What is the risk of HIV exposure after condom failure?

Hi doctor,

I had intercourse with a female sex worker. I had used the protection which broke either during or perhaps before penetration. But after I experienced continuous change in sensation, I checked and the condom was broken, at which point I withdrew from the intercourse before ejaculation. I asked the girl about her history and she told me she started having paid sex very recently and that she had not been doing this for too long and told me she was clean, though I cannot trust that totally. Since then, I had severe anxiety and experienced body pain, throat trouble and tiredness.

I took a CBC test on the 10th day (CBC report attached). Then, after an exact gap of 10 days post-intercourse, I took the HIV RNA PCR qualitative test, and the report said "not detected" (PCR report attached- the lower limit of detection of this test was 100 copies / mL). On the same day, I also went to an ENT for throat issue and he prescribed me some medicines (ENT Prescription attached). However, there still seems to be some throat trouble.

However, even after the test, I have been very anxious since my exposure. A few days after the exposure, I started experiencing head itching, which eventually became a bit more and I went to see a dermatologist who I told about my exposure also. He wrote me a prescription for a lotion (Zydiwon) and a tablet (Teczine) for head itching.

Ever since my exposure, I have felt pain in my left wrist. Apart from that, I have a lump on my right collarbone, where it meets the throat. I have had this for about one or months now after exposure. Ever since a few days after exposure, I have occasionally felt mild pain around my chin which comes and goes. Apart from that, sometimes I have some pain in and around my ear and at the back of my head, where I suspect there is some swelling on the left of the back of my head, but I have not been to a doctor for this.

Recently, I went to a general physician about his and he asked me to get my uric acid checked, and I did. My serum uric acid came to be 6.65 against the normal reference value of 3.6 – 7.7 mg/dL (male). I also notice sometimes a swelling towards my left inguinal region. However, I recall this being there even last year.

Since my exposure, and especially these days, I have been very anxious and stresses regarding the possibility of contracting HIV. I have not taken any test after RNA PCR. I am especially worried since I read it online that scalp itching (seborrheic dermatitis) can be because of HIV and also that persistent swollen lymph nodes or glands are signs of HIV. Kindly go through my reports and advise me. I have been really worried. Kindly help.

Thank you.

Hi,

Thank you for the reply

Have you been able to see all the reports and prescriptions that I have annexed along with my query? I have these following queries-

1. The lower limit of detection of the RNA PCR as provided in it says 100 copies/mL. Is that sensitive enough for perfect detection or is this test any less sophisticated? Also, I took the test on the 11th day of exposure. Did I cross the window period or did I take the test earlier than I should have, thus hindering its accuracy?
2. I am worried about the fact that I read online that seborrheic dermatitis and persistent swollen lymph nodes or glands are signs of HIV. I have had head-itching and also swelling near collarbone, left wrist and behind head. Is this related to HIV?
3. I shall be completing three months since my exposure. If I have to take an antibody test, is this ELISA H3T profile good enough for HIV detection? If yes, when can I take it?
4. What are the chances of a negative or undetected result, as shown in the PCR RNA test, now turning positive in the antibody test? Kindly answer these questions. It should help.

Thank you.

Hi doctor,

Thank you for the reply.

In consequence of our previous discussion, having completed 90 days since exposure, I took the H3T test, primarily for the HIV 1 and 2 antibody test. The reports have come in, and although the interpretation is negative, my concern stems from the value it shows, which is 0.21. Last year, I had a risky exposure, after which I took an ELISA test seven days after exposure and another one after four months. Both these reports from last year are annexed as 1 and 2.

I am providing the following values below. The first column represents values from last year, the second column is from four months after last year's encounter, and the third (final) column represents this year's results for the exposure three months ago:

1. Anti-HSV: 0.07, 0.05, 0.04
2. HBsAg: 0.12, 0.15, 0.18
3. HIV 1 & 2: 0.03, 0.06, 0.21
4. TSH: 1.10, 2.13, 1.91

This year’s test was not ELISA but ECLIA. My question is: The values for all other components have remained almost the same, with very minor variations in this year's report compared to the previous ones. However, the only exception is the HIV 1 and 2 values, which have increased from 0.03 and 0.06 last year to 0.21 this time. What accounts for this increase? Am I at risk? I have not tested for any STDs, and I am very concerned. I have noticed swelling in my wrist, a lump on my collarbone, and joint pain. Kindly review all three reports and advise. Additionally, I had taken an RNA PCR qualitative test 10 days after exposure this year, which came back as 'not detected.

Thank you.

Hi doctor,

Thank you for the reply.

So the change from 0.06 last year to 0.21 in HIV 1 and 2 value this year is only a minor variation as per your opinion? Were you able to see reports? Also, having taken the HIV test, do I need to test for STDs as well to be on the safe side? Also, what is the difference in accuracy between ELISA and ECLIA (which is the current test I took)?

Please help.