Question: Dear Doctor, "Greetings". This forum is very informative and you are giving a useful information, thanks for that. I had vaginal sex for first time with an escort girl in malaysia 6 weeks back & she didnt allow me to kiss on her lips also. I had intercourse for 2 times with protection. I am fully confident on the second one. But i am little bit worrying about the first one. What happened was, she gave protected BJ for few seconds (not more than 5s), then she sat at the top of me and did the intercourse and it was not more than a minute. I continued for few sec after ejaculation also & my semons came out of the condom as she was at the top. She asked me that why i didnt tell that i am finished... she worried that semens touched her vagina. I didnt check for condom breakage also. After coming back here, i had acid secretion exactly after first week, severe acid formation happened in my stomach and had a full burning sensation and some times neck pain. I consulted the doctor and advised me some tablets and i got recovered after 2 weeks. I had my fourth generation duo test by ELFA vidas method at 30 day and the result came as Negative. My queries are, 1. Please assess my risk based on the above scenario 2. How safe the condom protected intercourse? 3. How reliable the fourth generation ELFA vidas test after 30 days? is it conclusive?shall i move on with the result? 4. I was taking antacid medicine and will it have any impact on my test result? 5. For the past three days i am feeling slight pain in my tooth, is it related to any infection? I am restless because of this incident. Please clarify my queries? Thanks in anticipation

Thanks for your clarification doctor... I gone through many sites and information related to window period is confusing. Some people are telling that the result is accurate only after 3 or 6 months , is it true ? Also I am not sure abt the condom breakage , but I read that it will break wide open and no need to check for the breakage visually and we would have know and feel for sure , when it breaks .. is it true ?? i can believe this test result and no need to go for further testing doctor... based on your reply i will make my mind and move along doctor. Thanks in anticipation

Dear Doctor; Many thanks for your detailed clarification doctor. From your clarification ,i understood that ,the fourth generation result after 4 weeks is accurate and conclusive. It overrules how risky the exposure is. Also, p24 will be detectable for positive person after a week and it will be undetectable after the generation of antibodies . Hence for a affected person the fourth generation will identify either p24 or antibodies or both after 4 weeks from the exposure. Also, the fourth generation is a highly reliable testing and it will fail in safe side only i.e. will give only false positive and not a false negative after 4 weeks. I am little bit scared and even if I get a pain somewhere , my mind starts thinking about this... thats why I am asking these many questions. I realized my blunder and learnt a lesson from this incident. So finally your opinion is "this result is conclusive and no need to go for further testing." Thanks in advance doctor

Many thanks for your tolerance and detailed clarification doctor.... I try to forget this and start my routine activities... Thank you doctor Regards, XXXX

Dear Doctor; I am back... because of anxiety, i am keep on searching the internet... :( 24/7 am using internet in searching the related sites.. am struggling a lot to overcome this... :( Suddenly, after seeing the test report, i got a doubt on that. In my report, it is mentioned as "HIV - DUO fourth generation test performed by the combination of P24 antigen and HIV - 1/2 antibodies by using ELFA vidas method". I done the test at SRL diagnostics Mumbai. The result interpretation is (>=25 - positive and < 25 - negative); my result index value is 0.04 and negative. 1. As it is performed with both P24 and antibodies, it should have two index value or only one index value it will have ? I got only one index value whether it missed any one of the parameter ? 2. Is there any chance, where both P24 antigen and antibodies will be in undetectable state? 3. Did any false negative documented in 4th generation test using ELFA method in your experience? 4. Again, sorry to ask this, read in internet and many people are telling that after 3 months only it will be conclusive. As you are having more than 30+ years of experience, did you come across any situation that a person got negative after 4 weeks turned positive later ? My sincere apologies for keep on asking many questions, those might be silly also, but it is putting me in a restless state. i am putting some many "what if" probabilities and getting many concerns. Thanks in advance. Regards, XXXX

Dear Doctor; Thanks for your clarification. Many things are running into my mind, that's why i came back. My mind started think about the whether the condom was fine or not. Because the semons came out and it was there at the base of my penis. i think it is because she was at the top, condom also loose and not tight and i continued after ejaculation also, so obviously it will come down, but my mind is not accepting that and thinking in other way that because of failure it came out. I looked that condom also, now i cant remember that, whether it was fine or not. The duration of the intercourse was very less, maximum 1 min. I read that, P24 will be peak at the earlier stage only and it will not be detectable after 4 weeks of time, hence p24 antigen test will not helpful after 4 weeks. is it true ? I hope the testing facilities in india are upto the mark, the lab where i tested is NABL accreditation, hence i can believe the result completely, rite. Once again please accept my apologies doctor, and dont think that I am not believing your words, my anxiety is at the peak and making me to think like this. Thanks in advance Regards, XXXX Doctor, one more question in follow up with the above one. 6 years back, i had severe nausea and i was hospitalized for 4 days and they diagnosed, that my spleens bulged and recovered that time itself. As spleen relates to immune system, will it have any significant impact in my result ? I am sure that, this is my last post and i wont disturb you again. Thanks in advance Regards, XXXX

Dear Doctor; Once again thanks a lot for your patience and detailed clarification. My profession is like that doctor, that's why my negative thinking is dominating my mind... Any way, i believe your words and try to come out of this situation Thank you once again Regards, XXXX

Dear Doctor; Thanks and once again sorry for asking a silly question. Here after i wont ask any question and if i am having any query means i will pay additionally and i will ask. Just read that, continuing after ejaculation in the condom will make the condom to break. All of my semens came out of my condom and it was there at the base of my penis. was it because of any failure in the condom or as said because of the position and also my penis erecion gone and condom was very loose. The fourth generation result after 30 days over rules any risky exposure and in case of any risky exposure, if the result of fourth generation after 30th day is negative means, no need to worry about that rite doctor. Now really i am feeling very bad and scared to go for testing also because of this. Usually You wont suggest for any additional testing for your patients in case of getting negative result in P24 antigen after 4 weeks doctor? Once again sorry and as said, if i am having any queries means, i will pay for that or else i will meet you in person by fixing an appointment. Thank in advance

Dear Doctor; I am back.... But this time came with a very relaxed mind set.. :) Out of anxiety, i went for one more fourth generation test ELFA test yesterday (58th Day). Today i got my result and it is 0.02 (negative). So no need to worry about the 3 months conclusive period na doctor. XXXXXXX think that, i didnt believe your words and went for testing, but to get rid of my anxiety, i did the test. Now I am feeling very much relaxed. Frankly speaking doctor, i went for the escort service out of my frustration and because of my work pressure, but i didnt expect that it will make me to worry like this. I was literally surfing the internet for 24/7 and keep on searching about the information. Really it was a very tough time for me, I cant concentrate on anything. i didnt take my food properly, didnt sleep well... :( Really learned a lesson from this.. I didnt expect such kind of support from you doctor, that too from online forum. I know that, I was asking very very silly questions, but you understand my situation and answered all my questions with full patience. So kind of you doctor. Once again many thanks from my deep heart doctor. In my family they started searching bridal for me doctor, so without any hesitation i can go ahead na doctor, this will be my final question. Thanks in advance

Thank you doctor... I am sure that this will be my final post and question... 1. The HIV Duo is checking for P24 antigen which is a protein available in HIV -1 only na doctor. Then how come this test is conclusive even at 4 weeks also? 2. If some one is infected by HIV - 2 and he checks for the duo test and unfortunately if his antibody is not generated, based on the result, it is concluded that, he is not infected, then it will be catastrophic rite? 3. Do you have any idea about data related to HIV - 2 infection in malaysia? 4. What makes the body to delay antibody generation? How we can check our immune system, whether it is normal or not? is there any specific test available for checking our immune system? 5. I am having some skin allergic problem in my trunk area, i am having black spots in my arms and my back for more than 8 years. I used to get immediate sneezing if am exposed to dust. Is it not related to weak immune system doctor? Once again sorry for asking these many questions doctor.. Thanks in advance

Thank you doctor... Just came across this information, hence asked to clarify.... I have to stop looking into the internet :) Once again thanks for your reply doctor.. Regards, XXXX