Thank you

[21allgood]

I had a possible exposure with CSW.  Reused condom not sure if it was put on the same way the 2nd time.  I have Herpes 2 & noticed either a ulcer or cut on my penis (she did knick me with her nail in taking condom off the first time) the next day. 1) My question is if the condom was not covering that cut / ulcer obviously that would be a entry point for HIV correct?  In looking at my penis I am hopeful the condom covered it but cannot verify.  I took RNA Quant and 4th gen 20 days, both came back undetectable, have retested at 29 days for both and am waiting for confirming results.  2). I am hoping for similar results & am curious what your thoughts on the likelihood of them changing in 9 days?  As far as symptoms, do have an unwell feeling that started today somewhat nausea, no fever, no rash except a little on face, no swollen nodes so I can tell, no sore throat but do have a white looking ulcer on my uvula not painful, not sure its an ulcer or that's what it is supposed to look like?  Please let me know your thoughts, I should have my results in a few days and will share them with you all.  

[Edward W Hook, MD]

Briefly, the 4th generation tests turn positve earlier becasue they test for antigen which is present in the blood before antibodies are detectable.  Either antigen or antibody is detectable by 4 weeks after exposure in all persons who acuire HIV. The three month figure that the very knowledgable folks on the HIV Community site give is the official recommendation of the CDC. The CDC's recommendations tend to be conservative and lag behind results of the scientific studies which Dr. handsfiled, I and other experts base our recommendations on.

Your current symptoms are due to something other than HIV.  You need to move forward from here and believe your test results.  It is also time for this thread to end.  Take care. EWH

[21allgood]

Dr hook

I woke up this morning with a swollen lymph node and what looks like thrush.  I brushed my tounge and it bled, I also have a swollen left tonsil, is thrush a symptom of primary infection?   I am 36 days beyond exposure you have told me to move on based on my results.  Can I feel confident that these latest symptoms are not related to HIV and despite what I have been told in the community I can feel good that I was not infected?

[21allgood]

One other question, I have seen in the community that Teak & others tell us that the only way to be conclusive is to do an antibodies test at 3 months.  Obviously your opinion is what matters and maybe that's where the conversation ends.  Is it simply that the 4th gen test is more advanced that it detects things that older tests were able to pick up at 12 weeks?  I notice that data states people on average convert between 2 - 12 weeks, can the 4th gen test pick up p24 at 4 weeks in people that may not have yet converted?  If one is asymptomatic then you would think the RNA test would pick up the virus at 28 days?  

I do not want to waste your time but would like to understand the science behind why the 4th gen test proves at 28 days one has not picked up the virus.

Thank you!

[Edward W Hook, MD]

Yes, the testing you have performed, the 4th generation result at 28 days proved that you did not get HIV.  You should move forward. there is no need for further testing.  EWH

[21allgood]

I received my 28 day tests, RNA Quantitative & 4th generation, both came back negative and backed my day 20 tests for both tests above which came back negative as well.  Considering my low risk should I be concerned that these 4 tests missed the virus or can I move forward felling good that I did not acquire HIV?  Thank you for your advice and reassurance.

[Edward W Hook, MD]

I see nothing in your additional comments to change my recommendations or assessment.  Take care. EWH

[21allgood]

Thank you very much!   I did ask her and she said she did not have HIV, just do not know how much I believe her.   The cut occurred probably 15 minutes before our second attempt and not during sex, does that make a difference?   Also, do my symptoms to date raise any red flags for you?

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to comment.  This was a low risk event.  You do not know that your partner had HIV and, statistically it is unlikely that she did.  In addition, your use of a condom offered some protection although using the same condom twice, even if you put it on the same way both times was unwise.  Condoms used twice are more likely to break.

As far as the sore on your penis is concerned, unless it occurred during sex, this does not change your risk either.

It is not clear how many infections would be missed by testing at 20 days, but certainly not many.  It is quite unlikely that your 29 day test results will be different from your 20 day test results.   I would not worry too much if I were you.

I hope these comments will be helpful.  EWH