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HIV Testing: Unique Story
I began a casual relationship with a young waitress in November '09. Prior to sexual involvement, I suggested that we should both be tested for STDs. Several days later, we both happily reported our negative results. Things were great the first few weeks, until the nightmare began a couple of weeks ago. As it turns out, she is actually HIV positive and lied to me. My sources on this include a close friend of hers to whom she showed the results, as well as my attorney who investigated the claim.
Facts: Do to fear of pregnancy we always had protected intercourse with the exception of one time. On 12/5/09 I had sex with her without a condom. I estimate that throughout the short term relationship we had protected sex a total of 10 times. Our last intimate encounter took place on 1/2/10, and although I did use a condom prior to intercourse I stimulated her clitoris with the tip of my penis without a condom (I apologize for the graphic detail but it's relevant to my question).
Recent testing:
1-25-10: Antibody test
Result: negative
1-27-10: HIV test was performed using the COBAS (R) Ampliprep/Cobas (R) HIV- 1 Test Kit (Roche Molecular Systems, Inc) and performed by Quest Diagnostics Nichols Institute.
Result: not detected (I was told by the lab tech this means negative)
Two questions:
1. Based on these test results and taking into account window periods; am I definitely negative, probably negative, or possible negative?
My research is coming up with anywhere from 6 weeks to 6 months on the antibody window period, and regarding the RNA (which I think the 2nd test is?) some say 9 to 11 days while others say there is not a dependable window period.
2. How concerned should I be regarding our last intimate encounter on 1/2/10. Is it possible that when wet the viral load is enough on the exterior of the vagina to be a threat?
I'm a bit malnourished and sleep deprived. Advice is greatly appreciated.
Facts: Do to fear of pregnancy we always had protected intercourse with the exception of one time. On 12/5/09 I had sex with her without a condom. I estimate that throughout the short term relationship we had protected sex a total of 10 times. Our last intimate encounter took place on 1/2/10, and although I did use a condom prior to intercourse I stimulated her clitoris with the tip of my penis without a condom (I apologize for the graphic detail but it's relevant to my question).
Recent testing:
1-25-10: Antibody test
Result: negative
1-27-10: HIV test was performed using the COBAS (R) Ampliprep/Cobas (R) HIV- 1 Test Kit (Roche Molecular Systems, Inc) and performed by Quest Diagnostics Nichols Institute.
Result: not detected (I was told by the lab tech this means negative)
Two questions:
1. Based on these test results and taking into account window periods; am I definitely negative, probably negative, or possible negative?
My research is coming up with anywhere from 6 weeks to 6 months on the antibody window period, and regarding the RNA (which I think the 2nd test is?) some say 9 to 11 days while others say there is not a dependable window period.
2. How concerned should I be regarding our last intimate encounter on 1/2/10. Is it possible that when wet the viral load is enough on the exterior of the vagina to be a threat?
I'm a bit malnourished and sleep deprived. Advice is greatly appreciated.
MEDICAL PROFESSIONAL
Wow! What an unpleasant surprise! Your concern is reasonable. Happily, however, you can be sure you weren't infected. Your risk probably was lower than you fear, and your negative test results are reliable.
Among HIV discordant heterosexual couples, most couples can have unprotected sex quite frequently, often for several years, without transmission every happening. According to one calculation, the average transmission risk for female to male transmission is around once for every 2,000 episodes of unprotected vaginal sex. Factors that raise the risk are recent HIV infection (within 3 months), advanced HIV disease, STDS (especially genital HSV-2) in either partner, and if the male partner is uncircumcised. Things that reduce it are for the infected person to be taking anti-HIV drugs, to have a relatively healthy immune system, and to have a low HIV viral load (i.e., not much virus in the blood) -- and, of course, consistent condom use. You don't mention all these factors, but some of them (her infection is probably not new and no STDs) are in your favor. In the worst case scenario, the chance you were infected, having had only one or two episodes of unprotected sex -- even if you count the non-penetrating penile-genital contact -- is very low. (In fact, non-penetrating genital contact has never been known to transmit HIV.)
The combination of a negative antibody test (1/25) and negative HIV RNA test (1/27) is virtually 100% proof you were not infected. To drop the "virtually", i.e. to be absolutely certain you aren't infected, you should have repeat antibody tests at about 6 and 12 weeks after the last exposure, i.e. around February 13 and April 2.
Having said that, people in your situation should be under the personal care of an infectious diseases specialist, or other physician or clinic with substantial HIV expertise; then follow that provider's advice about the details.
In the meantime, try to stop worrying about the outcome. Combining the low transmission risk plus the test results, you can safely have a bottle of good wine in celebration that you aren't infected. All is well.
I hope this helps. Best wishes-- HHH, MD
Among HIV discordant heterosexual couples, most couples can have unprotected sex quite frequently, often for several years, without transmission every happening. According to one calculation, the average transmission risk for female to male transmission is around once for every 2,000 episodes of unprotected vaginal sex. Factors that raise the risk are recent HIV infection (within 3 months), advanced HIV disease, STDS (especially genital HSV-2) in either partner, and if the male partner is uncircumcised. Things that reduce it are for the infected person to be taking anti-HIV drugs, to have a relatively healthy immune system, and to have a low HIV viral load (i.e., not much virus in the blood) -- and, of course, consistent condom use. You don't mention all these factors, but some of them (her infection is probably not new and no STDs) are in your favor. In the worst case scenario, the chance you were infected, having had only one or two episodes of unprotected sex -- even if you count the non-penetrating penile-genital contact -- is very low. (In fact, non-penetrating genital contact has never been known to transmit HIV.)
The combination of a negative antibody test (1/25) and negative HIV RNA test (1/27) is virtually 100% proof you were not infected. To drop the "virtually", i.e. to be absolutely certain you aren't infected, you should have repeat antibody tests at about 6 and 12 weeks after the last exposure, i.e. around February 13 and April 2.
Having said that, people in your situation should be under the personal care of an infectious diseases specialist, or other physician or clinic with substantial HIV expertise; then follow that provider's advice about the details.
In the meantime, try to stop worrying about the outcome. Combining the low transmission risk plus the test results, you can safely have a bottle of good wine in celebration that you aren't infected. All is well.
I hope this helps. Best wishes-- HHH, MD
Consider this the end of my thread. You've addressed all of my concerns. The impact that you've had on my state of mind is significant. Thank you again.
MEDICAL PROFESSIONAL
Even with those risk factors, the chance you caught HIV is less than 1 in 1,000. And your negative test results so far are 99% reliable. Therefore, at this moment, the odds you are infected are no more than 0.001 x 0.001 = 0.000001, i.e. under 1 in a million. If it were me, I would take those odds to the bank and stop worrying about it.
Best wishes.
Best wishes.
Thank you so much both for your timely, comprehensive answer, and your commitment to this forum.
My source did inform me that she may also have herpes, although there were obviously no visible outbreaks otherwise my concerns would have originated sooner. My source also tells me that the HIV positive result is fairly new...so I do have those factors negatively impacting the probability. I am circumsized.
So it would seem that those two factors work against my chances, although with the statistics you state I'm assuming that I can still feel comfortable that I'm virtually 100% in the clear???
As far as the Herpes, I'll get all of the other test results back next week. I've always been STD free and hope that's still the case. I've had no symptoms so far.
The fact that somebody would lie about their HIV status is something I would have viewed as a myth, rather than an actual occurance. I've notified the authorities so that this hopefully doesn't happen to the next person.
If you know of a good HIV/STD Specialist in the Greenville S.C. area, feel free to pass along the info. Scary how little some of the doctors I've spoken with actually know on the subject....one told me my chances could be as high as 30% probable.
Although I'm not out of the woods yet as far as other std results, knowing that I probably don't have HIV is cause for a much needed good night's rest.
Thanks again. Time for that glass of wine...
My source did inform me that she may also have herpes, although there were obviously no visible outbreaks otherwise my concerns would have originated sooner. My source also tells me that the HIV positive result is fairly new...so I do have those factors negatively impacting the probability. I am circumsized.
So it would seem that those two factors work against my chances, although with the statistics you state I'm assuming that I can still feel comfortable that I'm virtually 100% in the clear???
As far as the Herpes, I'll get all of the other test results back next week. I've always been STD free and hope that's still the case. I've had no symptoms so far.
The fact that somebody would lie about their HIV status is something I would have viewed as a myth, rather than an actual occurance. I've notified the authorities so that this hopefully doesn't happen to the next person.
If you know of a good HIV/STD Specialist in the Greenville S.C. area, feel free to pass along the info. Scary how little some of the doctors I've spoken with actually know on the subject....one told me my chances could be as high as 30% probable.
Although I'm not out of the woods yet as far as other std results, knowing that I probably don't have HIV is cause for a much needed good night's rest.
Thanks again. Time for that glass of wine...
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