2 False Negative Tests?

[catey77]

Hi Doctor,
I am a 26 year old, white, female who has had sex with 12 men in my life, not all protected. The guys were, as far as I am aware, non-drug using, heterosexual, white males (if that matters). Anyway, in an effort to put this promiscuity behind me I was tested for HIV 9 months post last possible exposure (during which time I was celibate and have been until present). I became worried about HIV because of a long list of non-specific symptoms and this past sexual history. I know that symptoms are unreliable, but considering myself to be healthy overall and not having had many health issues prior, I was a wreck. I don't want to list my symptoms given the long list/limited amount of space, but I got tested at Planned Parenthood at this 9 month mark and it was negative. They used a Unigold rapid test. Unsatisfied with this after reading on this forum that rapid tests are not as accurate (95%?), I went to my doctor and he drew blood and sent it to a lab. I know the test was for HIV 1/2 antibodies. The result was available a day or two later. Also negative. I still have symptoms that concern me to this day, and given that I did not know the status of all of the men I slept with, I am worried I could have gotten 2 false negatives.(1) What are the chances of this? (2)Could the rapid have missed infection and the second test been lab error? (3)Do you recommend retesting? The reason I am also concerned is because in getting tested for all STDs at PP, I tested positive for HSV2 2.79. At my doctor's he re-did the herpes panel along with the HIV test and said HSV2 was "very negative" and I was positive for HSV1 3.89. (4)Could my doctor have mixed up my blood and this been a mistake? It got me worried that my 2nd HIV test was a lab error. (5) Do you think I have HSV2 (Though that is the least of my concerns right now) I don't know what to do. Am I being paranoid? (5) Do you recommend a PCR? Your help would be appreciated. Thank you.

[Edward W Hook, MD]

Glad to help.  EWH

[catey77]

Thank you very much for your help

[Edward W Hook, MD]

There is no medical reason for you to test further.  You do not have HIV and do not need further evaluation related to your past exposures. There is no reason in your past to worry as you enter into new relationships.  EWH

[catey77]

Thank you Doctor. Your reassurance has been helpful. I feel that when someone is very frigtened of something as I am about HIV, it can warp your perception of reaity and it can be helpful to hear someone from an outside perspective comment. I just want to confirm that I do not (medically speaking) need further testing and that I can enter into a monogamous relationship with someone I care about without fear of infecting them? Is that accurate? I have been worried about this for so long and I just want to know that test results overrule symptoms/exposure and that I'm healthy and can move on with my life.

[Edward W Hook, MD]

Welcome to our Forum.  I hope that I can help.  I worry that you are beating yourself up unnecessarily.  Your numbers of sexual partners is not substantially above average and your risk for infection, particularly if you have been tested and have negative tests is exceedingly low. At the present time tests for STIs, including HIV, are exceedingly reliable and easily performed in licensed labs.  I'll try to address your questions:

.(1) What are the chances of this?
Your partners do not sound to be particularly high risk.  Most people do not have STIs, including HIV, and most STIs are not transmitted in a single exposure.  If you have negative tests, it is unlikely that you  were infected.  The chance of having two false negative tests in a role is close to zero and not something to worry about.

With respect to your questions about the rapid (Unigold) tests that you had, the fact is that these tests have to match the same very high standards that are set by the FDA, whether they are rapid or laboratory-based tests.  The comments by Dr. Handsfield that you mention regarding lower sensitivity for the rapid tests were made with respect to when tests are performed relatively soon (at 8 weeks) after a potential exposure.  At 9 months these tests are excellent and results should be believed.

(2)Could the rapid have missed infection and the second test been lab error?
The chance of this is far lower than your chance of being struck by lightning while reading my reply.

(3)Do you recommend retesting? The reason I am also concerned is because in getting tested for all STDs at PP, I tested positive for HSV2 2.79. At my doctor's he re-did the herpes panel along with the HIV test and said HSV2 was "very negative" and I was positive for HSV1 3.89.

HIV tests are far more reliable than tests for HSV.  Believe your multiple negative HIV tests. On the other hand, your HSV test results are readily explained by the fact (discussed many times on other posts on our STD Forum) that in persons with HSV-1, and particularly those whose "positive HSV-2 results are less than 3.0, so-called positive blood tests for HSV-2 can often be falsely positive. If you have not had lesions suggestive of HSV-2, this is likely to be your explanation (this is a separate issue and I will not discuss it further here- I suggest you use the search function on the STD Forum for more information)

(4)Could my doctor have mixed up my blood and this been a mistake? It got me worried that my 2nd HIV test was a lab error.
Again, terribly unlikely.

(5) Do you think I have HSV2 (Though that is the least of my concerns right now) I don't know what to do. Am I being paranoid?
No. I doubt that you have HSV-2, see above.

(5) Do you recommend a PCR?
Absolutely not.  I presume you mean a PCR for HIV.  If so, this would be a waste of time and money.

I hope that my comments are helpful to you.  Believe your tests.  If  your symptoms continue to trouble you, I suggest you work with your doctor to look for other causes. EWH