Am I at risk of HIV or HCV after a possible blood exposure?

Hello doctor,

I am a bicurious male who experienced a possible environmental blood exposure. This was my first male-to-male encounter. I was unsure about engaging in anal sex, so I only attempted insertion briefly.

I am certain I was not fully erect and did not penetrate. However, I noticed him fingering his anus beforehand. I then removed the condom and ejaculated. Before that, I had unprotected oral sex.

As I was about to leave, I noticed a small tinge of blood on the outside of the used condom. I tested the partner the same day with a 4th-generation HIV Ag/Ab test, and he tested negative.

Since then, I have been panicking about contracting HIV or HCV. Later, I developed a small sore on my penis, which was examined by a dermatologist around eight weeks after exposure. He was confident that it was not a syphilis sore after I explained the situation.

I then requested that my partner undergo a full STD screening, including tests for syphilis, HCV, and HIV. He tested positive for syphilis and has only recently started treatment. My own VDRL and TPHA results were negative 90 days after exposure.

Further, I underwent the following tests:

• HIV Combo Ag/Ab: Non-reactive.
• HIV Combo Ag/Ab, Anti-HCV, VDRL, TPHA: Non-reactive.
• VDRL and TPHA: Non-reactive.
• HIV Ag/Ab and HIV RNA PCR qualitative: Not detected.
• Anti-HCV and HBsAg: Negative.
• VDRL and TPHA: Non-reactive.
• HCV RNA qualitative: Not detected.
• Anti-HCV and VDRL: Non-reactive.

It has now been 14 weeks since the possible exposure. I also underwent additional tests:

• HIV RNA qualitative and Western blot: Not detected (eight weeks post-exposure).
• HIV RNA qualitative and Western blot: Not detected (10 weeks post-exposure).

My concerns are:

• If there was any exposure from touching the blood while removing the condom, and if it contacted my penile glans when I ejaculated (though I had no open cuts or sores, and saw no blood on my penis when I washed afterward), would that place me at significant risk of contracting HIV or HCV? My partner also tested negative for HIV and HCV two months after the incident.
• Given all the tests performed after three months, what is the likelihood that I contracted HIV or HCV? I have read online about HIV/HCV co-infection delaying HIV seroconversion, which has increased my anxiety. Can I at least be reassured regarding HIV?
• Since my partner tested positive for syphilis, is my negative VDRL at three months conclusive?
• Is there any other test I should do for peace of mind? It has been three months of poor sleep, and now I feel as though my liver is enlarged and my ribs are aching. I know I may be overthinking this, but reassurance from you as a doctor would help me greatly.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

The reason I remain paranoid is that my partner was tested for HIV on the day of the episode itself, and for both HIV and HCV again two months after the incident.

Since I have read that the window period for HCV can be up to six months, I am worried about the possibility that he may have been in the window period. I am also anxious about the chance that he could have been co-infected with HCV, and whether that could have delayed HIV seroconversion in him.

Do HIV RNA PCR and HCV RNA PCR tests provide additional certainty and help put my mind at ease? Please shed some light on this so that my mind can calm down.

Thanks in advance.

Hello doctor,

Thank you for the reply.

I tried to calm my mind, but could not, so I tested myself again for HCV viral load and requested an HCV Western blot. However, the sample was instead forwarded to the processing team for HCV viral load and HIV Western Blot.

The HCV viral load result came back as undetected. However, the HIV Western blot result was reported as “inconclusive,” with the comment: “ELISA negative but an unspecific band is seen,” suggesting either a very early infection or cross-contamination, although rare. They advised me to undergo an HIV RNA PCR test or repeat the HIV Western blot after three weeks with a new blood sample.

I am extremely panicked and shattered now. In my case, the possible exposure occurred almost 100 days earlier. This sample was drawn more than three months after the exposure. If it were an early infection, would it have been detected by the number of tests I mentioned in my previous query?

Moreover, after receiving this result, I again tested myself with an HIV combo Ag/Ab test and an Anti-HIV (ELFA) test, and both came back non-reactive as well.

Please shed some light on this and help restore my confidence. Should I undergo any further testing? I am already beyond the three-month window period.

Please advise.

Hello doctor,

Thank you for the reply.

I underwent an HIV combo Ag/Ab test following the Western blot result, as mentioned above. My most recent HIV Combo test and HIV Antibody (ELFA) test were non-reactive.

What further test, if any, should I undergo, and at what timeline?

Please advise.

Hello doctor,

Thank you for the reply.

As the email from the laboratory (after almost 100 days) stated that the inconclusive Western blot with an unspecific band is usually seen either in early infection or due to cross-contamination, although rare, and recommended repeating the Western blot after four to six weeks or undergoing more specific tests such as an HIV RNA PCR, I became very panicked.

Further, three days after the sample was drawn for the Western blot, I underwent an HIV RNA PCR qualitative test following their advice, and the result came back as undetected (lower limit of the assay being 76 IU/mL).

Does this rule out the possibility of HIV infection in my case, as suggested by the laboratory, or should I repeat any other test? I may be troubling you, but I do not understand science well. Your reply would help silence the fear in my mind.

Thank you.

Hello doctor,

Thank you for the reply.

To be honest, I am worried about late seroconversion beyond three months and the six-month window period mentioned on some online portals. The inconclusive Western blot result also keeps troubling my mind and making me restless.

Are the test results at three months conclusive? Should I be concerned about the six-month window period and continue testing until the end of six months to ensure the results are conclusive?

These are the questions that keep troubling my mind. I am really in a distressed state.

Please help.