P24 vs Viral load for early detection?

[PleaseHelpThankU]

Hi doc, I am a 32 y/o heterosexual male.  I had three episodes of unprotected vaginal intercourse with three women within the last two months.  They were all women that I know, although, not all that well.  To make a long story short, about 12 days after my last encounter I began experiencing myalgias, 1st along the muscles of my posterior neck, then my quads, then calves.  I had a swollen lymph node right next to my thyroid cartilage (my doctor thought it felt swollen too)that has since reduced in size, but it is still a little palpable.  Im not sure if I developed a rash because I usually have acne on my back and chest, so it's hard to tell. I never developed a fever or sore throught.  I do have a dry cough still. The symptoms lasted for about a week and a half.  Currently my stools are a little softer, but not diarrhea.  And my neck still hurts when I look to my far left are right, but not as bad.  I know my risk is low, but I need to know because I'm in a relationship with a new girl and I don't want to expose her.

I was already tested for HIV, chlamydia, syphillis, and gonorrhea about 15 after my last exposure from my primary physician, all negative.  22 days after my last exposure I saw a physician who advertises to be an expert on STDs and HIV.  This new physician recomended the p24 antigen test, as well as another antibody test.  This makes sense to me, you either have antigen present in the blood, or it is bound by antibody, in which case the antibody test will be positive.  Well, both these tests came back negative.  But I'm still worried because:

1. He used the rapid HIV-1 antibody test by Uni-Gold Recombigen, where they ***** your finger and use a drop of blood, results in 10 minutes.  Is this a sensitive test?

2. Since then I've been reading alot about p24 antigen testing. From what I've read, its seems this test is not all that sensitive. I've read figures anywhere from 65-90% sensitivity.  I think the lab they sent my sample to was LabCorps.  Id like your opinion on p24 antigen testing?

3.  Before testing, I inquired about viral load testing using PCR.  He said this test will tell him nothing.  But I've read that although more expensive, it is alot more sensitive than the p24 anitgen test, and it is used by some physicians for early detection.  This costed me $470.  Was he saving money testing p24 antigen rather than testing for viral load?

It is now my 5th week since my last exposure and my life has been misserable due to worries.  I suppose I can just wait another week and get an antibody test on my 6th week.  But I would like your opinion on these early testing methods.

Thank you so much for your help and this forum...

[jo292454]

A related discussion, 4 yrs later for number23_lucky was started.

[number23_lucky]

I just received a rapid oral-swab HIV antibody test. They told me that there is a 3 month window and that at the three-month-mark it would be only 90-95% effective. In this post you mentioned that 4-6 weeks is all that is needed. Why is there a discrepancy between what they said and what you wrote?
Why did you advise against PCR tests as early indicator tests?  
Why did you advise against the P24 test as an early indicator test?
What are the drawbacks to PCR and P24 tests as early indicator tests?

Thanks,
23

[H. Hunter Handsfield, M.D.]

Your symptoms are meaningless as a risk factor for HIV (see many other threads on this topic).  Based on the virtualy zero risk of the exposures you describe, the proper approach would have been to ask your partners if they have HIV.  If they said no, you should have had no testing at all.  If you don't know or they refused to tell you, then a single antibody test after 4-6 weeks was all you needed.  All the rest was a waste of money, time and energy.  I suspect the STD specialist you saw "recommended" the P24 test more because of your anxiety and insistence than his own judgment that you needed testing.

1) The rapid HIV tests are just as accurate as standard tests.  2) Those senstivity figures sound about right.  3) You absolutely should not have a PCR test.

Based on the tests you have had to date, and the low risk of your exposures, your risk of HIV simply is too low to even think about.  Relax, just wait for the final antibody test.  It will be negative.

HHH, MD