Unsure About Test Results and Scared about Possible Transmission

[soworried21]

Hi.  So two weeks ago, I had a very unfortunate and stupid sexual encounter. I am a male and engaged in protected anal sex with another guy that I met at a club here in Athens, Greece (I hope their infection rate is really low). I was on the receiving end of the anal sex.  Sadly, the condom broke sometime while we were having sex.  I had never been penetrated prior to this experience…in fact I was technically a virgin until this one encounter.  I am so scared that I was infected with an STD, particularly HIV.  Contact was very minimal and short.  He could not penetrate far at all and he definitely did not ejaculate.  There may have been a small amount of preseminal fluid. As soon as he noticed the condom was broken he pulled out immediately.  Contact was a few minutes maximum, probably much briefer.  He told me he was HIV negative and that he was tested in late January after having no sex for about 4 or 5 months.  The scary part is that he engaged in unprotected sex with his ex-boyfriend for about a month following that test.  They broke up and he told me he hasn’t slept with anyone since.  He said he had unprotected sex with his ex-boyfriend bc they both tested negative for HIV before they started having sex.  I am sooo scared of the possibility of a window period and if he was telling me the truth.   I was so worried, I took a test at the hospital here in Athens, Greece two weeks after the incident.  I know that a two week test is virtually inconclusive, but I wanted some sense of solace at least for a few weeks.  Unfortunately, I don’t understand my lab results at all.  I know that at least for now I am HIV negative, but some of the numbers on the results scare me.  They did a CPR (I assume here in Greece that means PCR test…the doctor I saw said that it’s a “marker” test for HIV…any thoughts?)  The value for that test was 0.07mg/dL…I don’t understand what this means.  My doctor told me it was within the normal range, so that was good. (I’m still confused about that test.)  Also, they did an HIV AgAb test…which I assume is an Antigen-Antibody test.  Is this test the same as a P24 Antigen test?  Is it different from the ELISA test?  Also, the value on the AgAb test scares me…it read 0.37.  The range for non-infection was 0.00-0.89.  For infection, the range was >=1.00.  I don’t understand these values at all.  What are they measuring?  Also, is the 0.37 value something I should be concerned about?  I know it’s in the non-infection range, but does the value seem abnormally high?  I don’t know if tests work differently here in Greece or not…I assume they follow the same procedures as those in the USA.  I am so scared right now.  My doctor didn’t have time to explain the results to me except she told me I was negative and that I had a very low probability of having acquired HIV.  Please help, I really need some clarification.  I would appreciate any insight you can give me.

[H. Hunter Handsfield, M.D.]

The bottom line (no pun intended) is that your doctor is right.  Given your partner's belief he doesn't have HIV, the one-time exposure (even with condom breakage), the relatively low risk of transmission from any one exposure, plus your negative test results so far, the odds are overwhelming that you were not infected.

The reply before mine (Brian123, below) also is right.  I haven't a clue about the HIV prevalence among gay men in Athens, but I agree that most people do not knowingly lie about being HIV negative. If your partner was infected, the per-exposure transmission risk for receptive anal sex is estimated to be one chance in 100-200. That is high enough to warrant testing, and even high enough for post-exposure prophylaxis with anti-HIV drugs (if you knew he was infected and could be treated within 72 hours)--but still statistically in your strong favor.

There are all sorts of sites that describe the various HIV tests and I'm not going to go into details. Suffice to say that the tests you have had so far all are negative, which is somewhat reassuring.  Although too soon for the antibody test (ELISA), most infected people would have a positive PCR and many a positive P24 antigen test at 2 weeks.

Your doctor probably recommended follow-up testing.  My suggestion is a repeat standard HIV antibody test 4-6 weeks after exposure and again at 3 months.  The odds are strong that both will be negative.

Best wishes--  HHH, MD

[Brian123]

Well, for starters, I myself had recently had a risk factor similar to yours 3 weeks ago.
Nonethless, I had not used a condom (foolishly enough). You did.
I think the mental wear-and-tear on your mind is much more significant than the actual possibility of acquiring HIV.
Some factors I had to consider are:
(1) most people would not lie about their HIV status, knowing full well that they have HIV and could transmit it.
(2) He had to actually have HIV.
(3) You would have to have gotten it. From what I see and have learned..HIV is not an easy virus to contract.
(4) And if he was negative at the recent test, what are the chances of him having it and ALSO passing ot on to you?

I know that with the gay community it is portrayed in the media/Internet/etc.. (and even on here) that all gay men must have HIV.....this is such a perpetuated myth...but yet because the gay community has a significant higher risk factor for HIV due to a smaller percentage of gay men having unprotected sex, the stats sem higher.

Don't get frightened. Try not to think about how you may have acquired a possible STI and think about how possible it was NOT to acquire and STI.

Best wishes.

Brian

[soworried21]

Hi Dr. Handsfield...thanks much for your reply to my question.  Sorry, but I have another question, something I forgot to ask yesterday...one you may not be able to answer, but I really hope you can help me out.  For the AgAb test, the letters S/CO were placed next to the lab results.  I really hope this isn't what I think it could mean.  For my Hepatitis B antibody test, the letters S/N were typed next to my lab results.  I know you may not know the answer, but if you do, could please give me some advice?  If the S/CO does mean seroconversion, why not just alert me to the fact that I'm positive?  Can you even tell if someone is in the seroconversion phase?  I thought it was impossible to do so because the antibodies were not detectable.  I'm so confused and angry at my physician for not taking the time to explain any of this.  Any info would be greatly appreciated.  Thanks so much.

[who_is_this]

Your physician said you were negative, right?

[H. Hunter Handsfield, M.D.]

I don't know what S/CO means.  But as who_is_this implies, what does it matter to you if the result is negative?  If you really need to know, ask the provider who tested you.

HHH, MD

[fearfire]

It is probably a Greek terms? Don't worry too much, your doctor said your test was negative. PCR and P24 at 2 weeks is already very reliable as far as I know.

I understand that you must be very worried. Maybe you can go test at 4 weeks to make sure that you are negative? I am pretty sure that you are alright.

[forschung]

S/CO means signal/cutoff ratio. Greater than 1 is interpreted as positive.

[soworried21]

Thanks forschung for your help...the physician i saw will not help me...she thinks telling me i'm negative is all she has to do....which i guess is true, but I really would like to understand my results...she thinks otherwise.  Do you have any ideas about my AgAb value?  Also, I'm developing symptoms of a cold...scratchy, soar throat and slight mucus build up associated I think with a stuffy nose.  I hope there is no reason for concern.  It's been 16 days past possible exposure...not a good sign, I know.

[forschung]

It sounds like the test you had was a 4th generation ELISA which tests for both the antibody and the p24 antigen. Some of these tests report a single number (as yours did) whilst others give separate values for both Ag and Ab.

The S/CO number is the ratio between the result on your sample and a positive control sample. The use of a positive control guards against variations in the machine and the particular batch of reagents. Expressing the result as a ratio makes the answer easier to understand since a value of 1 or more is always positive regardless of the underlying values.

The underlying values are normally the optical density of the sample after reaction and because of this and the sensitivity of detection equiment no-ones going to get a value of zero (ie even if there was no reaction as in your case the optical density would not be zero).

So your value of 0.37 is negative.

As for symptoms, I'm not an expert but the Doc and all the other experts i've read and spoken with stress that symptoms are not used for diagnosis and all have far more common causes than HIV. It hayfever season where I live and my nose is stuffy and blocked. Stress and anexity can cause all sorts of symptoms including sore throat. They can also lower your general immune levels and make your more susceptible to passing colds.

Hang on in there. You've tested negative with the most advanced tests around including both p24 and PCR which are good at early detection. The odds are really good that you'll continue to test negative.

[fearfire]

Yes I agree. You have already been tested with 2 of the most advanced early detection tests - PCR and P24, even it was taken at 2 weeks, you can be very sure that you are ok. Get another Elisa 4th generation test at 4-6 weeks just to make sure nothing goes wrong. Don't worry, be happy.

[soworried21]

Hi...well, sorry to say but I think the CRP test I took is actually a c-reactive protein test (I'm not certain, but I think it is...I've done some research and all the CRP tests I have seen online say that this is what it stands for)...I've read on TheBody.com that this is not a test for HIV and does not mean anything.  I don't know why my doctor would order that test...perhaps she does not understand what she's talking about.  Also, I certainly hope that the AgAb test was 4th generation...is it possible it could be 3rd generation?  Either way, I'm still very frightened.  I have just recently gotten sick and am hoping beyond hope that it's not related to infection.  I guess I won't know anything for another 2.5 months..I'm trying not to get my hopes up in case of bad news.

[fearfire]

Hi soworried,

Ag/Ab test is a 4th generation test. It is a combo assay detecting both antibody and p24 antigen and has the same sensitivity of the 3rd generation antibody and the single p24 antigen test. According to Abbott, this test generally recommends testing window from 16 to 23 days but many cases can be detected 2 weeks or earlier.

See the link below for more info about p24 test:
http://www.labtestsonline.org/understanding/analytes/p24/sample.html

Disregard your CRP test (if you think it is not a PCR test), a Ag/Ab (4th generation Elisa) test has a very good sensitivity at 2 weeks, so it is very encouraging. You need to get a re-test at 4-6 weeks to be certain.

Good luck and take care.

[soworried21]

Hi, thanks everyone for your help.  I am still scared, as I'm sure all of you know by now.  I am concerned about lymph node enlargement.  About 4-5 days after possible exposure, one of the lymph nodes in my neck (left side of the face under the jaw) became obviously swollen (I think)...it's been about 2 weeks now and it has not returned to normal size....I can feel that something is abnormal.  I have just recently developed cold-like symptoms (about 2 days ago)..is the lymph node enlargement from two weeks ago possibly attributed to a minor infection like the cold that's just coming on now?  It seems odd that a swollen lymph node would linger that long before resulting in sickness.  The duration of the swollen lymph node scares me...it seems like it's been swollen too long to be due to something minor.  Please help...any thoughts?

[fearfire]

Hi soworried

Don't think any symptoms would start before 7 days after exposure so don't worry. Enlarged lymph nodes caused by HIV should be generalised rather than only one or two in the neck or armpit...

Everyone gets flu so it is not indicative at all. Do get a test at 4-6 weeks to put your anxiety at rest. As you have already got a 4th generation Elisa negative at 2 weeks, it is very likely that you will continue to test negative at 4-6 weeks.

Don't worry and have some good sleep. Good luck!

[timbo1]

Hi All,
I'm from Australia and like most of are very scared. Approximately 6 weeks ago I had sex (very drunk and I did wear a condom) with a prostitute in Vegas.  Approximately 10 days later I came down with every symptom (Flu, Dizziness, maliase, sore throat).  This lasted for approximately 1 week - 10 days.  Then over the past week (4-5 weeks post incident) I have had diarrhea and achy joints and muscles all over my body.
I can't but help feel that the Condon broke or something happened to make it non-effective.

I have had 2 fourth generation elisa tests both negative at 15 and 27 days.  What can I take from these results.

I am going for my 6 week test this week and I am freaking out.

Thank you

[fearfire]

Hi Timbo,

Your negative test result at 27 days is really encouraging. 4th generation test is very sensitive and it rarely has false negatives at 4 weeks. I don't have any doubt that your test will be negative also at 6 weeks.

Don't worry, sleep well.

[timbo1]

Hi Fearfire,
Thanks for your reassuring comments.  I am testing tomorrow.

Regards

[timbo1]

Thanks Fearfire - I appreciate your concern and comments.  Forum Doc what are your thoughts please!

[timbo1]

Hi Fearfire (& Forum),

What do you make of this claim by a pathology in the UK:

"HIV Duo Test - 28 Day Test
The Duo Test is an excellent and inexpensive test that reliably detects HIV infection that occurred just 28 days prior to the test. The test is known as the 'Duo' because it tests for both HIV antibodies as well as the 'P24 antigen'. We send a small blood sample to our laboratory and the results are usually available in a few hours. The cost of this test is £100 (all inclusive ). This test is rated as 99.8% accurate. "

Is this the 4th Generation test?

Their website is the following:

http://www.freedomhealth.co.uk/HIV_Testing.htm

Thank you,
Timbo1

[freaked15745]

hey guys this girl needs some advice. About two weeks ago I had unprotected sex with an old boyfriend who had cheated on me with other guys.I was drunk and it was very stupid. Around the end of august he had unprotected anal sex with another guy, whom he might have had sex with a few times before that. We are unsure if he had hiv or not. About three months later in december he had an hiv test. The people told us if he didnt receive a call from them that he was negative. He never received a call and hasn't been able to check his results yet. Is there any chance I could be infected?

freaked15745

[timbo1]

Hi Forum,

My 6 week test came back Negative - thank you for your support

Timbo1

[oceans3]

now hopefully you will be able to let this go. did you really think the test would be anything but negative seeing you wore a condom? good thing you did. can you imagine how you would be feeling (prior to testing) if you didnt?
you were safe and sound!! no need to worry anymore. glad you feel better.

[mikaella]

I have a similar event with soworried,as we tested in Greece and were unsure about the results of the test.I also did an agab test six weeks after the last event and was negative.The problem is that here in Greece we dont have good organisation about this..I dont really know if i should stop on this test or if i should retest at three months..They dont really know which generation test is.É guess i will go for an other final test..I am really scared..Any comments..