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dr bob, please answer. second time posting
Nov 13, 2009

hello dr bob,

i had an exposure to hiv with a SW in bangalore 39 days back. the exposure was protected vaginal sex and unprotected cunnilingus and fallatio for about 15 sec max. the mistake i did was to brush and clean my tongue before cunnilingus and i am uncircumcised. after about 10 days i started getting rashes in my genital region. so took a proviral pcr dna test on 18 day which came back not detected. now from 15th day to 31 day i had no symptoms, then my neck lymp nodes started to swell. on 36th day, consumed by extreme anxiety i confronted the SW and convinced her to take a hiv ag/ab combo cmia test which said non reactive with a value of 0.31. the logic behind this was if she is not infected then how the hell can i get infected as i am not at all sexually active. the question is can this 37 day combo test of the sw confirm that she is not hiv + and 2)is my 18 day dna pcr reliable or not? please help me. i promise to make a donation.

Response from Dr. Frascino

Hello,

Regarding your HIV-acquisition risk, protected vaginal sex is indeed protected, assuming the latex or polyurethane condom was used properly and did not break. Oral sex carries only a very small risk for HIV transmission, even considering your tongue brushing prior to your brief "lunch at the Y."

The SW's negative HIV-antibody/antigen combo test at day 36 is extremely encouraging. The only remote possibility for HIV transmission would involve her still being in the "window period" (first three months after primary HIV infection) during which she could test HIV negative, but still be HIV-infected. Your negative qualitative HIV proviral PCR DNA test at day 18 is also very encouraging. However, PCR tests are not routinely recommended for HIV diagnostic screening (due to the rate of false-positive results, other technical considerations and cost). Generally speaking, false-negative tests are not a problem with PCR assays.

All things considered, the evidence very strongly suggests you did not acquire HIV from this Bangalorian sexperience. In fact the odds are now astronomically in your favor that you are HIV negative. If you want an absolutely definitive test result, you should repeat an HIV-antibody test at the three-month mark. I'm very confident the result will remain negative.

Thank you for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's very much appreciated.

Be well. Stay well.

Dr. Bob



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