risk assessment vaginal exposure

[Benliv]

Dear Dr HHH  and EWH

I apologize to post this as i have asked question in his international Dr support and hiv communities. However i require medical explanation as the reply in the hit international did not appear

I am 28 year old male.

4 weeks ago i am having one vaginal exposure withcsw using  condom. I have ejaculated inside,however after ejaculation the csw still on top for 2 minutes idle with my penis inside. (Position woman on top)

After finish i still sure the condom intake and not broke. However my penis already decrease after chum and condom wrinkle bit.

My question are :

1. Do you think those condition still safe sex with ho risk exposure?
2. Any possibility semen leak in the base penis mix with vaginal fluid than hiv viruses climb to head penis and mucous with head penis covered? Some already confirm no way but please confirm with medical advice.
3. I take test negative 2 weeks after exposure with hiv 1/2 go Abbott  with meia. Which generation the test is? Is it reliable? In Indonesia if result suspect than they continue to head4th gen.
4. Should i test on 7 week?

Thanks Dr for your explanation.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  However, I cannot add anything important to the advice you had on the international forum 2 weeks ago.

1) This was entirely safe sex, with no chance of HIV infection.

2) Small amounts of vaginal secretions commonly get inside the condom, along the penile skin, but probably never enough for infection to occur.  As long as the condom covers the head of the penis and the opening, protection against HIV is complete.

3,4) This is an antibody-only test, i.e. "third generation".  Two weeks is too early for it to be meaningful.  However, this should not worry you.  Your risk was too low to need testing at all.  But if you want definitive results, you will need a duo ("4th generation") test at 4 weeks, or another antibody test at 6-8 weeks.  

Here is a recent thread that goes into detail about the types of HIV tests and times to reliable results:   http://www.medhelp.org/posts/show/1704700  However, I stress that testing is only necessary to help you deal with your anxiety.  You should not be at all worried as you wait to have additional tests.

Regards--  HHH, MD

[Benliv]

Hi Doc

Find a quite good articles in case there is other anxiety people like me. This show that testing these day has been more advance in this sample using abbott Architect AB/AG Combo. The sensitivity is quite close to PCR & RNA. Also the presentation show how the diagnostic made with high sensitivity. In conclusion it show that 4th gen test virtually can detect on day 10 - 20 where 3rd gen test on day 30 - 40 (6 to 8 week).

http://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&ved=0CGIQFjAF&url=http%3A%2F%2Fwww.theaidsinstitute.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2FBrennan.pdf&ei=1YMnUIatN4nJrAf2_oDwCQ&usg=AFQjCNExp6_uDP7CAPXh79sNSevXjOM5Ig

Its on PDF hope this help for reference.

Thanks

[H. Hunter Handsfield, M.D.]

Thanks for your kind words about the forum.  But "That will end this thread.  I won't have any further comments or advice" meant what it said.  And of course I haven't changed my mind about the time to reliable test results.

Take care.  Try to move on without any worry about HIV.

[Benliv]

Dear Dr HHH

Thanks for your assurance, i am not relying because want to wait my result back. I am sorry because my anxiety keep bother you on anxiety driven question

Finalllyyy. At 6 weeks i have done AB / AG Combo using Abott Architect. The result O.11 (Non Reactive). According to your previous post this result on the time frame and low ris is conclusive right?? Please kindlu advice than i will move on.

Lastly thanking you for all information, patience, and knowledge. Without medhelp i won't even know that 4th Gen test exist in my country and period of time for it. I wish you very best for whatever you done


Best Weishes

[H. Hunter Handsfield, M.D.]

No distant expert can guarantee anything.  Don't over-interpret every word!  I have given you very strong reassurance that you are very unlikely to have acquired HIV.  You cannot expect more from this sort of service.

That will end this thread.  I won't have any further comments or advice.

[Benliv]

Dear Dr HHH

Thanks again ur comment. But i am bit nervous now. Previously you said on first comment "this is entire safe sex with no change HIV infection". Moreover in following comment "you can not guarantee not infected".

Is there some risk factor after i state additional comment?

Hopefully the following statement is stated because i have not explained my background. Before this exposure, i "never" having sex with CSW. This is my first time having sex with CSW. 1 year before exposure (pre marital checking) both of us HIV negative. My wife also cheked HIV recently (2 months ago) with negative result.

From those background i can inform that uncertain status only happen one time which mentioned before with CSW.

I hope there is no activity that add risk factor.

Thanks in advance. God bless you

Regards

[H. Hunter Handsfield, M.D.]

People rarely lie about HIV status when asked directly (even CSWs), so it is unlikely your partner is HIV+.

There has been no research on the details of condom use that you have asked.  But we do know that condoms are virtually 100% effective in preventing HIV.  So these details probably make no difference.

I cannot guarantee you are not infected.  However, the chance is extremely low and if I were in your situaiton, I would continue unprotected sex with my wife without worry of infecting her.

[Benliv]

Dear DR HHH

Thanks for the reply. It is very generous and meaningful for me. In my country no extend research and updated info like this.
The CSW in Indonesia said she check up regularly. However i can't trust on that so i assume if she is +.
Also im using condom DKT International product. Hopes this not change the opinion

Following that, i have some question as well :
1. "Small amounts of vaginal secretions commonly get inside the condom, along the penile skin, but probably never enough for infection to occur".
Is there any medical stories where the vaginal fluid mixed with semen in base and viruses climb to penis head and infection occur?

2. Does this mean if we ejaculate than keep penis inside considered save as long as condom intake?

3. If you consider im practicing save sex, do allow me to have sex with my wife? Considering still waiting 3 more week before test.

Thanks in advance the rest i'll update you my test result when i get it.


Best Regards

[H. Hunter Handsfield, M.D.]

I saw this before I replied above.  It makes no difference in my opinion or advice.

[Benliv]

Sorry typo in no 2 mucous actually i want write way where semen get out in head penis.

Also do you know how to reply your response in the forum?

Thx