordoctor]

Just a follow up. I took a Home Access test this past Wednesday (8.5 weeks past exposure). The test was negative. I'll follow up at the 3 month mark. Is the 8.5 week a relative indicator to forecast my 3 month test? I discovered that the Home Access test is an "older generation" test (I think 2nd???).

Thanks

[Edward W Hook, MD]

A.  Yes, the Home Access test is FDA approved and has to pass the same testing standards as other tests.  It is reliable.

B.  I see no reason for screening.  I would just get the vaccine

C.  Of the more common STIs syphilis is probably the one that testing takes longest for.  In your case testing at 60 days is more than enough and, to be honest, I would say that if you do not develop lesions or a positive test within 30 days there is rally no Raison to be worry.  To be honest, if I were you I would not worry.  EWH

[questionfordoctor]

Thank you for your response.
I initially wanted to ask as well (if you would not mind responding on):

A. I have a Home Access Test left over (not expired). I will test with this @ 8 weeks and plan to test again @ 3 months with Health Dept. Is the Home Access test just as reliable as the rapid POC tests?

B. I've yet to get vaccinated for Hep B. I will this new year as I have a physical coming up.  Should I get screened for the Hep B antigen/antibody before getting the vaccination?

C. Which std has the longest time frame for accurate screening? (excluding Herpes as I see that many of the Herpes Select tests are not as accurate).

Thanks again!  Have a great New Year!

[Edward W Hook, MD]

Welcome to the Forum.  Your question is a good one.   Let me first congratulate you on your commitment to safe sex and let you know that you may have done nothing wrong during the encounter that you describe.  Unfortunately condoms do break about 1% of the time they are used.

I suspect your partner was really HIV negative- most people do tell the truth. that said, I totally agree with your choice to get tested "just in case" and hope that the evaluation that you had included testing for otehr far more common STIs like gonorrhea and chlamydia as well as HIV.  If not, it still might be a good idea to do so as these infections can be present without symptoms.

As for your chances of being infected., they are now very, very low.  Your test at six weeks would have certainly detected over 95% of recent infections IF you were infected and even that is unlikely.  When you consider that your partner was probably not infected, the brevity of your exposure, and that you have had negative tests so far, my advice would be to not worry, to repeat the test at some point when you are more than 8 weeks out from the exposure (at that time your results will be conclusive) and move forward without fear or concern.

I hope these comments are helpful to you. EWH

[questionfordoctor]

I apologize for the confusion of the last statement :"I can get a HIV Duo test which is about 2 hours away, but am wondering if it is worth it?"  I  meant to say that would have to drive to Pennsylvania as my state does not permit DUO testing. Though I found the closest lab (2 hours away in Scranton, Pa: Lab Corp.) that is willing to do the Duo test.