Concerned About HIV After One-Time Unprotected Sexual Encounter

[debilitatinglyworried]

Hi Doctors,
I am a 42 year old female.  Three weeks ago, I had unprotected sex with a 37 year old male of unknown status.  We had vaginal sex three times, and he pulled out each time.  He is not an I.V. drug user.  He is not bisexual.  According to him, he has had unprotected sex (some and/or all of it around the same time he had sex with me) with three other women besides me since his last negative hiv test (which was in December of 2013).
I had a negative rapid finger blood test 6 days after the incident.

I called an hiv hotline and was advised to have a combo Naat/PCR test at four weeks (which is one week from now).  It will cost me $760 to have the test but I am willing to put it on my credit card if it saves me two more weeks of not knowing. I was also told a rapid finger (Unigold specifically) test would be very reliable at 30 days.
Here are my questions:
1.  I realize I either have it or I don’t and only testing will tell.  Still, based on the information I’ve given can you break down my chances for me?
2.  Does the negative result on my 6 day post potential exposure test mean anything at all in terms of a “good sign”?
3.  Is it worth it to have the $760 dollar Naat/PCR duo test at four weeks? Meaning, will that give me a conclusive result? Or should I wait and have the rapid finger test at 6 weeks (or possibly even 30 days like the man at the hotline suggested)?

I am experiencing extreme anxiety over having made this choice so the sooner I can know the result one way or the other, the better.
Thank You for taking the time to listen, answer my questions and offer any possible comments/advice/suggestions you may have.

Debilitatingly Worried

[Edward W Hook, MD]

The Unigold test at 6 weeks would detect over 95% of recent infections and, in your case would be strong evidence showing that you did not get HIV.  

Alternatively, I suspect if you go to your local health department, you can get tested for free.  EWH

[debilitatinglyworried]

I have discovered that without insurance it will cost me $199 for the DUO test and $125 to see a doctor after to get the results.

I'm not feeling as convicted as I was around "the sooner I get tested the better."

Based on the potential exposure I described, would you say having the Unigold rapid finger test at 6 weeks like I originally planned is "enough" in terms of trusting the (hopefully) negative result and moving on?

[Edward W Hook, MD]

The DUO or 4th generation tests are widely available.  Your doctor just needs to ask..

Your partner's strep throat does not change anything I said above,  eWH

[debilitatinglyworried]

Thank You, Dr. Hook.  Yes, your comments are helpful and somewhat reassuring.

This coming Tuesday will be 28 days so I plan to do the DUO test then like you suggested (assuming I can find someone in my area who offers this specific test). I'm going to try the clinic first.  Otherwise, would I just check a regular doctor's office?  A Labcore? With a place like Labcore, I was told I need something from a doctor.  I read there's a way to get a form online.  Do you know anything about any of this?

Lastly, I just found out today that the man with whom I had the potential exposure had Strep Throat last week.  This really scared me as that would have been 3 weeks after our encounter and around the same time he was having sex with other women.  I didn't ask if he was diagnosed with Strep by a swab or if he diagnosed himself.  I see that the symptoms of Strep are the exact same symptoms of ARS and I feel extremely worried yet again, especially since, in the midst of all of this, I had a dream that I was hiv positive after praying for dream guidance one way or the other (I know that doesn't mean a whole lot but I'm just putting it all out there).  The timing of all of these things feels like torture to me.

Again, I realize I either have it or I don't and only the test will tell.  Also, I realize my chances of having it are low based on your response.  Still, with each added piece, I get more and more scared.

Any comments related to how I go about getting the DUO test and/or any comments around the Strep Throat thing?  Also, anything else you would add?

Thank You again.

[Edward W Hook, MD]

Welcome to our Forum. I'll be happy to provide my perspective to your questions.  It is unlikely that you acquired HIV from the exposures that you describe.  Your partner was not in a risk group for HIV and despite the fact that he has had three other sex partners since his last HIV test (good for him for acknowledging this), I suspect his recent behavior is not too different from the behaviors he has practiced while remaining HIV - for the past 37 years.  On average, fewer than 1 in 1000 American men have HIV and this man's risk is, if anything, lower than average.   Further average risk for HIV from a single sexual exposure to an HIV infected partner is less than 1 infection per 1000 sex acts, thus even if he had HIV, your risk for infection is less than 1/3 of 1%.  With regard to your specific questions:

1.  I realize I either have it or I don’t and only testing will tell.  Still, based on the information I’ve given can you break down my chances for me?

See above.  I estimate your risk for HIV to be less than 1/10th or 1% and probably less.

2.  Does the negative result on my 6 day post potential exposure test mean anything at all in terms of a “good sign”?

This result has relatively little to predictive value for you related to the exposures you describe.

3.  Is it worth it to have the $760 dollar Naat/PCR duo test at four weeks? Meaning, will that give me a conclusive result? Or should I wait and have the rapid finger test at 6 weeks (or possibly even 30 days like the man at the hotline suggested)?

Please do not waste your money on a NAAT/PCR test for HIV.  We do not recommend these tests for HIV diagnosis- they are more expensive than recommended tests, they have more false positive test results, and the time course over which they become positive is unknown.  Instead, we recommend that you seek testing with a 4th generation, combination HIV antigen/HIV antibody test (sometimes called a DUO test).  these test provide conclusive results at 28 days/4 weeks after exposure.

I hope these comments are helpful to you.  EWH