DNA PCR for HIV and Overall Risk Assesment

[scaredinmo]

Hi Doc. Thank you for all you do. I am a 33 yr old male, heterosexual. On 27 September I had received unprotected oral sex followed by protected vaginal intercourse. The intercourse was quite lubricated for lack of better words. Anyway, I did not see any holes in the condom after the fact, but later developed NSU not caused by chlamydia (all tested negative). Since that made me scared about HIV, I instantly thought that maybe with the extraordinary amount of fluids that perhaps I had gotten some of her secretions on me while taking off the condom.

Also, following my panic of possible HIV exposure, I purchased a DNA by PCR test for HIV with an ELISA (3rd generation) 25 days post exposure. Both were non-reactive and I was told I am good to go. I asked my possible exposure if she'd be willing to get tested to calm my nerves, she did. I got her the same package I got. Her ELISA was negative, but her DNA by PCR was indeterminate. Since that result was revealed, the establishment that did it offered me to redo it. Instead of asking her to do it again, I just did another myself 43 days (6 weeks) post possible exposure. Again, both the DNA PCR and ELISA were non-reactive or negative. So, my question for you is in your opinion, do I possess conclusive results of my HIV status? And, if possible, can you shed some light on the DNA PCR test accuracy? I am told that the reason it is not frequently offered is due to the high cost and high risk of false positive results, but I wanted to get an expert opinion on that if you would?

To recap, my questions are:
1) Risk of HIV exposure while taking condom off - excessive female secretions?
2) DNA by PCR and ELISA negative results at 43 days (6 weeks) conclusive?
3) DNA by PCR test accuracy (two negatives, one at 25 and the other at 43 days post possible exposure)?
4) Lastly, just like to know what my overall risk is in the first place? Would my testing be just as accurate if my experience was unprotected all the way around?

[H. Hunter Handsfield, M.D.]

The bottom line is that you can be sure you weren't infected, and your risk was low to start with.  More than likely your NGU (same as NSU) was related to the oral exposure; some cases probably result from entirely normal oral bacteria that the urethra doesn't like very much.

1) People ask that a lot:  "If the condom was taken off in a way that might have exposed me to secretions, after all that trouble to prevent exposure, yada, yada, yada."  Of course there are no data.  How could there be?  It's not something possible to study, at least not in a way that I can envision.  But people take condoms off in various ways all the time, and I'm sure that there often is minor exposure to secretions when that happens.  And yet condoms appear to be completely protective.  So if such factors influence the risk, it is trivial and can be ignored.

2,3) Taken either individually or collectively, the results are conclusive.  You didn't catch HIV.

4) What does it matter, since you weren't infected?  Anyway, less than one chance in many thousand, maybe less than 1 in a million.  I would not have recommended HIV testing at all if you hadn't done it anyway.  But of course the risk would have been higher without the condom.

I hope this helps.  Best wishes--  HHH, MD

[scaredinmo]

I posted in the wrong forum on accident. Can this be moved to the HIV prevention forum? Thank you.

[H. Hunter Handsfield, M.D.]

We try not to come down hard on apparently honest mistakes!

[scaredinmo]

Thank you Doctor. For personal reasons, can I ask why the DNA PCR is so controversial in the medical community? That's all I have. Thanks again and thank you for moving my question to the correct forum.

[H. Hunter Handsfield, M.D.]

I am unaware of any controversy about HIV PCR testing in the medical community.

[scaredinmo]

Thanks Doctor. I hear a lot of confusion about the test which is why I asked. I guess I do have one more, should I ask my contact to get tested again since her DNA PCR was indeterminate (ELISA negative)?

[H. Hunter Handsfield, M.D.]

I see no reason for that, but you should discuss it with your own provider.  Online advice should not be the basis for individual medical decisions.

Last post on this thread.