3.5 Weeks and Valid HIV Test?

[airseven]

3.5 weeks ago I had protected vaginal sex with a CSW (ordered through an agency).  I do not think the condom broke, but can't be 100% sure. I remember taking it off an throwing it away.  I am experiencing flu like symptoms today -- mild fever, sore throat etc and up til now have been pretty confident that I was not exposed to any STD in any meaningful way. With the onset of these symptoms and their timing I am now worried. I was tested for Chlamydia/Gon a little more than 72 hours after exposure, and the test results came back negative.  

1.  Is it too soon to be tested for HIV and collect any meaningful result? I would like to go in this afternoon. I will if I absolutely have to, but I don't want to sit and wait for 8 more weeks.
3.  Would I know if the condom broke? it was provided by the CSW.
2.  If my urine sample was collected first thing in the morning, do I have any reason to doubt the negative result?  Was it collected too soon after exposure etc.? I have a general irritation in my genital region -- irritated urethra etc. -- that has been persistent, predating the exposure mentioned above.

Thanks Doc. I'm trying to keep a level head about this. I just can't seem to shake the feeling that something is terribly wrong with me.

[Edward W Hook, MD]

Clasical ARS is a syndrome with high fever, severe musscle and joint aches and a rash which may not be obvious.  It is pretty dramatic.  

At 4 weeks 90% of tests would be positive, at 5 weeks 95% and at 8 weeks virtually all persons with newly acquired HIV would have positive tests. EWH

[airseven]

Thanks.  That adds clarity.

All the best.

[airseven]

Thank you for the prompt reply.

A couple of follow up questions (and that will be all for me on this thread) -- Do ARS symptoms (sore throat, fever) have any commonalities in severity?  Meaning are they subtle or dramatic, typically?  I could not seem to find any one answer to that question, and that may be because there is not one.  And when do they typically manifest themselves and what are they?  I could not seem to find an answer there either.

I'll wait for 8 weeks, but could you possibly break down the what the percentages for newly infected people to test positive are at 4, 5, and 6 weeks.

Thanks and that should be it for me on this post.

[Edward W Hook, MD]

Welcome to the Forum.  Your questions are well stated and important.   The punch line to my reply is that the exposure you describe did not put you at risk for HIV or for other STDs.  Condom protected sex is safe sex and most experts would say that with properly used condoms which do not break, as occurs about 1% of the time condoms are used, they are highly effective for preventing disease transmission.  When the high effectiveness of condoms is combined with the fact that most people, even commercial sex workers do not have HIV or other STDs and that transmission of infection only occurs in a small percentage of exposures even when condoms are not used, there is no reason for concern about STDs or HIV following condom protected sex.  I will elaborate in point by point fashion below.

1.  It depends on the test. Recently a new "DUO" test manufactured by Abbott was approved for use in the U.S.  This test tests for both the HIV p24 antigen and antibodies to HIV and at 4 weeks results are definitive.  In contrast regular antibody tests do not give definitive results until 8 weeks. In your case I need to point out, as implied above, your really do not need testing except for the peace of mind it will provide to you.

2.  No, believe your test results A urine test at 3 days following exposure is highly reliable.  In fact a urine collected first thing in the morning is, if anything, more reliable than one taken later in the day.  I say "if anything" since all such tests are VERY accurate.

3.  CSWs use condoms to protect themselves, not to protect their partners. Thus they have a vested interest in using good, effective condoms.  When condoms break you know it because they break wide open. Condoms do not just "leak a little".

Bottom line, you have little to worry about. I hope my comments are helpful to you. EWH