Extreme Anxiety, PCR Question

USA
Oct 13 2010 Exposure
Myself: White, 30, Non Drug, Straght, Male,
Her: White, 30, Stripper, Unknown status, Female

We both had unprotected oral sex in a hotel room in which I ejaculated in her mouth, one night deal with a stripper which I feel horrible.  I am married.  I dont remember any blood on my penis after wards when I took a shower.  I am uncircumcised.  I dont know her status.  I took a blood hiv test 8 days after exposure, which was negative.  Right now I have body aches, and a chest congestion which is making me go insane White film on my tongue, but maybe that is from me not brushing my teeth today?
I know you say DNA PCR is a spendy test, but now at 13/14 days can it be accurate to tell me my status with a great %?  I cannot wait till 28 days.  

[Edward W Hook, MD]

Welcome to our Forum. Before I comment on testing of any sort, let me inform you that there is no risk to you from receipt of oral sex from this partner, no matter what her HIV status (and the fact is, it is statistically quite unlikely that she has HIV).  . The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  Your circumcision status is irrelevant in this situation.

As for PCR testing, in general we do not recommend HIV PCR tests for HIV diagnosis.  The problems with these tests are: that they have a higher false positive rate than antibody tests, that the time course by which they become positive in infected persons, while certainly sooner than the antibody tests, is not well characterized; and that they tend to be expensive.  They are becoming more widely used but at the present time are not sufficient for a definitive diagnosis of HIV and while a negative test is somewhat helpful information in many situations, it is not sufficiently well characterized to be definitive.  at 13/14 days a negative test is further evidence that you did not get HIV from the exposure you report.  Is it definitive- well, in your situation a negative PCR is about as definitive as my statement that you do not need testing.  Get tested if you wish.  It will be negative.  

I hope my comments are helpful to you. EWH

[JenkinsGrant31]

What about my tongue, chest pain, sharp pain in upper arm, fatigue but no fever?

[Edward W Hook, MD]

What about them?  they certainly do not suggest HIV.  You have provided an explanation for your tongue and there are no data to suggest that there are changes of the tongue that are indicative of early HIV.  Simialrly nothing to suggest that your other symptoms are due to HIV either, particularly after a NO RISK exposure. EWH

[JenkinsGrant31]

Thank you doctor for your answers and I dont want to be that person who posts every day about this and that.  I want a test to show this for my own benefit, I trust your answers but I believe you have done to all to often to recognize a anxiety driven person.  I promise this will be my last post of the string.

What are the % for a PCR test at 13/14 days?  

I know 25 days for a rapid/blood test is 90%.

[Edward W Hook, MD]

We presume that virtually all PCRs are positive by 14 days but as I have said, since the tests are not formally approved for the pupose of diagnosis, they have not been studied in this way and therefore there are no data.  With regard to that, I will repeat one last time, there is no risk fo you of HIV from the exposure you describe.

Take care.  EWH

[JenkinsGrant31]

I have scheduled next week a DNA PCR test (Day20.5).  Shall this be ground for a concrete answer?  I talked with our neighborhood HIV council who said 90 day mark.  Please advise

[Edward W Hook, MD]

You have my advice.  Your tests proved that you did not have HIV.  You chose to search for other answers and I am sure you can find them but they will be incorrect.  You do not have HIV.  Repeating the PCR or for that matter any other test is a waste of time and resources and will not change the answer - you still will not have HIV. If you are paying for the tests yourself you could just as productively burn the money wyou will be spending.  

[JenkinsGrant31]

My tests though showed That I don't have the ABs right now ehich I needed the reassurance since I had tight chest and shoulders hurt.
Can you please let me know that science wise that the PCR test at 21 days would be concrete?
This local HIV office has freakede out.  

[Edward W Hook, MD]

I will not repeat myself.  Please read the responses above.  EWH