New OraQuick Home Swab test: usage/current risks/49 days

Hello Dr. Hansfield, I'm a 34-year-old, heterosexual, uncircumcised male. I had unprotected vaginal/oral-both-ways sex (I'm not worried about the oral) with a 37-year-old Latina girl I met at a bar on Sept. 3rd. For reasons I enumerated in the member's forum on Oct. 3rd, I felt the encounter was far more suspect than it sounds. I took the Uni-gold blood test at Planned Parenthood at 4 weeks & got a negative result; all other STD tests were clear at that time as well. Tonight, at 49 days post-possible-exposure, I just now took the new OraQuick oral swab test & got a negative result. According to the test kit, you're supposed to swab the upper & lower gums just once, then put the swab in a tube with solution. The swabbing procedure felt extremely... how shall I put it... fraught with possibility for user error. Also, a tiny little bit of the solution in the test tube bubbled out when I "gently popped" it off, per the instructions. The instructions said if the solution spills, the test won't work. However, the Control line clearly appeared. Does that mean I used it correctly? I would venture to guess so.

If it was correctly done, where do you think I stand at this point re: likelihood of truly being hiv-negative, given that the test claims a false negative rate of 8.3%?  At this point, if I were to have vaginal sex with someone, and the condom came off/broke, and I didn't realize it for a good solid while, would I be putting her at much risk, in your opinion?

Thank you.

[Edward W Hook, MD]

Welcome to the Forum.  As you know, Dr. Handsfield and I share the Forum.  I'll be answering your question this evening.  

In order to receive Federal approval to be sold as an HIV test, the OraQuick assay had to be tested in thousands of persons with and without the infection.  These requirements are quite rigorous and are designed to make the specimen collection and processing about as fool-proof as possible.  Thus the potential for "user error" if you did follow instructions is miniscule and not something to be concerned about.  Further, the bursting of the fluid bubble that occurred when you opened the reagent tube is not uncommon and does not invalidate the test- as you noted, the presence of a clear control line tells you that the test worked as designed.

Finally, with regard to your mention of the 8.3% false negative rate, please remember that this is 8.3% of 0.1% (the likelihood you would catch HIV if your partner was infected), not 8.3%overall.

Lastly, to your final question, based on your history and test result(s), I would not worry that you are putting partners at risk should you have unprotected sex with them.

I hope these comments are helpful. EWH

[stefan158]

Thank you Dr. Hook. Your answer is very helpful & encouraging. Thank you!  I gather you don't recommend any further testing.

[Edward W Hook, MD]

Correct.  No need for additional testing.  EWH