Condom break, Risk/Test info

[Montreal1989]

Hello, I had a sexual encounter with a female CSW in the Dominican Republic, Punta Cana area. She is 20 years old and worked out of the tourist night clubs.

We were having vaginal sex when at some point during the session the condom broke. I did not notice but she did.  When she told me, I removed my penis and saw that there was no condom from half way up my shaft to the tip of my penis. It was approximately 10-15 minutes in the session that this occurred. I do not know how long I was exposed and for your info I am un-circumsized. I re applied a new condom and finished the session.

Two days after the incident I took her to a clinic. They administered an HIV test. I cannot tell you what type of test they did but it was a blood test from her arm and it came up negative within the hour. It was taken on April 15th. I got her tested again on May 9th, and the result was negative.

I got tested in Canada with a Rapid POC test at the 4 week point, which was May 10th, and it was negative.

Using the timelines and info provided: what can you determine (if anything) about her HIV status, and what can be said about my negative Rapid POC test at 4 weeks?

Symptoms:
Day 8: I had a painful kink in my neck that lasted 4-6 days and felt like the cause was coming from the upper left back area, and 4 days of a mild sore throat
Day 14: Noticed loss of appetite and in turn weight loss (not sure if that was caused by mental or physical issues)
Days 19-21: 2 nights of night sweats
Day 22: Noticed 1 purplish pimple like irritation on the cheek of my trunk, and two pimplish like red spots on my chest that arent typical pimples
Days 23-29: Noticed a discomfortable feeling in my right armpit, and have been having diarrhea, usually in the morning after I wake up

Please analyze these symptoms and assess my risk. My worry is that she was in her window period and thus testing negative, I am very worried. I have high high anxiety about this situation and seek your advice.

Thank you

[nomi977]

Hi dude,
I can understand your anxiety and feel sorry for you. Actually you are suffering from OCD (Obsessive Compulsive Disorder) and no matter what you do, you will not be satisfied. You need to see a psychiatrist, he will prescribe you with anti-depressants also called SSRIs. These medications are highly effective in treating such conditions of extreme panic, anxiety, OCD and depression. I am telling you with personal experience, as I also went through such period in my life before. So don't delay it, consult a psychiatrist right away to restore your peace of mind and confidence. Otherwise, I again repeat that no matter what you do, whatever test you take you will never be satisfied.

[Edward W Hook, MD]

Your anxiety did not allow you to comprehend my answer. This question was answered.  Re-read my answer. If it holds for 4 weeks, it holds for 5 and 6 weeks.  EWH

[Montreal1989]

With all do respect Doctor I don't believe I should be discriminated because of a conversation that another individual initiated with me.  I do apologize for the conversation between me and Nomi on this thread and if in the future if I have to use this forum I will not respond to outsiders questions.  I came here and paid for your professional advice and there is a final question from my last post that was neglected that I would appreciate for you to answer.

From my last post:

"Final question, should I go attend this p24 test on Thursday (which would be the 5 week and 1 day point from the incident) and accompany it with a Rapid POC test again?  Or should I just do a simple Rapid POC test this Thursday and then another Rapic POC at the 6 week point? Are these tests the same ones that you have been telling people never change from negative to positive after a 6 week test? And what can be said about the 5 week test?"

Thanks for your time and effort.

[Montreal1989]

Thanks buddy, whenever you have a minute Doctor please advise on the questions I posted to you and my testing questions.

Thanks again for your time and words Domi.

[Edward W Hook, MD]

This thread is getting our of control and as nomi has said, your anxiety appears to be getting the best of you.  I will briefly address your recent questions.  At that point, the thread will be over and there will be no further answers.  If you and nomi wish to continue the exchange please take it to the HIV Prevention Community site.  

A 4 weeks POC is highly reliable and will detect well over 90% of recently acquired infections at the 4 week point.  

Please put your concerns about the "generation" of test aside. These references are relevant from a historical perspective and in situations in which experts talk about older data.  they are not relevant to your situation.  Simply think of the tests as tests for antibodies alone and combined tests that test both for antibody and p24 antigen.  Those that test for both p24 antigen and antibodies at the same time provide results a bit sooner as the p24 antigen appears in blood before antibodies.  Once antibodies are present, antibody tests will be positive from then on.  The p24 antigen, on the other hand can become undetectable as antibodies appear.  If you are tested for both p24 antigen and HIV antibodies at 4 weeks and are negative on both tests, you can be confident of your results and do not need further testing.  

This ends this thread.   Further questions will be deleted.  EWH

[nomi977]

Yes 100%. Your problem is anxiety and OCD. Fortunately, these days this problem can be 100% cured. So just act quickly and restore your peace of mind and start enjoying your life again. Anti-depressants will be lethal for your anxiety and OCD nd you will very soon be back in ur lyf invading all ur negative thoughts which r haunting u at the moment. So just chill nd relax dude.

[Montreal1989]

Thanks Nomi, you are right I am very anxiety ridden.. you telling me that my problem is OCD anxiety/extreme panic related is a relief to what I am worried that my problem is.  Thanks for your comment friend.

[nomi977]

Dude, as I told you before you should see a psychiatrist ASAP otherwise your anxiety will continue to grow moment by moment. Your mind will come up with another 1000 reasons to convince yourself that you have all the symptoms of the disease. I am also a medical doctor and its my sincere advice to see a psychiatrist without any further delay. Don't let these consistent negative thoughts ruin ur lyf.

[Montreal1989]

Also Doctor, I have noticed these tiny little pinhole-size blood red marks (dots) on both of my hands.  3 on my left hand, and 5 of my right hand.  Please advise.

[Montreal1989]

Thanks for your time and detailed response. I did post on the international forum as well; being that the incident happened outside North America. In addition, I was reading multiple of your posts and was eager to hear your professional opinion.

What is the validity of my Rapid POC test at 4 weeks that was conducted in Montreal, Canada. It was a finger prick tets.  They took my blood, put it in a clear liquid, put that liquid into a little bowl, then added a blue liquid to reveal the results. Two dots being positive, one dot being negative. I received one dot indicating a negative test result at that point.

I hear all this talk about 2nd gen, 3rd gen, 4th gen tests. Would you happen to know what type of test this was and what the accuracy would have been at 4 weeks? Also what would the accuracy be at 5 weeks as I am very eager to get tested again for peace of mind.

In Canada our health care system seems quite far behind in terms of HIV detection. The only test available is the Rapid POC test, and there is no private health care facility to offer any of the other tests. Only in extreme circumstances (ie. I had unprotected ANAL sex, not even vaginal) with an HIV+ person, and I am under the 4 week period will they grant a p24 antigen test. I pulled some strings with a friend of mine who works in the HIV testing dept and she managed to get a p24 test scheduled for me next Thursday which will be the 5 week, 1 day point since the incident. The problem is it will take a minimum of 1 week, but an average of 2 weeks to get the results from the blood work.

I am very eager to rule out and grey area from this incident as it is plaguing my life. One of the HIV counsellors told me that the p24 test is not accurate from after 4 weeks, but I'm reading other places that it is accurate any point after 4 weeks. Please clear up that misconception for me.

Final question, should I go attend this p24 test on Thursday and accompany it with a Rapid POC test again?  Or should I just do a simple Rapid POC test this Thursday and then another Rapic POC at the 6 week point? Are these tests the same ones that you have been telling people never change from negative to positive after a 6 week test? What can be said at 5 weeks?

Sorry about the excess of questions and my eagerness to bleed as much information as possible, but through my painful research there is so much misinformation online I do not know what to believe and would love for you to help clear up the clouds in my mind.

Thanks so much for your time, patience and help.

[Edward W Hook, MD]

Welcome to our Forum.  I see that you have asked the same question on the International Forum.  I anticipate that you'll get similar answers from both sites with both of us assuring you that the likelyhood that you acquired HIV as the result of your condom failure is virtually zero.

Just as an FYI, condoms do fail about 1% of the time.  I hope that this mishap will not keep you from using condoms in the future.

Now for your likelyhood of being infected- effectively zero.  Your questions can be distilled into the question of whether your partner was infected at the time of your exposure or not.  The answer is it is close to certain that she was not.   Had she been infected her HIV test would have been positive.  The 2nd test adds further assurrance to this statement.  I realize that you might be wondering if her blood test could have been negative because she was infected but it had not yet turned positive (i.e. she was in the window period of seroconversion).  Unlikely. FIrst, HIV infections are not all that common and she appears to favor condom use with her clients making her risk for becoming infected, even as a CSW, rather low.  Second, had she, hypothetically, become infected a day before you had sex, by May 9, there is a greater than 50% probability her test would have been positve at the time of the second testing.  

Could she have been positive- I suppose.  Is it likely?, no, not at all. it is far more likely that you'll be hit by lightning today than that she had HIV.

Finally, about your symptoms, a brief answer.  Your symptoms are non-specific and do no suggest HIV.  They do suggest however that you are quite anxious about this exposure and are examining yourself more closely than you would otherwise.  Try to relax.  

I  hope my comments are helpful.  I am quite confident that you did not get HIV from the exposure you describe.  EWH