Assessing HIV Risk After Oral and Protected Sex: Your Questions Answered

HIV testing issues

Hello Dr.
Hong, I would like to ask you some questions about HIV, thank you.
I had unprotected oral sex with my ex-girlfriend on July 26th, and on August 2nd, we had protected intercourse.
However, I also kissed her and swallowed her saliva.
Afterward, I learned that she had engaged in casual sex, which makes me quite worried.
I subsequently underwent several HIV tests, and I would like your assessment of my risk of infection.
Additionally, how accurate are these tests during their window periods?
- August 6: Rapid test at Taoyuan Hospital
- August 7: RT-PCR
- August 21: RT-PCR
- August 28: HIV Ag/Ab combo
All of the tests returned negative.

P.S.: On August 7, I experienced tonsillitis and had a small ulcer on my tonsil.
An ENT doctor mentioned that if there were two or more ulcers, it would be considered a viral infection, but since there was only one, it could just be a result of something sharp I ate.
I have been dealing with this cold for a month, which has made me very anxious about the possibility of an HIV infection.

Feichang danxin de ren, 20~29 year old female. Ask Date: 2020/09/27

Dr. Hong Yuanbin reply Internal Medicine

Hello, I understand your concerns about infection.
Regarding the HIV testing you underwent, the accuracy should be very high, so you are likely not infected.
However, as you mentioned, there is a window period associated with precise testing.
The HIV Ag/Ab combo test currently has a window period estimated to be around 3 months, so it may be advisable to consider retesting after 3 months.
As for your cold symptoms, based on your description, it is more likely to be a common cold.
Thank you for your question.

Reply Date: 2020/09/27

More Info

When it comes to assessing the risk of HIV transmission after engaging in sexual activities, it is essential to understand the various factors involved, including the type of sexual contact, the presence of any injuries or open wounds, and the overall health status of both partners.

In your case, you mentioned having unprotected oral sex with your ex-girlfriend on July 26 and then engaging in protected vaginal intercourse on August 2. You also noted that you kissed her and swallowed her saliva. It’s important to clarify that while oral sex is generally considered a lower-risk activity for HIV transmission compared to anal or vaginal intercourse, it is not without risk, especially if there are cuts or sores in the mouth or throat.

The risk of HIV transmission through oral sex can be influenced by several factors:
1. Presence of Cuts or Sores: If you had any cuts or sores in your mouth, this could increase the risk of HIV entering your bloodstream.

2. Viral Load: The risk is also dependent on the viral load of the HIV-positive partner. If they are on effective antiretroviral therapy and have an undetectable viral load, the risk of transmission is significantly reduced.

3. Other STIs: The presence of other sexually transmitted infections (STIs) can increase susceptibility to HIV.

Regarding your testing, you underwent several tests:
- Rapid Test on August 6: This test can provide quick results, but its accuracy can vary based on the timing of exposure and the test's sensitivity.

- RT-PCR on August 7 and August 21: This test detects the actual virus and can identify HIV earlier than antibody tests. However, it is typically used in specific circumstances, such as in cases of potential acute infection.

- HIV Ag/Ab Combo on August 28: This test detects both HIV antibodies and the p24 antigen, which can indicate an HIV infection earlier than antibody tests alone.

The timing of your tests is crucial. The "window period" for HIV tests varies depending on the type of test used. For antibody tests, it can take several weeks to months for antibodies to be detectable. However, the RT-PCR test can detect HIV earlier, often within 10 days of exposure. Given that your tests returned negative results, it is a positive sign, but it is essential to consider the window periods.

In terms of your symptoms, such as the sore throat and the ulcer on your tonsil, these could be attributed to various causes, including viral infections, allergies, or even irritation from food. While symptoms can sometimes be associated with acute HIV infection, they are not definitive indicators of HIV. The best course of action is to continue monitoring your health and consult with a healthcare provider for further evaluation.

In summary, while your risk of HIV transmission from the activities you described is not negligible, the negative test results you received are encouraging. It is advisable to follow up with additional testing after the window period has passed, typically around three months post-exposure, to ensure accurate results. If you have ongoing concerns or symptoms, seeking medical advice is crucial for proper assessment and peace of mind.

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