HIV Testing: Your Questions Answered

Regarding HIV screening issues?

Hello, Dr.
Hong.
Three months ago, I had a delivery of tea, and the lady performed unprotected oral sex on me, followed by unprotected vaginal intercourse.
Twenty-six days later, I underwent RT-PCR for HIV and FTA-Abs for syphilis screening, and the results were negative.
After three months of exposure, I went for a follow-up HIV and syphilis antibody test, and the results were also negative.
Can I rule out HIV with these results? Do I need to continue regular HIV testing? I have seen some cases online where individuals tested negative after three months but later discovered issues with their health and tested positive afterward.
This has left me somewhat confused, so I wanted to clarify.
Thank you.

Ming, 20~29 year old female. Ask Date: 2022/05/17

Dr. Hong Yuanbin reply Internal Medicine

Hello, theoretically, if you are still negative after three months, the chance of infection is very low.
However, as you mentioned, there are extremely rare cases where a positive result may occur later on, but the probability is very low.
If you are still very concerned, you can retest after six months, and if it is still negative, there is no need to worry.
Thank you for your question.

Reply Date: 2022/05/17

More Info

Hello! Thank you for your question regarding HIV testing and the concerns surrounding it. Based on the information you've provided, it seems that you have taken the necessary steps to assess your HIV status after engaging in high-risk behaviors. Let's break down your situation and address your concerns.

First, you mentioned that you had unprotected oral and vaginal sex with a sex worker and subsequently underwent testing. After 26 days, you received a negative result from an RT-PCR test, which is a highly sensitive method for detecting HIV. This test can identify the virus itself rather than just the antibodies, making it effective in the early stages of infection. The fact that you tested negative at this point is a good sign, as it indicates that the virus was not present in detectable amounts at that time.

After three months, you underwent further testing for both HIV and syphilis, and again, the results were negative. According to current medical guidelines, if you have a negative result from an HIV antibody test after three months, it is generally considered conclusive. The window period for most HIV tests, including antibody tests, is typically around three months, meaning that if you have not engaged in any further high-risk behavior since then, the likelihood of being infected is very low.

However, it is important to note that while your results are reassuring, there are a few factors to consider regarding ongoing testing. The risk of "false negatives" can occur, particularly if someone has a unique strain of the virus or if the testing was done during the "window period" when antibodies may not yet be detectable. In your case, since you have already tested negative at both 26 days and three months, the chances of a false negative are significantly reduced.

Regarding your concern about needing to continue regular testing, it is advisable to follow the CDC guidelines based on your risk factors. If you engage in high-risk behaviors, such as unprotected sex or sharing needles, regular testing every 3 to 6 months is recommended. If you have not engaged in any further high-risk activities since your last test, annual testing may suffice.
Additionally, if you experience any unusual symptoms or health issues in the future, it is essential to consult a healthcare provider and consider retesting. Symptoms of HIV can sometimes take years to manifest, so being proactive about your health is crucial.

In summary, based on your negative results from both the RT-PCR and the antibody tests after three months, it is reasonable to conclude that you are not infected with HIV. However, maintaining regular check-ups and being aware of your sexual health is always a good practice. If you have any further questions or concerns, do not hesitate to reach out to a healthcare professional for personalized advice. Thank you for your inquiry, and take care!

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