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Strictly for medical experts like Dr HHH.. Possible exposure, few tests...
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Strictly for medical experts like Dr HHH.. Possible exposure, few tests, symptoms

HI Drs,
On 3rd of september 2012 monday night i had a sexual intercourse with an escort (sex worker). I penetrated her, sucked her breasts and also kissed on her body. Right in middle of intercourse, my condom broke and i was uncovered for approx. 10 to 15 seconds. I shaved my testicles and base of my penis and i had those fresh shaving cuts as well. i am not sure if they were bleeding at time of penetration or not. I changed the condom and continued the episode and ejaculated inside her when she was on top of me.
After that the only thing i can think of was HIV.
48 hours after that episode i visited my gum clinic and the nurse did checkup and said i am fine and do not need testing at first.
9 days and 4 hours after that episode i had PCR RNA Multiplex test for HIV 1, HIV 2 and HEP B and HEP c. It came out negative.
28 days post exposure i had HIV DUO test and it was also negative.
30 days post exposure i had syphilis, gonorrhoea and chlemedia test - negative
6 weeks and one days post exposure i had another HIV DUO test - negative
10 weeks and 2 days post exposure I had second generation hiv test while i was on a holiday in a resource limited setting - result negative
Exactly after 11 weeks now I feel like slight penile discomfort here and there but it is not continues. no fever, no rahs, no soar throat so far. some itchy feeling here and there on my body sometimes.
I want to ask few questions now.
1) please ***** my risk in detail
2) what is your opinion about all the testing i had including second generation test at 10 weeks,
3) should i test again if the lady was HIV +
4) Is it possible to have symptoms noW?
5) if i am fine can i continue unprotected sex with my wife? as i want a baby and i feel like that i am infected and will infect my wife and baby too.
please reply in detail and allow some follow up question too as i am very anxious and i have lost more than 5 kgs in these 11 weeks.
help me
300980_tn?1194933000
Welcome to the Forum.  I could tell you were anxious before you acknowledged it.  While we do allow follow-up, we have little patience with repetitive questions and will not repeat answers you have already received.

The exposure that you describe is not extremely high risk- you do not know that your partner had HIV and indeed, most CSWs do not have HIV.  Further, while the average risk of infection from unprotected genital intercourse is less than 1 infection in 1000 exposures, your risk, IF your partner was infected, is lower since the exposure was brief and condom protected.  That you had recently shaved your genitals and that you had nicks does not change this.  Still low risk.

Finally, you have PROVED with your testing at 4 weeks, 6 weeks, and 10 weeks that you did not get infected.,  To continue to worry or to test further is silly.

As to your specific questions:
1) please ***** my risk in detail
See above- low.

2) what is your opinion about all the testing i had including second generation test at 10 weeks,
The result is definitive - believe it.

3) should i test again if the lady was HIV +
No need for more testing.

4) Is it possible to have symptoms noW?
Your symptoms are not due to HIV.

5) if i am fine can i continue unprotected sex with my wife?
You are fine.  There is no need to not have unprotected sex with your wife.

Take care.  EWH
8 Comments
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1) the test i received at 9 days and 4 hours post exposure which is pcr rna - how reliable was it ?
2) are the second generation test accurate equally like third generation tests at 10 post exposure?
3) what are my chances of miaaing hiv infection in all the tests i had? E.g is it possible not to have antibodies nor antigens p24 at 4 or 6 weeks?
4) do you beleive that ars do not appear 10 or 11 weeks post exposure?
5) why have i lost weight is it caused by anxiety ?
I think i have not repeated any question if so then ignore that question and continue helping worried individuals like me :)
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300980_tn?1194933000
Your questions suggest that you do not believe what I told you above, i.e. that you do not have HIV and that your tests provide it.  Brief answers to your follow-up questions.

1) the test i received at 9 days and 4 hours post exposure which is pcr rna - how reliable was it ?
The PCR is not designed for this purpose and there are no data to answer your question.  This is irrelevant since your subsequent tests PROVE that you were not infected, as I noted above.

2) are the second generation test accurate equally like third generation tests at 10 post exposure? \
Yes, not that people use 2nd use these tests in most places any longer.

3) what are my chances of miaaing hiv infection in all the tests i had? E.g is it possible not to have antibodies nor antigens p24 at 4 or 6 weeks?
Virtually zero.

4) do you beleive that ars do not appear 10 or 11 weeks post exposure?
ARS does not occur 10 or 11 weeks following an exposure.  

5) why have i lost weight is it caused by anxiety ?
It is possible that anxiety has caused your weight loss.   HIV would not.

EWH
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Thanks dr for your followup and sorry for the bothering questions
The only thing which worried me just like others is the conflict on a window period and generation of tests etc. this is why mind plays dirty role and always keeps thinking of what ifs. Even though you are 5th dr after dr sean, jose and maryn to tell me that results are definitive and i dont newd further testing but this misleading information about window perioda and late immune response makes me impatient nan worried again and again
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300980_tn?1194933000
I appreciate your concern.  You need to determine who you are going to believe.  EWH
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I think it would be wise to go with all of you guys' advice.
But please clear me about if generation of tests really matter after 10 weeks post exposure? And why is this discrepency on window periods.
Regards
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300980_tn?1194933000
The generation of tests does not matter when testing is performed at times more than 8 weeks after an exposure.  The discrepancy is based on emotions, not science.

This will be my last answer.  You need to deal with your anxiety, not ask more questions of this sort.  EWH
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just a follow up.. had my RAPID POCT 3rd generation 12 weeks post exposure. it was negative. thanks for your help
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