-ve oraquick advance at 19 weeks, is it conclusive?

[mja81]

Dear Drs.

I am a 30 yo medical resident. I dated a girl and had sex with her at Feb/05/2011. On that encounter the condom slipped during two consecutive cts. In each one the condom stuck inside and my penis came out completely exposed. When she pulled out the condom in each instance, all the ejaculation fluid was inside it. At that point I decided not to do any penetrative action with her so we started to do gential rubbing only. My penis was exposed to her vaginal fluid during rubbing. I got really worried after that day and I asked her if she ever had tested for hiv and other STDs. She showed me her labs that belong to 12/04/2010 and all of them were negative. I continued to be worried and that has been affecting my job significantly. Last week I called her to ask her how is she doing, she said she has had a generalized lymphadenopathy that started in late April till beginning of June. Her PMD was suspecting lymphoma then she said they ruled it out and told her everything is fine(no biopsy was done. only cbc, mri and ct). I asked her to ask her PMD to do HIV testing for her but she got offended and started swearing that she is not that type of girl etc. I got really worried so I went to the testing center on 6/21/2011 and they did ORAQUICK ADVANCE for me (took blood from my finger) and it came back negative. The counselor told me that there is no way you have HIV taking into consideration that the test was done 19 weeks after exposure. Since then, I've had a piece of mind till today when I read your post about how ORAQUICK ADVANCE is not as accurate as it was first thought. I started to worry again and I am getting really nervous. The CDC website still considers this test as very accurate (sensitivity 99.6 %).

Please advise

[Edward W Hook, MD]

Welcome to the Forum.  Several comments.

1.  You did not get HIV from the encounters you describe. As you were told the ORAQUICK ADVANCE has excellent performance and a negative test at 19 weeks is definitive evidence that you did not get HIV.  Take that out of your worries.

2.  Your partner was low risk.  Less than 1 in 10,000 not drug using women in the U.S. have HIV and your partner had a negative test less than 6 months prior to your sexual encounter.  The chances she got HIV in the interim are miniscule.

3.  Your exposures were close to, if not completly no risk. When the condom comes off as a male exits a partner as sounds to be the case in your situation, the condom has done its job and there is almost no risk of HIV.  Subsequent rubbing of the sort you describe is not an activity associated with HIV acquisition.

4.  Sounds like she has worries of her own.  I would be surprised if her doctor had not already ruled out HIV. she needs your support, not more questions about "are you sure this is not HIV.",  I hope you will do this.

Hope these comments are helpful.  You did not get HIV from the contacts you describe.  EWH

[mja81]

Thanks so much for the prompt and reassuring reply. I really appreciate it.

1. I am glad that you confirmed what the counselor in the testing center(dept of health testing center) told me. Additionally, the CDC site website literally state the same thing(the -ve rapid test result is deifintive if it's >3 mos after the exposure). Yesterday, I was really worried and couldn't sleep because of Dr. HHH's post that says ORAQUICK is only 85% accurate. I hope he was talking about the previous ORAQUICK not ORAQUICK ADVANCE. It would be even more reassuring for me if you can clarify.

2. That's good to know.

3. I don't know how long exactly my penis was exposed without condom because there were few minutes between the ejaculation and pulling out. What I know for sure is that for most of the intercouse including ejaculation, the condom was there and that's why I found all the seminal fluid inside it but what I am not sure about at what point afterwards the condom slipped(weather just at the time of pulling out or just after ejaculation)

4. I agree that I wasn't that nice to her in reassuring her about her condition and I feel bad about that but as you know, as a doctor whenever I hear about generalized LAP in a young woman, HIV will cross my mind.


Thanks a million,
M

[Edward W Hook, MD]

Dr, Handsfield's old post is no longer correct.  While there were early concerns, subsequent studies have shown the OraQuick tests to be highly reliable.    Believe your result.

EWH

[mja81]

Sorry to bother you with my questions that purely come out of anxiety. Hopefully, this will be the last one.
Per CDC, the sensitivity of this kind of testing is 99.7% which means that there is 0.003 possibility of having a false negative result. Can you please explain the possible reasons for the false negative results in this test?

Thanks once again,
M

[Edward W Hook, MD]

Good qustion and thus the answer, which I've made before, bears repeating.  As a generalization for both you and other readers, you must realize that we VERY frequently get questions asking if different types of exposures or prevention measures are 100% effective.  The answer to that is that this is scientifically impossible.  For a variety of complex mathematical reasons far too complex to go into here, all one can do with well conducted scientific studies is estimate probabilities.  the precision of the estimates is limited by the application of statistical theory which says that unless everone on earth has been testing you cannot be "sure" that something is 100% true.  Tus., by definition, any estimate, cannot be 100% certain.  On the other hand, when the CDC, Dr. Handsfield or I say that something is very close to no risk or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.  You di not have HIV- really.  EWH

[mja81]

The reason I am asking is that recently, I started to have night sweat that is mainly on the face/neck and it gets the pillow almost wet. Honestly, that was along with nightmares/dreams about HIV testing.
I started to link those episodes of night sweat to possible retroviral infection and that's why I was asking about false -ves.

Thanks
M

[Edward W Hook, MD]

Lat answer.  There are many reasons for night sweats.  If they toruble you, talk to your doctor but you can be sure you do not have HIV.  EWH

[Edward W Hook, MD]

This thread is over, additonal repetitive, anxiety driven questions are of no value to our clients and will be deleted from the thread without comment.  EWH

[book04]

Possible exposure mid june 2011. Was on meds for staph infection aug 6th for 28 days. 4-5 weeks later diag with oral thrush. Anxiety is high worries to no end. Took rapdi test (finger pric) nov 4th (neg results) still worried if my results are conclusive

[book04]

Possible exposure mid june 2011. Was on meds for staph infection aug 6th for 28 days. 4-5 weeks later diag with oral thrush. Anxiety is high worries to no end. Took rapdi test (finger pric) nov 4th (neg results) still worried if my results are conclusive