[Question #11701] Receptive with other on PrEP [potentially]
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12 months ago
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Hello,
Gay man, had one sexual event: Receptive anal with condom that broke on June 24th, 2024.
Had the following tests done:
1. HIV RNA QL via Quest Diagnostics on July 10th, 2024 [16 days later]: "Not detected"
2. HIV POC Rapid Test: Alere Determine : Monday, July 22, 2024- "non-reactive" 20 min test
3. HIV 1/2 4th Gen- via Quest Diagonostics vein blood draw- Wednesday, July 24th, 2024 [29 days later] "non-reactive"
I was provided Doxy Pep on June 28th [4 days after the incident via my Doctor] for 7 days 100mg/2x day.
Am I in the clear with HIV? Ill follow up next week at the 42-45 day mark per CDC Guidelines.
I took a POC syphilis test same day with the HIV POC Alere test- "it was non-reactive".
Partner stated he was just in for his HIV/PREP review the week before we had sex.
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12 months ago
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Just additional info: I was on PreP late last year, was taken off it as I was doing Keto regimen that increased my liver enzymes. IF this partner was HIV+, which I do believe he was truthful in stating he was on PrEP and recently tested, would the HIV tests be indicative of being accurate at the times I tested? I started the Doxy Pep on Day 4 [unfortunately as my Doctor did not get the message until that Friday June 28th when I started it that morning at 9 am.] It was Doxycycline 100mg/2x day for 7 days.
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Edward W. Hook M.D.
12 months ago
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Welcome back to the Forum. Thanks for your confidence in our service. I happened to be on the site when your questions arrived so you are getting a reply somewhat more quickly than is typical. Any follow ups may take longer. I’ll be glad to comment. There have been some changes to our understanding of HIV test performance since you interacted with Dr. Handsfield about a year ago.
Over the past year we have gained confidence in the performance of HIV RNA PCR tests and at this time feel that negative tests taken more than 11 days following an exposure are conclusive. We have never seen or heard of a person with a negative PCR test going on to subsequently become positive. Thus your July 10 test result indicates that you were not infected. Your July 24 result is also strong evidence that you were not infected- 4th generation tests of the sort you took are more than 99% conclusive at 28 days although they are not 100% conclusive until day 42-45.
You can be confident that you were not infected by your condom mishap. Your POC syphilis test is strong evidence that you did not get syphilis although I’d advise repeating the test at the time you get your 45 day HIV test.
I hope this information is helpful. I would not be worried. EWH
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12 months ago
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Thank You Dr. Hook.
I will follow up with a swab test shortly for Gonorrhea/Chlamydia/retest for Syphilis at 42 days. I do hope the 7 day Doxy would have been curative for minimally the Chlamydia/Syphilis [if exposed]?. Even though I started that on the morning of the 4th day after the incident.
Lastly, had I been potentially exposed to HSV-2, would potential symptoms have occurred by now? I did my best by researching the forum, and the best I came up with were some interactions you had with Terry Warren, whereby she stated "most people, if exposed to HSV-2, would have blisters within 5-10 days". Just curious.
Thank you and Dr. Handsfield for offering this forum. I will contribute to ASHA.
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Edward W. Hook M.D.
12 months ago
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I would anticipate that the doxycycline you took would cure chlamydia if present and prevent development of syphilis
You are correct that if you were going to develop lesions of herpes, that would have occurred before 10 days had passed after your exposure. Since you have not, you can be confident you will not develop HSV lesions EWH
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12 months ago
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Dr. Hook, if you would not mind reflecting on the latest results, and if possible, if I could get some closure on this: I tested at 45 days with Quest Diagnostics for HIV and Syphilis [8/8/24]. Both came back as "non-reactive" this afternoon. Based on my testing history for the last 45 days, can I conclusively state that I am HIV- with this result as well with the syphilis from the June 24th incident? I have read that the 3 months window period is "out of date". Quest Diagnostics used the 4th Generation on the 8/8/24 test for HIV. Regarding syphilis, and being a gay male, I know I am at a higher risk factor. Could you steer me into which direction I need to see if I had Syphilis in the past? I am unaware if the current test was a RPR? or trepanonema test? Are there clear distinctions between having current syphilis which they test for or if I have to have another test to see if I was "exposed" to syphilis in the past? Thanks for your time in this matter.
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12 months ago
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I spoke with Quest Diagnostics via phone, they did what was called RPR [DX] with Reflex Titer and T.Pallidum AB?
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Edward W. Hook M.D.
12 months ago
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As you know, this will be my final response. There should be no need for you to return to the forum whatsoever. Should you return your questions may be closed without a response and without return of your posting fee.
You can be 100% confident that you do not have HIV, that you do not have syphilis, and that you have ruled out the possibility of ever having syphilis. The point of care test which you had was a Treponema test which would have been positive if you had ever had syphilis. All of the testing that you have now was performed at times when your results are absolutely conclusive. You do not have HIV, you do not have active syphilis, and you have never had syphilis in the past.
The three month window for Syphilis testing is certainly out of date. It is a result, which is left over from the pre-antibiotic era. I would have complete confidence that you do not have Syphilis and can assure you based on my own years of research including writing textbook chapters on this topic that there is no chance that your Syphilis blood test will become positive at this time.
I hope this information has been helpful to you. As I said this completes this thread, which will be closed shortly. EWH.
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