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Oral Exposure and Tests
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Oral Exposure and Tests

Hello Doctor,

I have had two exposures:
Oct 22:protected sex, unprotected fellatio and cunnilingus with a woman of unknown status
On Nov 20 protected sex with another woman. no cunnilingus but long and repeated blowjobs.
I did several sets of tests:

- Day 20 and Day 30 (of my first exposure): DNA PCR - RNA PCR - P24 Antigen Test - HIV DUO:  all negative
- Day 44 for first exposure and Day 15 for Second: HIV DUO negative
- Day 58 of first exposure and Day 29 of second: HIV DUO negative

After second exposure by two weeks, very sore throat for 2 days, then stuffed/runny nose / sneezing and a very dry cough all for 4 days, the sore throat would then come and go.
Symptoms that got me worried are muscle /joint aches that come and go, a diarrhea for 3 weeks and a rash on my face, arms, shoulders and back which I still have.The rash has no color (same color as skin) made of small bumpy spots. Sometimes I would get more spots which would be slightly red but they wouldnt be that many before they would disappear within a day or two or become smaller.

1 - Do you think my last test is conclusive for both exposures? especially for the second exposure, do you think HIV DUO on Day 29 would catch an infection if I had it?

2 - In some posts you recommend a 6 weeks DUO test. Is it at all possible if one caught HIV, that it would not show on HIV DUO on Day 29 although there were symptoms prior to test?

3 - Does the rash I described look like an HIV rash?

4 - I am thinking of doing more tests, do you think I should?

5 - Finally, in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?

Sorry for long message on a low risk exposure but I do have an unhealthy fear of this disease and I just want to get some sanity back to my life. Your help would be most appreciated.
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1024580_tn?1331577721
Hello there!
First of all, I would like to say that from your description of the events, you have not put yourself at any risk of HIV infection whatsoever.  You did not require any of those tests in the first place.  I hope you have been tested for other STD such as throat and urethral Chalmydia, Gonorrhoea and Syphilis.  These can be easily transmitted through unprotected oral sex, both ways, and are very common.  These are the conditions you need to be tested for, if you haven't done so already, and not HIV.  Now I am going to try to answer to each of your queries:

1 - Do you think my last test is conclusive for both exposures? especially for the second exposure, do you think HIV DUO on Day 29 would catch an infection if I had it?  YES, FOR BOTH EXPOSURES.

2 - In some posts you recommend a 6 weeks DUO test. Is it at all possible if one caught HIV, that it would not show on HIV DUO on Day 29 although there were symptoms prior to test?  IF YOU HAVE SYMPTOMS THAT MEANS THAT YOU ARE SRO-CONVERTING AND THE TEST WOULD PICK IT UP. 29 DAYS CAN BE CONSIDERED CONCLUSIVE.

3 - Does the rash I described look like an HIV rash?  NO

4 - I am thinking of doing more tests, do you think I should? NO

5 - Finally, in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?  I TOTALLY AGREE.

Best wishes,
Dr Jose Gonzalez-Garcia
18 Comments
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Avatar_m_tn
Sounds like extreme anxiety which is causing you to have or think you are having HIV symptoms. Test again if it will put your mind at ease. I went through anxiety too until I tested yesterday. I thought for SURE I had HIV...I darn near covinced myself I did...the test is spot on. If you are Negative after all those times...you are negative now. Stay well and you are in my prayers.
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186166_tn?1385262982
ppl pay money to get answers from the doctors who man this forum.  it is not the appropriate place for you to be commenting in.
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Avatar_m_tn
Dear Dr Jose,

many thanks for your elaborate answer. i will definitely do a full STD test as soon as i put this HIV scare under control.
just quick follow up questions:

- what got me real worried are the symptoms. in your opinion (excluding rash) do they look like ARS symptoms? what does an ARS rash look like anyway?

- if HIV DUO is conclusive at 28 days, why is it in several posts that Dr. Sean recommends test at 6 weeks? also if he deemed the exposure to be high risk, he would ask for a 3 months re-test even if 28 days DUO is negagive. i mean it is after all the same virus. regardless of the risk level of the exposure, if DUO is conclusive on 28 days, then there shouldnt be another one at 3 month, right?

- many health authorities as well as moderators on MedHelp public forum maintain that the test is only conclusive at 3 months. this 3-months issue i think is the main reason for anxiety for many people like me and for their inability to put this behind them even if they test negative at 28 days+.  do you think this is justified or old practice?

i would appreciate your comment on the above. i assure you i am not planning to waste your time with excessive posting.
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Avatar_m_tn
- sorry but an add on question: assume one caught the virus but didnt have symptoms before 29 days (so he didnt seroconvert). would his HIV DUO test be negative or would it still be able to detect the virus?

many thanks again.
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1024580_tn?1331577721
Not everybody that seroconverts has symptoms, but if someone has symptoms, that would mena that they are seroconverting.  This happens in most people at 2 to 4 weeks after infection.  Therefore a negative Duo test at 28 days, with or without symptoms, can be considered conclusive.
Best wishes,
Dr Jose Gonzalez-Garcia
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Avatar_m_tn
thanks Dr.
my question was could someone seroconvert, say during week 5 and the DUO test on Day 29 doesnt catch the virus? or the test is bound to catch the virus regardless whether there is seroconversion or not?
also, could you please answer my follow up questions above?
much appreciated.
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Avatar_m_tn
could you please answer the folow up questions? those would be my last questions. i will repeat them below for ease of reference:

- could someone seroconvert, say during week 5 and the DUO test on Day 29 doesnt catch the virus? or is the test bound to catch the virus regardless whether serocoversaion is before 4 weeks or after?

- what got me real worried are the symptoms. in your opinion (excluding rash) do they look like ARS symptoms? what does an ARS rash look like anyway?

- many health authorities as well as moderators on MedHelp public forum maintain that the test is only conclusive at 3 months. this 3-months issue i think is the main reason for anxiety for many people like me and for their inability to put this behind them even if they test negative at 28 days+.  do you think this is justified or old practice?

this is my last post. many thanks.
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Avatar_m_tn
Dear Drs.

can someone please answer my final questions????
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Avatar_n_tn
this is a good question, what happens is the p24 remains for some time even after the ab begins to be prodused,so either way the duo traps and gives accurate results, so there is no gap or lapse,antigen is at its peak at 21 days and ab is at its peak at 42 days so thats why the 4 weeks mark for duo, in short it will trap ag and ab or either..... Need i say more.
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580755_tn?1357673215
You did not have a risk as the Dr has told you.
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1024580_tn?1331577721
Here are my answers:

- could someone seroconvert, say during week 5 and the DUO test on Day 29 doesnt catch the virus? or is the test bound to catch the virus regardless whether serocoversaion is before 4 weeks or after?  THE TEST WOULD AT LEAST DETECT THE VIRUS AG P24, WHICH AT DAY 28 IT WOULD BE AT ITS HIGHEST LEVEL, EVEN IF THE INDIVIDUAL HAD NOT SERO-CONVERTED

- what got me real worried are the symptoms. in your opinion (excluding rash) do they look like ARS symptoms? what does an ARS rash look like anyway? NOT AT ALL.  THE RASH IS A TYPICAL VIRAL RASH, RED, DIFFUESE WITH SMALL PAPULES, ALL OVER THE BODY

- many health authorities as well as moderators on MedHelp public forum maintain that the test is only conclusive at 3 months. this 3-months issue i think is the main reason for anxiety for many people like me and for their inability to put this behind them even if they test negative at 28 days+.  do you think this is justified or old practice? THOSE ARE THE OLD GUIDELINES, AND ONLY WHEN USING SIMPLE ANTIBODY TESTS AND NOT THE HIV DUO TEST THAT YOU HAD.  THIS ONLY REQUIRES FOUR WEEKS.
KIND REGARDS,

DR JOSE GONZALEZ-GARCIA

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Avatar_m_tn
Many thanks Dr. as i promised i will not ask any further questions. it would be worth it though if it is clarified to others that HIV DUO is for HIV 1 and HIV 2 and that both strains can be caught at the 29th day as i have read in many posts that p24 is only for HIV 1.
this is surely not accurate...
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Avatar_m_tn
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf

Post-test discussion for individuals who test HIV negative
The need for a repeat HIV test if still within the window period after a specific exposure should be discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to definitively exclude HIV infection.
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Avatar_m_tn
You mean depending on the exposure risk? In case above as I read what Doc says is that it is not warranted
Cheers
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Avatar_m_tn
thanks Teak, but what you are posting is in direct contradiction with what the Dr. Jose is saying in his last statement (read above).
Besides, it has nothing to do with my last comment about whether DUO test can catch detect HIV 1 or 2 at 29th Day.


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Avatar_m_tn
Yes, HIVprobe did not have a risk of contracting HIV.
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Avatar_m_tn
HI Teak, what i dont understand about giving cunnilingus, is how doesnt it have any risk, when there is the vaginal fluid that was licked/sucked by me while in the process?
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