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Both risk of transmission and test accuracy question
Dec 2, 2008

Hi doctor!

I truly appreciate your efforts here to eduacate the masses on HIV. For me it has had a calming effect.

But here is my story. I first went (in the middle of the night) to a brothel where I had protected sex. However I performed unprotected oral sex on the (female) prostitute.

Then in the afternoon I went to a gay sauna where a man (in his forties) performed oral sex on me for 1 or 2 minutes.

I am worried both because of the oral sex to the prostitute and because the prostitute masturbated me while I had a condom on which caused some "trauma" to the penis. So I guess I had a bit of sores on the head of my penis when the man in the sauna performed oral sex on me.

What are my risks of contracting HIV?

Second part of question: I had a HIV tests done after two weeks. These included an antibody/antigen(P24) test (a socalled combo test) and an RNA PCR. All negative. Doctors in my European home country say that a negative test of the kind I took after two weeks which are negative greatly reduces the chance of me having HIV. What do you think?

Second, I am having a new test (after six weeks) done in a few days. My doctor says that he has never seen anyone sero converting after six weeks when using the combo test. Should I trust him?

I beg of you for an answer for this as I have not seen the combo tests adressed frequently on this forum. Why don't you use combo tests in the US?

Of course, if I receive an answer I will donate. Thank you.

Response from Dr. Frascino

Hello,

You went in the middle of the night to a brothel and had protected vaginal sex plus unprotected oral sex with a female prostitute and then in the afternoon went to a gay sauna and had unprotected oral sex with a guy???? Hmm . . . . OK, maybe the first thing we should do is check your dose of Viagra. Remember that warning about erections lasting more than four hours?

Regarding oral sex on your "traumatized" Mr. Happy, oral sex is considered to carry a very low risk for HIV acquisition. Saliva that does not contain visible blood is not considered to be a risk for HIV transmission.

Regarding HIV testing, your negative combo test and RNA PCR at two weeks are encouraging; however, not conclusive. Current guidelines continue to recommend HIV-antibody testing at the three-month mark for a definitive result. HIV plasma viral load tests (RNA PCR) are not recommended for routine HIV screening, due to the rate of false positives, other technical considerations and cost.

The combo test combining an HIV-antibody test with a p24 antigen test was designed to help catch HIV infections earlier (before detectable levels of anti-HIV antibodies could be found in the blood). However, their reliability at six weeks has not been confirmed to my satisfaction in order to call this test definitive to rule out false negative results.

Thanks for your interest in making a donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Be well.

Dr. Bob



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