Unprotected vaginal oral with CSW, rapid test at six weeks

[worriedintucson]

Dear Doctors
Dr. hook asked me not to post until March (tomorrow) but due to home privacy and urgency I need to submit tonight, if that's OK. It's not my intent to monopolize this forum.

HIV concerns me. I had unprotected oral & vaginal sex with a female CSW on Jan 2.  I have known her for 6years. The first portion was condom protected, but I foolishly took it off to finish, no more than 5 minutes. She said "Don't come in me!" & I determined no birth control and won't let men ejaculate inside her.  She said she was clean.

I went for the chlamydia/gonorrhea check a week later at PPH - negative. Then at six weeks (less one day) I did a rapid HIV blood test at PPH, with a blood test for syphilis thrown in. Both negative.

Does it make any sense to resume sex with my wife based on odds?  I was told to do a lab blood test at 12 weeks to be really sure. Is 8 weeks enough to confirm the rapid test?

I want to move on. I stopped my sad behaviors. Thanks for the service that you provide.

[H. Hunter Handsfield, M.D.]

"...most people are posting here based on fear, anxiety, coupled often with some regret."  Ya think??  The moderators are confronted with this continually.

New evidence is that the oral fluids rapid test takes longer (3 months) to achieve 100% reliability than the lab-based or rapid blood tests (6-8 weeks).  Whether Dr. Hook or I have personally seen patients like you describe is irrelevant.  I also have never had a patient who was struck by lightning.  Rare things happen.

That will end this thread, and it should be your last need to post a new question on this forum unless and until you have much higher risks than the ones you have described so far.  Best wishes.

[worriedintucson]

Thank you for your reply, my anxiety is reduced more than a 4 million fold or more (at least .0005*.01*.05 actually, this is 2000 to 1 infection rate, conservative 10% chance she had hiv, and conservative 5% missed detection in the test results in 1 in 4 million odds - effectively zero). This is the reasoned approach as you say.

I would say however that most people are posting here based on fear, anxiety, coupled often with some regret.

I read the links provided and was just wondering if it known a year later with any scientific certainty whether the rapid HIV tests are performing at 99% or closer to 99.99%, say, at six weeks, based on any evidence even if anecdotal. If I had to guess neither you nor Dr. EWH have ever seen any ones test turn negative after 6 weeks. It sounds as though this is an opportunity for some researcher to write a nice paper on if they can gather any data.

Best regards,

worried in Tucson no longer and staying clean BTW

[H. Hunter Handsfield, M.D.]

You may be almost within the guidelines for frequency of posting new questions on the professionally moderated forums.  However, another rule prohibits repeated anxiety driven questions that are similar to previous ones -- regardless of frequency.

You had a low risk exposure, since it is unlikely your CSW partner has HIV (both because most CSWs aren't infected, and mostly they don't lie if they are); even if she had it, the average transmission risk for a single vaginal sex exposure is around 1 in 2,000; and most important, the rapid HIV blood tests are virtually 100% reliable at 6 weeks.  It really isn't necessary to wait until 12 weeks to be certain, especially since your risk was so low that HIV testing really wasn't even required.  See the thread linked below for more information about time to reliable HIV test results.

http://www.medhelp.org/posts/show/1704700

Based on the information you have provided, you can safely have unprotected sex without fear of infecting her with HIV.

Regards--  HHH, MD