Condom Slippage

Dear Drs,

I was having protected sex  with a girl whom I met online (1st date). During the encounter, she was on top (riding me). After I came 1st time she didn't let me pull it out of her vagina and she continued moving (for around 5 minutes) trying to have me come again. I was not able to come again so she then let me pull out and when I did that, my penis came out without condom. She pulled out the condom from her vagina and the semen was inside it which means that the slippage happened at some point after she restarted moving trying to have me come again. The same problem happened again on our second date(last date). At that point, I freaked out and I asked her about her medical history esp HIV history. She was reluctant and very hesitant to answer. I tried hard to get an answer from her but she was avoiding the answer saying that it was just a condom slippage...nothing happened, etc. By the end she said she is negative in a way that was obviously not convincing.
I was really worried about that mishap and tried to wait till week 24 to go and get tested to get a definitive answer. I couldn't wait that long. During week 20, I went to the closest DOH testing center and had a finger stick oraquick advance rapid test which came back negative. I had a brief relief until I resumed my internet search through which I got to know that this test can miss 4 cases in every 1000 and started to think that I might be one of them. I also found that CDC website considers this kind of testing after 12 weeks Definitive. Now what should I believe? What would you recommend me to do? I keep thinking about this issue to the extent that affects my life (socially and occupationally)

I would really appreciate your help.

Sincerely,
OZ09

[Edward W Hook, MD]

Welcome to the Forum.  I have several comments which I hope you'll find helpful.

First your test results.   They are definitive. Any test result for HIV antibodies taken at more than 8 weeks provides definitive evidence that you were not infected through these mishaps.  I would not worry further.

Secondly, in most instances when a condom comes off and is left behind under circumstances such as yours, the condom comes off during withdrawal and thus has done its protective job.  Obviously and based on your description I cannot be 100% sure that this was the way things happened but it is certainly likely.

Third, perhaps her reticence was not due to HIV but other STD.  I hope you were checked for the other common STDs- gonorrhea and chlamydia?

Finally, if this is an ongoing relationship, perhaps the two of you could go to get tested together.  It's a great way to start a relationship free of doubt and concern.

Hope these comments are helpful to you.  EWH

[oz09]

Thanks so much for the reassuring and fast response.
Few comments:
1. What about the possibility of 4/1000 that this kind of tests can miss a case?
2. She found the condom a bit deep in her vagina. Does that change anything?
3. She was hesitant when I specifically asked about HIV.
4. We are not in a relationship anymore.

I appreciate your feedback.

Thanks once again,
OZ09

[Edward W Hook, MD]

1. When you consider you low risk of infection and the excellent performance of all tests on the market, there is simply no reasonable concern that an infection was missed.
2.  Deep in the vagina suggests it may have come off before you removed yourself but it does not change the test result.
3.  I understand why this concerns you but it does not change the test result.
4.  Understood.

Bottom line- believe the test result. EWH

[oz09]

Last question/Last Update,

I just spoke to the girl to ask her if she has been tested since our last date/intercourse 6 months ago. She said that after a month from our last date, her annual employment exam was due and she asked her MD at that time to do HIV test for her as well as gonorrhea, chlamydia, syphilis, hep B. She said few days later all the results came back negative except for HIV the result didn't come back. When she inquired why, she was told that the MD mistakenly checked the box  of HIV 1 Genotype test instead of HIV Ab test(I don't know if such mistake is possible). She said it took 3 weeks to get back the result of genotype which came back NA all the way down and it says undetected(as per her words) and she was told by her MD that everything is fine and no need to worry about anything.
I don't understand what's NA all the way down nor its interpretation.

I won't bother you with further questions.

Thanks,
OZ

[Edward W Hook, MD]

The HIV genotype assay requires that HIV be present and detected. The NA result means that there was no HIV detectable.  .  This is strong evidence that she does not have HIV.  EWH

[oz09]

Thanks so much. Your help is appreciated.

Best,
OZ