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Conclusive Test and Time?
Hello Experts,
A few weeks back one of my clients hired an escort for me. During my session, I engaged in mutual masturbation and outer-course with secretions. After scouring the expert ran forums, I have found that my actions carry minuscule, perhaps even non-existent risk. Although understanding the risk level, I did want to get tested anyways since I've never tested for std/hiv in my life and I soon will be married.
PCR/DNA, including full STD panel ~ 2 weeks after - Neg
Rapid Oral Swap ~ 3 weeks after - Neg
Rapid finger prick ~ 5 weeks after - Neg
In any event, I have researched and found that the test I've taken (PCR/DNA) is not approved by the FDA nor is it used as a diagnostic tool for HIV. Although, both experts on this forum view this test accompanied by an antibody is just as good as a DUO test at 4 weeks, I wanted confirmation on my specific situation. I am confused as to the window period to obtain a conclusive result. Many sites state different "window periods" CDC being the longest. Being an attorney I do understand the legal ramifications of understating window periods and not accounting for every possibility, both practical and theoretical. The lady I spoke with at the clinic ensured reliability of the PCR/DNA test after 2 weeks.
1) Given my test dates, would my test results be considered conclusive? From my understanding a conclusive result is really subjective and is different for each individual. My laymen understanding is that a conclusive result is derived from the following formula: Exposure risk level * Odds of partner being Poz * Odds of a 1 time exposure = results . Is my analysis correct?
2) Given the timing of my test, theoretically there is a possibility for the virus to be in limbo during the two weeks gap where the PCR does not show poz and antibodies have not formed. Does this happen in "real life?" Since my tests were done on two different days, is this equivalent to a DUO?
Thank you for your answer in advance.
A few weeks back one of my clients hired an escort for me. During my session, I engaged in mutual masturbation and outer-course with secretions. After scouring the expert ran forums, I have found that my actions carry minuscule, perhaps even non-existent risk. Although understanding the risk level, I did want to get tested anyways since I've never tested for std/hiv in my life and I soon will be married.
PCR/DNA, including full STD panel ~ 2 weeks after - Neg
Rapid Oral Swap ~ 3 weeks after - Neg
Rapid finger prick ~ 5 weeks after - Neg
In any event, I have researched and found that the test I've taken (PCR/DNA) is not approved by the FDA nor is it used as a diagnostic tool for HIV. Although, both experts on this forum view this test accompanied by an antibody is just as good as a DUO test at 4 weeks, I wanted confirmation on my specific situation. I am confused as to the window period to obtain a conclusive result. Many sites state different "window periods" CDC being the longest. Being an attorney I do understand the legal ramifications of understating window periods and not accounting for every possibility, both practical and theoretical. The lady I spoke with at the clinic ensured reliability of the PCR/DNA test after 2 weeks.
1) Given my test dates, would my test results be considered conclusive? From my understanding a conclusive result is really subjective and is different for each individual. My laymen understanding is that a conclusive result is derived from the following formula: Exposure risk level * Odds of partner being Poz * Odds of a 1 time exposure = results . Is my analysis correct?
2) Given the timing of my test, theoretically there is a possibility for the virus to be in limbo during the two weeks gap where the PCR does not show poz and antibodies have not formed. Does this happen in "real life?" Since my tests were done on two different days, is this equivalent to a DUO?
Thank you for your answer in advance.
MEDICAL PROFESSIONAL
Unfortunately, there is a large lobby which feels that sexuality is an inappropriate topic for school and school age folks. Its a shame. EWH
Thank you Doctor for your insight. You and Dr. HHH are providing a valuable service to the community and I extend a high level of gratitude. One question unrelated to this thread, and please feel free to decline to answer but why do you think our school systems don't teach in detail the possible risks and non risks of STD transmission? Maybe this has changed since its been nearly a decade since I have been out of law school. The only thing I remember from my sex ed class from high school is to wear a condom for protection against STD and pregnancy and that is a bit concerning in my eyes. I believe STD is something that can be avoided if all the proper measures and understanding of risks are explained thoroughly.
Being a soon to be father, I hope the educational system beefs up it's sexual education and provides a more in depth teaching of STDs. I'm sure there are alot of political and financial reasons for barriers but hopefully it can change. Anyways, thought I give my 2 cents on the "social" matter of STDs. Thanks again Doctor and please keep this site running for a long time. You have surely helped ALL of the worried wells that come on this site over anxiety and guilt.
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Being a soon to be father, I hope the educational system beefs up it's sexual education and provides a more in depth teaching of STDs. I'm sure there are alot of political and financial reasons for barriers but hopefully it can change. Anyways, thought I give my 2 cents on the "social" matter of STDs. Thanks again Doctor and please keep this site running for a long time. You have surely helped ALL of the worried wells that come on this site over anxiety and guilt.
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MEDICAL PROFESSIONAL
As I think I already indicated, I have never seen or heard of anyone who got HIV from the sort of exposure you have described. EWH
Great! Thanks Doctor. Have you in your career ever seen or heard of anyone who might have contracted the virus through my particular exposure or turn positive after such test and timing? This is my last question. Thank you once again and all is well!
MEDICAL PROFESSIONAL
Yes, your results are certainly "close enough" for you to assume that you did not get HIV from this exposure. EWH
Thank you Dr. for your quick response. Based on your feedback I understand the complexity of window periods and the time/type of testing. It seems like 85%-90% of people who are infected will show from an antibody at the 5 week mark. Given my no risk (99% +) exposure and the timing of the PCR and antibody, my odds is probably close to 1 in 10 million or so? I guess the odds would be astronomically in my favor. I see that you would have not recommended any testing regarding my circumstances and surely would not have performed any of these test. With that said is it safe to say that my results, purely from a mathematical standpoint, are "close enough" to be considered conclusive. I know over testing can sometimes cause more harm than good since "false positives" are always a possibility and the emotional strain for a few days to clear it up can be detrimental to one's mental health. Anyways, thanks for all your good work on this site. I wish they would teach these things in school.
MEDICAL PROFESSIONAL
Welcome to our forum. I'll try to help. I also wish that things were not so easily complicated. Unfortunately there is lots of misinformation out there regarding HIV risk and HIV test results. Some of the confusion comes from the fact that people quote or use older, out of date data for the basis of their explanations. Another reason for confusion is conservatism on the part of governmental and other official sources who feel that when they place information on web sites they cannot "afford" to be wrong. Finally, there's just a lot of misinterpretation of data. The end result of all of this is that you can find lots of highly variable answers to questions such as the ones you ask.
In addition, even before we discuss your test results, let's assess your results. This was a no risk exposure. Most commercial sex workers do not have HIV. Even if they do, most exposures do not lead to transmission of infection. HIV infection is transmitted, on average, only once per thousand acts of unprotected intercourse with an infected partner. Finally, HIV is only transmitted in adults through penetrative genital or ano-genital sex and injection of infected material deep into tissue. It is not transmitted in the fluid exchange which often accompanies mutual masturbation, frottage (outercourse), or other non-penetrative encounters. thus your risk for HIV form this exposure is so low that I would not even recommend testing.
With this as background, let's go through your questions:
1) Given my test dates, would my test results be considered conclusive? From my understanding a conclusive result is really subjective and is different for each individual. My laymen understanding is that a conclusive result is derived from the following formula: Exposure risk level * Odds of partner being Poz * Odds of a 1 time exposure = results . Is my analysis correct?
Test results are test results and the circumstances of the encounter which lead to HIV transmission do not change test interpretation. Thus test results are interpreted based only on the type of test used and the time of testing relative to the time of exposure.
2) Given the timing of my test, theoretically there is a possibility for the virus to be in limbo during the two weeks gap where the PCR does not show poz and antibodies have not formed. Does this happen in "real life?" Since my tests were done on two different days, is this equivalent to a DUO?
Your test results are not equivalent to those of a DUO test because of the differential testing times. DUO test results, like the test results coming from the combination of a standard antibody test and a PCR test performed on specimens taken at the same time are definitive at 4 weeks. This is not the same as PCR at 2 weeks and an antibody test, rapid or otherwise, at 4 weeks. Sorry.
Bottom line, in terms of the tests you had at the times you had them are not definitive. BUT, since you are not at risk from the exposure you had, I see no need for further testing. If you feel you must test for peace of mind, now, more than 4 weeks after your exposure, a combination of PCR and antibody test would be definitive, as would a DUO test.
I hope these comments are helpful. EWH
In addition, even before we discuss your test results, let's assess your results. This was a no risk exposure. Most commercial sex workers do not have HIV. Even if they do, most exposures do not lead to transmission of infection. HIV infection is transmitted, on average, only once per thousand acts of unprotected intercourse with an infected partner. Finally, HIV is only transmitted in adults through penetrative genital or ano-genital sex and injection of infected material deep into tissue. It is not transmitted in the fluid exchange which often accompanies mutual masturbation, frottage (outercourse), or other non-penetrative encounters. thus your risk for HIV form this exposure is so low that I would not even recommend testing.
With this as background, let's go through your questions:
1) Given my test dates, would my test results be considered conclusive? From my understanding a conclusive result is really subjective and is different for each individual. My laymen understanding is that a conclusive result is derived from the following formula: Exposure risk level * Odds of partner being Poz * Odds of a 1 time exposure = results . Is my analysis correct?
Test results are test results and the circumstances of the encounter which lead to HIV transmission do not change test interpretation. Thus test results are interpreted based only on the type of test used and the time of testing relative to the time of exposure.
2) Given the timing of my test, theoretically there is a possibility for the virus to be in limbo during the two weeks gap where the PCR does not show poz and antibodies have not formed. Does this happen in "real life?" Since my tests were done on two different days, is this equivalent to a DUO?
Your test results are not equivalent to those of a DUO test because of the differential testing times. DUO test results, like the test results coming from the combination of a standard antibody test and a PCR test performed on specimens taken at the same time are definitive at 4 weeks. This is not the same as PCR at 2 weeks and an antibody test, rapid or otherwise, at 4 weeks. Sorry.
Bottom line, in terms of the tests you had at the times you had them are not definitive. BUT, since you are not at risk from the exposure you had, I see no need for further testing. If you feel you must test for peace of mind, now, more than 4 weeks after your exposure, a combination of PCR and antibody test would be definitive, as would a DUO test.
I hope these comments are helpful. EWH
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