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Worried about type 0/ rare strain
Hello Doctors. I have had an exposure that let has left me extremely anxious/worried. While on vacation in Europe almost 2 years ago I had protected oral/vaginal sex in red light district of Amsterdam. As far as I know the condom did not have any issues, but I didn't really check well. The CSW said she was from West Africa and at the time I didn't think much of it. Upon returning home I researched std's that I could have potentially exposed myself to and realized that there are many more types/groups/ strains of hiv than I really ever knew existed and that the greatest variety exists in West Africa. I have tested since then through Labcorp in the US and test results are as follows:
6months - ICMA HIV 1/o/2 and HIV 1 RNA Qualitative
7months - Oraquick Advance
18 months - HIV 4th generation Duo Test
All results were negative. 1) Is it possible that the condom could have had a slight tear/hole that would have gone unnoticed? Normally I thought that if the condom malfunctions it breaks apart completely, but I have read some things that suggest this is not always the case. 2) Can you comment on the likelihood that this West African CSW was HIV +? I think that the tests I have taken were pretty thorough, but I have recently read a published article by Plantier basically saying that not all tests are great at picking up Type O infections and that there is a lot of variability among Type O strains. This scared me to death. I realize that the chance that this woman had a Type O is very small, but I can't seem to shake the idea of "what if". Would you be able to comment on the accuracy of Labcorp's tests that I had, especially for Type O or other rare subtypes? Is there any other test that I should talk to my doctor about taking? I'm trying work my way through this, but your advice/expertise would be most appreciated. I feel as if through my research, I have begun to think that I will never be 100% certain that I am HIV -.
6months - ICMA HIV 1/o/2 and HIV 1 RNA Qualitative
7months - Oraquick Advance
18 months - HIV 4th generation Duo Test
All results were negative. 1) Is it possible that the condom could have had a slight tear/hole that would have gone unnoticed? Normally I thought that if the condom malfunctions it breaks apart completely, but I have read some things that suggest this is not always the case. 2) Can you comment on the likelihood that this West African CSW was HIV +? I think that the tests I have taken were pretty thorough, but I have recently read a published article by Plantier basically saying that not all tests are great at picking up Type O infections and that there is a lot of variability among Type O strains. This scared me to death. I realize that the chance that this woman had a Type O is very small, but I can't seem to shake the idea of "what if". Would you be able to comment on the accuracy of Labcorp's tests that I had, especially for Type O or other rare subtypes? Is there any other test that I should talk to my doctor about taking? I'm trying work my way through this, but your advice/expertise would be most appreciated. I feel as if through my research, I have begun to think that I will never be 100% certain that I am HIV -.
MEDICAL PROFESSIONAL
Yes, I am saying "even if I had unprotected sex, my tests would have definitely picked up group o or some strange variant".
I have no way of "confirming" what tests Labcorp offers, but I see no reason for you to worry that what you found online is inaccurate.
These questions continue to reflect the underlying emotional disorder I noted above. There is no way that "knowing exactly what tests I have taken will help to put my mind at further ease and help me to move on and repair my mental state due to the toll this anxiety has caused me." That won't happen -- I have no doubt you're going to continue these abnormal emotional responses until you get professional help. This forum isn't a substitute for that, so that will end this thread. Any further comments will be deleted without reply.
I have no way of "confirming" what tests Labcorp offers, but I see no reason for you to worry that what you found online is inaccurate.
These questions continue to reflect the underlying emotional disorder I noted above. There is no way that "knowing exactly what tests I have taken will help to put my mind at further ease and help me to move on and repair my mental state due to the toll this anxiety has caused me." That won't happen -- I have no doubt you're going to continue these abnormal emotional responses until you get professional help. This forum isn't a substitute for that, so that will end this thread. Any further comments will be deleted without reply.
Thank you for your response Doctor. There is definitely regret over this event and realize I am excessively worried. The whole event has put me through the ringer mentally and at times I question if the condom stayed on throughout the event because I don't remember even taking it off. But from what you are saying, even if I had unprotected sex, my tests would have definitely picked up group o or some strange variant? I have 2 more questions for you that I think may also help future readers as well as myself to have a better understanding: 1) In the studies (such as Plantier's) that have suggested that tests may not be adequately equipped to detect group o variants, is this mostly due to some of the tests in the study not having a specific group o antigen? 2) In my excessive research with this topic I believe that I have confirmed that Labcorp's tests that I had are FDA approved and I believe they were the Advia Centaur 1/o/2, Aptima RNA Qualitative, and Genscreen ag/ab for the antibody, RNA, and duo tests respectively. Is there any way that you can confirm that these are the specific tests that Labcorp offers? I apologize in advance for my excessive worrying and for asking for further research on your part (I have tried calling labcorp and can't get any answers). I just feel that knowing exactly what tests I have taken will help to put my mind at further ease and help me to move on and repair my mental state due to the toll this anxiety has caused me.
MEDICAL PROFESSIONAL
Welcome to the forum.
I'll first comment that the Amsterdam's RLD CSWs rarely have HIV; they are tested regularly. Second, you had protected sex -- even for oral sex, which never transmits HIV anyway, even wihtout a condom. Third, type O or other rare or newly evolved HIV types are very rare in Europe and North America. Fourth, it's an urban myth that such unusual HIV types cannot be detected by the standard tests in everyday use. Antibody, antigen, and/or DNA/RNA testing would detect any such infection -- and you have had all three of these test types. To your specific questions:
1) Microscopic condom defects that allow HIV transmission are also an urban myth. If the condom did not break wide open, protection was complete. (I never recommend "water testing" for condom leaks.)
2) West African or otherwise, it is unlikely she had HIV. See above.
3) My comments above apply to all the tests LabCorp does.
The bottom line is that you had an exposure that couldn't have given you HIV and your test results have confirmed you aren't infected.
I hope this helps you get beyond your fear that you "...will never be 100% certain that I am HIV -". There's really no logical or rational reason for it. I have to wonder whether there's an underlying psychological issue here -- maybe guilt or shame over a regretted sexual decision? If this obsession (and I think it's fair to call it that) persists, you should consider professional counseling. I suggest it from compassion, not criticism.
Best wishes-- HHH, MD
I'll first comment that the Amsterdam's RLD CSWs rarely have HIV; they are tested regularly. Second, you had protected sex -- even for oral sex, which never transmits HIV anyway, even wihtout a condom. Third, type O or other rare or newly evolved HIV types are very rare in Europe and North America. Fourth, it's an urban myth that such unusual HIV types cannot be detected by the standard tests in everyday use. Antibody, antigen, and/or DNA/RNA testing would detect any such infection -- and you have had all three of these test types. To your specific questions:
1) Microscopic condom defects that allow HIV transmission are also an urban myth. If the condom did not break wide open, protection was complete. (I never recommend "water testing" for condom leaks.)
2) West African or otherwise, it is unlikely she had HIV. See above.
3) My comments above apply to all the tests LabCorp does.
The bottom line is that you had an exposure that couldn't have given you HIV and your test results have confirmed you aren't infected.
I hope this helps you get beyond your fear that you "...will never be 100% certain that I am HIV -". There's really no logical or rational reason for it. I have to wonder whether there's an underlying psychological issue here -- maybe guilt or shame over a regretted sexual decision? If this obsession (and I think it's fair to call it that) persists, you should consider professional counseling. I suggest it from compassion, not criticism.
Best wishes-- HHH, MD
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