High Risk Encounter

[panicked2011]

Dr,

Last night I briefly had unprotected sex w/ a stripper in an east coast city known for a high std rate.  She was on top in an encounter that may have last 30 seconds.  Afterwards, I noticed Blood in on my clothing.  She swore she is clean and was recently tested.  She claimed she had a kid 4-6 months ago and gets tested reguarly.  I am engaged and feel horrible at what I did.  How high is my risk, and how long do I have to wait for an HIV RNA test to be conlcusive.

[Stircrazy10]

A related discussion, Help. Window period confliction.. was started.

[Edward W Hook, MD]

These results are defintive and indicate that you do not have HIV.  

The value/range are the numerical values of your negative test.  On occasion they are useful to laboratorians for issues related to quality control but they are of no meaning to you.  The negative result however is- believe it.  

You do not need further testing. EWH

[panicked2011]

I tried to have a duo test at 28 days post exposure, but that was suprisingly difficult.  the clinic that I previously went to didn't offer it, so I googled it on the internet.  I signed up for an "HIV panel" test that came up under a p24 antigen search, but I don't think that's what I was tested for.  My tests(all through a LabCorp facility) and results were as follows:
HIV- Antibody, Confirmation/Wester Blot- Negative.  It says the value/range were both <1.0.
HIV 1/0/2 Abs, Qual HIV 1/0/2 ABS, non-reactive/negative
HIV-A DNA by PCR w/ HIV antibodies by ICMA, Negative.  I did not realize I was being tested for this until I got the results. The cost($200) should have tipped me off.

These were all taken at 27 days post exposure. So, I guess my final questions are:
-is this sequence of tests as definitative as the combo test?
-what does the value/range of less than 1.0 on the first test mean?  
-is any other testing(follow-up HIV, Hepatitis, etc.) warranted at this point?

I apologize if this should have been under a seperate thread and appreciate all of the help that you have provided.

[Edward W Hook, MD]

Your risk is 1 in 10,000 at most-probably lower.  EWH

[panicked2011]

Dr.,

I had tests at my general practitioner roughly 6 days post exposure for Gonorreah, trichomonoaisis, chlamidyia, syphilis, Hepatitis A/B/C(the blood made me go through with these, although I now realize it's too early to detect any of these), and NGU.  All came back negative.  I didn't have a HSV test since I have shown a baseline ever since my first test in high school before starting a relationship(even though I have never had any kind of an outbreak).  While that's comforting on it's own, should I also be taking additional comfort that either she didn't have these(and is less likely to have HIV), or if she did, the exposure wasn't long enough for me to catch it(and the same logic would apply to hiv)?  Also, after reading through these forums, it seems like the 10 percent number is thrown around alot as it relates to csws infected w/ hiv, and the odds are roughly 1 in 1,000 if infected, so mine are  basically 1 in 10,000? I will have no further comments other than the results of the 28 day hiv/hepatitis tests.

[Edward W Hook, MD]

Following uprotected intercourse with a partner who may have had other recent partners, it is a good idea to be tested for far more common STDs such as gonorrhea, chlamydia and NGU.  

Please read what I said about PCR tests above.  Antibody or combined p24 antigen/HIV antibody tests are the recommended means for diagnosing and ruling out HIV.  EWH

[panicked2011]

Dr H,

They are, my nerves are less freaked out, although still elevated.  After scrolling through other forums, I probably should have mentioned that I am circumcised and don't have any scrapes or abrasions in that area.  Do you recommed testing for any other diseases?  In addition, would the additon of a DNA test to the antibody test at 28 days be considered conclusive if I am lucky enough to pass? I want to thank you in advance as you provide a tremendous service to people like myself who have no other place to turn.

[Edward W Hook, MD]

Welcome to our Forum.  I would not call this a "high risk" exposure.  Your risk from this encounter is not high.  Most women, particularly if they are not IV drug users, do not have HIV.   Further, even if your partner was infected, your risk of infection from a single encounter is, on average, about 1 in 1000 and in your case is likely even lower given the brevity of your exposure.  That your partner told you both the she gets checked regularly and that she recently had a child both suggest it is unlikely that she is infected.  Finally, that you may have been exposed to menstrual blood does not increase your risk.

Despite all of the factors which make your risk low, it is normal to want to get tested.  In general we do not recommend HIV PCR testing for diagnosis is HIV infection for several reasons.  While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two.  In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner.  PCR tests are also more expensive than regular antibody tests.  Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests.  Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR.   At 4 weeks a standard HIV antibody test will detect over 90% of recently aquired HIV infections.

Hope these comments are helpful. EWH