Do i need further testing after a negative rapid HIV antibody test at 10.5 weeks.

[pratyman]

Dear Docs,
This is with regard to a HIV risk that i might have been exposed to. I am in mid 20s and 10.5 weeks ago i had a risky sexual encounter with a CSW in singapore. I had protected oral and then protected vaginal sex with her but to my dismay on retracting i found that the condom remained in her and i was unable to see whether it was hanging out or not. I had remained inside her for a short time (a minute possibly) after ejaculation. The CSW seemed quite satisfied that the entire ejaculate remained in the condom( a little below the tip). However, since i am unsure whether the condom slipped between the time of ejaculation and the retraction or only during the retraction, i consider it an HIV exposure. The status of the CSW is not known as I did not ask her. But she made sure that we had protected sex.
I was not very worried initially but panicked later on. I have had rapid finger prick tests for HIV at 2.5, 6 , 7 and 10.5  wks(73rd day- today). All resulting negative. Also, have tested -ve for Chlamydia and gonorrhea at 17 days and syphilis at 17 and 45 days.
i hoped the 7 wk (47th day) test to be good but to my horror i developed a dry throat on the morning of the 46th day (one day prior) which became a mild sore throat (right side) with a couple of tender whitish spots on the right side of the throat(the spots vanished in less than  48 hrs). The sore throat progressed for week and developed into acute sore throat and stuffy/runny nose with thick yellow mucus from the right sinuses in 8th wk.10 days of antibiotics followed, with the acute sore throat gone in 5 days and the yellow mucus in 10. Since then I have off and on mild sore throat/pain and swollen glands around the throat. Just to let you know that i suffer from chronic sinusitis/rhinitis issues due to a deviated septum.
Due to the said symptoms do i need to test again at 12 wks or can I consider the 10.5 wks rapid fingerprick antibody test conclusive?
Many thanks and hoping to hear from you.

[pratyman]

Thank you  doctor.

I am much relieved now.  I will consider this conclusive and try to put this behind me and move on.

Thanks again and god bless you.

[H. Hunter Handsfield, M.D.]

You seem to have missed the main point of my reply and are re-asking the same questions with different words.  Your test results PROVE you did not catch HIV.  How high the risk was at the time makes no difference and neither do your symptoms.  The test results overrule everything else.  If you haven't done so,please read the other thread linked above.  I won't have any further comments or advice.

[pratyman]

Dear Doctor,

Thanks a lot for the quick response.
More on the symptoms:
I had a similar dry/sore throat with an ulcer kind of eruption on the 6th day post exp which cleared by the 10th day with hot water and chlorhexidine gargle.No other symptoms till 45 days. The 8th week sinusitis (and pharyngitis for which i got the antibiotics) was accompanied with feverish feeling for a few hours on 2 days. No high fever, no rash.
I got worried because the lady at the testing center said that it might take up to 6 months to be positive and when i asked her if i need to test again she said that i might want to test by the end of September - 5 month post :(. I don't understand as even the boards at the center recommend to test at 1 month and then confirm in the third.

1. Also, you said that-"your sex was protected.  Protection is generally considered to be complete when the condom stays beyind as the penis is withdrawn from the vagina". But I am unsure whether the condom slipped after the time of ejaculation and before the retraction (i minute or so) or only during the retraction. I am a little confused.
2. i have only had rapid antibody blood tests and no lab based rigorous tests as they are not available anonymously. Does this and the additional symptom info change your assessment.
3. Is it practically possible to be positive after 11th wk -ve? I am worried abt giving it to the girl whom i have grown close to in the last 2 months.

My apologies for being repetitive but i want to be worry-free.
Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Some questions have sufficient information in the title to accurately reply, before even reading the question itself.  Yours is the third or fourth such question just today!  Actually, I cheated a little bit -- I read enough of the question to know you're asking about a rapid blood test, not the oral fluids test.

All the HIV blood tests, including the rapid tests, are 100% reliable any time more than 6-8 weeks after exposure.  (The oral fluids test may take a bit longer to reach 100% reliability, closer to 3 months.)  Although standard advice from the test manufacturers and many experts is that 3 months is required for definitive testing, this has to do mostly with regulatory issues and conservative policy, not with actual test accuracy.  For more information about this, see this thread:  http://www.medhelp.org/posts//show/1704700

Looking at the details of your question, there is nothing that changes the conclusion of the comments I just wrote:  your negative tests prove with 100% certainty you did not catch HIV during the exposure you are concerned about.  Statistically, it is unlikely your partner had HIV -- the vast majority of CSWs don't have it -- but even if she did, your sex was protected.  Protection is generally considered to be complete when the condom stays beyind as the penis is withdrawn from the vagina.

But most important, for the reasons above, the HIV blood tests are among the most accurate diagnostic tests that exist for any medical condition.  Negative test results always overrule exposure history and symptoms, as long as testing is done sufficiently long after exposure.  You really were quite over-tested considering the low risk of the exposure -- and you could have been entirely confident in the results after the negative 6 week test.  A little sore throat makes no difference -- among other things, 6 weeks is much too late for onset of acute HIV symptoms.

So all is well and you can stop worrying.  If you have a regular partner, you can continue (or resume) unprotected sex without fear of transmitting HIV.

I hope this has helped.  Best wishes--  HHH, MD