Please Help, a bit confused

[Dreamer20]

Dear Dr,

Firstly, I wanted to thank you so much for your time. You are providing a tremendous service to everyone and I hope you realize how much we appreciate it.

I am a 20 year old gay male and I had sex with someone I did not really know well. They told me they did not have any STDs beforehand. The encounter consisted of unprotected oral (gave/received - no swallowing) and rimming (gave/received). I'm not sure if I was even at risk to begin with, but I had 2 HIV tests done at almost 9 weeks (ELISA and a point-of-care test) which both came back negative. Do you think I need any further testing or would you regard my test as conclusive? I asked this question on the HIV prevention support forum and some said I didn't need more testing, but others said I had to wait until I reached the 13 week mark. I'm confused about this whole window period business, is it really necessary to wait 3 months?

I also had a question about the window period. Is this whole window period an issue because people make antibodies at different rates, and it takes a while for them to show up on tests? Wouldn't virtually everyone would begin to make antibodies to a new antigen almost immediately?

Once again, thank you so much for your time - this site has been really educational and such a tremendous resource!

[Edward W Hook, MD]

Your confusion is legitimate.  You can find all sorts of estimates as to the time it takes for tests to become positive and how long one should wait.  The problem is that sites trying to make generalizations to fit all situations wind up having to be very conservative in their recommendations.  The factors which impact risk have a lot to do with the type of sexual activity, the numbers of exposures, and the coexistence of other problems such as STDs.  

In your case, your risk is very low.  You had a single exposure, your sex was oral (all of it) which is a low risk exposure, you do not have STDs, and your test was negative at 9 weeks when between 98 and 99% of tests that are going to become positive will be.  Thus putting all of this together, you can consider your nine week results as fact.  You do not have HIV.  Further testing is, to be honest, a waste of time.  At this time, you are far more likely to be hit by lightening than to have a positive test from the exposure you describe.  Time to move on.  EWH

[Edward W Hook, MD]

AS mentioned above, you have little to gain by further testing.  Take care.  EWH

[Dreamer20]

Doctor, I honestly wanted to extend to you my sincerest thanks for your response. Thank you for listening to my concerns and rationalizing this for me. Not a surprise to me that you were the Parran award recipient recently. =)

If you do not feel I am at any risk by not taking the testing again at 12 weeks, then I will just move on from this matter.

My kind regards,

Dreamer20

[Edward W Hook, MD]

I do think you need further testing.  Your 9 week test would have detected between 98 and 99% of all positives that would occur in that time frame.  Getting tested at 12 weeks picks up another 1%, or over 99% of all positives.  when you combine this with the fact that the exposure you describe was very low risk, there is no need for further testing.  EWH

[Dreamer20]

Dear Dr. Hook,

I am not sure if you will reply to this or not, but really hope you do. I have tried to just move on and not worry about this, but sometimes I still feel a bit of anxiety about not being tested at the 13 week mark. Are late seroconversions really that rare, that I should not be worried about it? I keep thinking, what if I am just a late seroconverter and by not testing I am not going to be able to seek treatment.... sorry if this sounds ridiculous.

In Canada, the rapid testing is not really available, so I'd have to go the US to get one (the drive alone is going to be extremely stressful) and I've heard that rapid tests sometimes give false positives, which would even get more stressful.  So if I really don't need testing, I'd rather not do it.

I just wanted to let you know what my concerns are, and see if this had any impact on your thoughts. I am so sorry to bring this up again, I know you are a busy man, but I truly, would greatly appreciate your reassurance/advice. Am I really not endangering my health or any future partner's health in anyway by not getting the 13 week test? Perhaps after getting this off my chest, I will finally be able to stop being worried.

[Dreamer20]

Thank you very much for clarifying this for me, time to move on. =)

[Dreamer20]

I also thought I'd add, I was tested for other STDs (chlamydia, gnorrhea, syphillis and hepatitis) but all of those came back negative as well. I just want to know, am I in the clear yet? :) thank you.