HIV rapid test at 4 weeks

[ben26]

Hello,

I had unprotected vaginal sex with a friend of mine who is known to be promiscuous. The intercourse lasted around 4 minutes and I stopped as my conscience came into play. Around 4 weeks later I developed a minor case of  epididymitis confirmed by ultrasound, the doctor in the ER gave me 1 gram azithromycin and a shot of ceftriaxone. I went to a urologist the following day who said it looked to him like a non-infectious epididmytis but he prescribed me Levaquin 500 mg PO QD x 7 days just incase to cover possible enteric organisms. The next day I went to a STD clinic to do a HIV rapid test via finger prick, the doctor told me it was a unigold rapid test which is 3rd generation to my understanding?  Result was negative. But I know there is a window period of 3 months. Also of note today on my last day on levaquin i started to have abdominal pain, diarrhea and had a fever of 101.3 however 2 days ago I visited a friend who also had similar symptoms of diarrhea/abdominal pain and we ate lunch together sharing a meal. I only found today that he had the diarrhea and abdominal pain. I took 1000mg of Tylenol and the fever went down to 99.5. However I still have diarrhea around 3 times so far today.

BUT my question is at 33 days post exposure how confident can I be about my results with this type of test?

The girl whom I slept with told me she got tested a year prior result negative and since then has had unprotected vaginal sex with one other man besides me. She is also getting the rapid test (unigold) tomorrow.

I am starting to worry.

[Edward W Hook, MD]

The ER doctor is being overly conservative.  You should not worry further. Believe these tests and move forward.  EWH

[ben26]

So I ended up going into the ER as my fever went up to 103.4. They did many tests including an HIV 1/2 ELISA test that was nonreactive. I also had no abnormal labs (no high/low white count). They told me I either had food poisoning or viral gastroenteritis.

But in regards to the HIV test since it has been 40 days should I retest at 8 weeks? I apologize for my questions but the ER docs told me I should retest at 12 weeks and its just confusing. I know that your an infectious disease specialist and take your advice over those who are not.

Thanks

[Edward W Hook, MD]

As a generalization, it is correct to say that laboratory based tests give completely reliable tests slightly before rapid tests but the differences are small.  A repeat test at 6-8 weeks will be reliable for you and that would be what I would advice.  I am confident that when you test, your test will be negative.  EWH

[ben26]

Thank you for your reply, it is was very helpful. But How long should I wait to get tested to be certain I am negative ? In your other posts i read 6 weeks is 95% and at 8 weeks it's 99%. Is this true? Just wanted to double check as different posts talk about different tests.

Thanks

[Edward W Hook, MD]

Welcome to our Forum. I'' try to help. Five weeks (33 days is close enough to call this five weeks) is a bit early to be completely confident about the results of an rapid HIV antibody test.  That said, the odds remain very much in your favor that you did not get HIV.  Let me expand below.

1.  It is unlikely that your partner has HIV.  "Promiscuity" (such a judgmental term) does not by any means assure you that she has HIV and the fact is it is still far, far more likely that she does not have HIV than she does.  Her negative HIV test a year ago makes the probability that she has HIV lower still.

2.  Your symptoms are meaningless and are not suggestive of the ARS.  It sounds far more likely that you have food poisoning or a viral gastroenteritis than anything else.  

3.  At five weeks about 90% of HIV antibody tests will be positive but at least 10% will not and will become positive later.  Since, based in the unlikelihood that your partner has HIV and the low chance of transmission if she does, your risk for infection from the encounter you describe is no more than 1 in 100,000.  Thus, if your test misses 10% of the positives,  this figure is a 10% of the 1 in 100,000 or so of the people who would become infected in a situation such as yours.

Bottom line- your risk for infection is very, very low. furthermore, if your partner's test is negative tomorrow, you can be completely comfortable that you have not been infected with HIV through the experience that you have described.

I hope my comments are helpful.  EWH