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Are my hiv and herpes tests reliable and accurate?

Hi there,
I have a question regarding a situation I placed myself in after far too much alcohol one night. I am currently in South East Asia, and while I was in Singapore I had vaginal sex with a female sex worker of unknown hiv status. She is from Thailand, and insisted she was clean of everything. It was very unprotected vaginal sex, no condom. I have read the statistics of transmission rates, but in SE asia the most common subtype of HIV is E, which is thought to be MUCH more transmissible than subtype B, most common in the USA. I have heard that in fact subtype E transmission risk per episode are 1 in 30 to 1 in 50 , while subtype B is around a risk factor per episode of 1 in 1000. My questions are:
1. Is this true? Does the risk 1 in 1000 per episode chance include subtype E? Or is the 1 in 30 to 50 accurate for subtype E? (assuming one partner is positive)

Now for some better news. This unprotected sex happened 74 days ago. As you can imagine I was COMPLETELy out of my mind with FEAR and ANXIETY the next day...and for the next month continuously. The only time I had peace of mind was for 1.0 seconds immediately after waking up in the morning, until I remembered my state!

On day 2 I went and got tested for everything and was negative for everything. I had a fairly acute sense of 'discomfort' in my penis, continuously, not during urination, but no discharge. I took 2 courses of antibiotics and the sensation went away.

I then (still day 2)started to get some very small, painless, mildly itch red bumps at the base of my shaft and 1 on my penis. These bumps would come one or two at a time, and NOT in clusters. They were so tiny they looked like ingrown hairs, but I have never had ingrown hairs on the base of my penis before. They would last between 1 and 4 days, then go away on their own. This reoccured for around 3 weeks. I went to a dermatologist and he said not herpes or std related, maybe bacterial infection or eczema or nothing at all, just infected hair follicles. He gave me some cream (corticosteroid) and that cleaned that up, not to reoccur yet!  

So on day 24 post exposure I went and had a PCR RNA test performed for HIV with a sensitivity of 50 copies/ml. It was NEGATIVE!!! I was very relieved and encouraged there may have been some SLIM chance I may live a full life and not actually have contracted HIV.

Then on day 40 I went and got tested for everything again, blood tests for herpes (simplex 1 and 2) and hiv(elisa for hiv 1 and 2 Ab/Ag), swab for Gonoreah, Chlamidya, and whatever else can be swabbed, Syphillus, etc. Everything was still negative.

I have heard hiv tests are not definative until 3 months post exposure. So, my question is..

2. Do you think my odds are good NOT to have acquired HIV, testing negative by RNA PCR at day 24 and Elisa at day 40(almost 6 weeks)? What are my odds?

3. How about herpes? Can it take longer than 40 days to create antibodies?

Thanks very much in advance!
10 Responses
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Avatar universal
A related discussion, subtype e was started.
Helpful - 0
Avatar universal
To whom it may concer,

I recently received my negative 6 week HIV test back and was extremely relived. However, I still feel extremely anxious and havent really been eating. My doctor prescribed me with Paxil to help with my anxiety which I've been taking for a little over 2 weeks now and really hope the drug is the cause of my lack of appetite. How confident can I be with the 6 week result. Any help would be appreciated.....thanks in advance!!!
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Avatar universal
Well Doc Ii guess you were right! I just got my definative 13 week test after unprotected vaginal sex with a Thai sex worker results, Negative for HIV!!! WOOOOOOOOOOOOOOOOOHOOOOOOOOOOOOOO! Thanks for your advice. All the worried wells reading this, I had a pretty high risk incident, and if I can get through this and still be HIV negative, I am sure your chances are much better! Stay safe! You will be allright!
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Avatar universal
The doctor will say a 40 day blood test for hsv is too soon.  The recommended waiting period for the HerpeSelect, WesternBlot and Rapid BioKit are all 12-16 weeks.  Some people will seroconvert (turn positive) in as little as 2-3 weeks, about half will seroconvert by week 6-8, and just about all will seroconvert by week 12-16.  If you're already hsv1 positive, then it may take longer.  Bottom line, the longer you can wait the higher the accuracy of a negative result.
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79258 tn?1190630410
I agree with the other poster. I have literally nothing to base this on except common sense, but I can't imagine that the transmission rate of subtype E would be that much greater than subtype B. If it were, I would think it would soon overtake subtype B both in Asia and then around the world, and cause an explosion in new HIV cases everywhere. I'm looking forward to hearing Dr. Handsfield's reply :-)
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Avatar universal
I have a feeling the DR. will have more faith in the 40 day ELISA than the 24 day PCR.

For the strain to be that much more contagious, I find it hard to believe it is not more widespread.
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Avatar universal
Thanks for everyone's comments! Dr M.D.HHH, it is very reassuring to hear from you that you are convinced I am 100% HIV free! That is the best news of my life! I will still get a 3 month Elisa test just because I think it will allow my mind to let go of the fear.

As for subtype E transmission, I read the info on the web at:

http://www.thailandguru.com/health-hiv.html

"Using mathematical modeling, researchers estimated that the probability of female-to-male HIV-1 transmission per sexual contact was approximately 1 in 30 to 50 contacts; previous estimates for HIV-1 subtype B were estimated at 1 in 500 to 1000 contacts"

Sillybugger2, these transmission rates are for vaginal penile intercourse. Not oral. It has to do with more virus concentrated on the cervix of women. My odds of acquiring HIV are/were FAR greater than yours of oral sex. In fact, I have read the chance for oral are around 0.5 per 10000 episodes, or 1 in 20,000. Relax! There is overwhelmingly good odds your flu like syptoms are not from ARS.

Monkeyflower,
in SouthEast Asia over 90% of HIV infections are subtype E, and only near 10% B. We are also seeing a higher % of E infections occurring in the USA and other parts of the world.

Thanks for everyones comments!
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Avatar universal
My exposure was in Singapore too
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Avatar universal
The bit about A/E being more transmissible was really something I didn't need to hear. I am waiting for my 6 week, 3 day HIV test result at the moment and have had/have every symptom that has been listed as being possible primary HIV infection related night sweats, fevers, aching muscles, sore throath, sore lymph glands neck (for 5 weeks), arms, groin and even at the back of my knees. I have just started to get more pronounce symptoms in the last few days - this has been going on now for 5 weeks and is driving me mad.
When you were gathering the stats on the transmission rates i.e. 1-30 and 1-50, did you happen to see if the transmission rate was also increased for oral sex?
Had these strains also got different 'window' periods?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Your test results mean you can be 100% confident you don't have HIV.  I would not have recommended PCR testing, as a waste of time and money--but the negative result is quite definitive, as is the negative antibody test at 6 weeks.  Your symptoms do not suggest either HIV or herpes (or any other STD).  I don't know what is going on with the penile symptoms, but if a dermatologist reassured you nothing important was going on, there is no reason not to believe him.

I can't say anything about relative transmissibility of HIV subtypes; not my area of expertise.  But I am quite certain that the average transmission risk of any subtype is nowhere near the high risk numbers you quote.  Anyway, the vast majority of Thai women, including commercial sex workers, are not HIV infected.

Most people develop HSV antibodies within 6 weeks, but it can take up to 3 months.  However, your negative result at 6 weeks plus lack of symptoms of herpes can be taken as 100% reassurance you don't have it.

Good luck--  HHH, MD
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