[Question #11828] Follow up [Question #11762] HIV and other STI
12 months ago
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Hi Dr, I have since also spoken to my Dr, and he
has confirmed that my 62 4th gen test is conclusive. I am however still
experiencing swollen lymph nodes in my neck, and I have since developed a sinus
infection which I was prescribed cefpodoxine (course will end tomorrow). I am
now at 12 weeks post my initial exposure. My concern however is in relation to
syphilis and HSV1 and 2. Yesterday I noticed a couple of red spots on my penis,
these are located on the inside of my foreskin just under the head of my penis,
they do not burn or itch, but seem inflamed, there is also no blistering.
As my initial HSV2 test was at 6 weeks as you are aware, the IGG positive and
the IGM negative (no values provided on report),the RPR syphilis test was also
negative. Questions 1. Do you believe my symptoms to be either HSV 1/2 or
syphilis, can these present themselves at 12 weeks only? 2. Will my
positive IGG test inevitably deliver a positive IGM result? 3. I have
read that the IGG can sometimes show false positive due to the presence of
HSV-1, is this true and how often can it happen (historically from time to time
i do get sores in my mouth) so I do believe HSV-1 is already present. 4.
I also read that the incubation period for Syphilis is 9 weeks, could my test have
missed an infection at 6 weeks how accurate is my test (10%-30-60% or 90%)? I
am not sure of the various HSV tests are available in South Africa, in the
event that the WB is not available would you recommend a PCR or another IGG and
IGM test.
12 months ago
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5. My exposure was unprotected oral and
protected vaginal sex, after removing the condom i did use a deposable wipe to
clean my penis, could this have spread the bacteria or virus (risk of cross
contamination). 6, how long will HSV-2 blisters be present when present, same
for the syphilis canker sores? 7. What is the percentage chance of
acquiring HSV-2 and syphilis from unprotected oral sex, in the event that
someone has an active infection. 8 could all the antibiotics I received over the past 8 weeks have delayed symptoms for syphilis and HSV-2?
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H. Hunter Handsfield, MD
12 months ago
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Welcome back. Unfortunately, we cannot help very much at this point.
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Your symptoms are not due to HIV; that is proved by your negative HIV test results. (Test results always overrule symptoms, no matter now typical for HIV or ARS they may seem to be.) And they appear not to be due to any other STI -- and we offer our expertise only for HIV/STI issues. Your symptoms do not fit genital herpes either, and for sure you do not have syphilis.
1. No, your symptoms and timing are not consistent with herpes or syphilis.
2. The HSV IgM test is a very poor test, not recommended by any genuine STI experts. It is highly misleading when positive. Rely only on the IgG results. And with your current negative IgG results and lack of symptoms that suggest herpes, you can be sure you do not have it.
3. I am unaware of any data that HIV of HSV antibody tests interfere with each other. It doesn't happen.
4. It is very rare for syphilis blood tests to take more than 6 weeks to become positive. And like HIV, it is not possible to have syphilis symptoms with negative blood test results. You might consider final RPR (syphilis) and HSV2 IgG tests at 12 weeks. You can expect those results to remain negative.
5. As discussed previously, this was a low risk exposure that was unlikely to transmit any of the infections you are worried about. We previously discussed the possibility of a non-STI infection like adenovirus, although its symptoms don't last as long as your apparently have done.
6. HSV sores typically begin within 3-5 days, sometimes as long as 2 weeks, and then clear up within a couple of weeks. Syphilis chancre is similar, but a bit longer. There is no possibility you have either of these.
7. Your risk for both was very low.
8. Antibiotics could affect timing of syphilis tests, but not HSV tests.
You'll need to keep working with your doctor on your symptoms. This forum cannot help further. Good luck to you.
HHH, MD
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12 months ago
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Hi Dr, I am not doubting my HIV result, I believe these to be conclusive. My concern is more around HSV 1 and 2. I believe you might have miss read my results, my IGG was actually positive and the IGM negative, does this mean that I am confirmed positive for HSV 2? Is there a possibility of a false positive due to HSV-1 antibodies? Please also confirm if the PCR is a testing option for me?
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H. Hunter Handsfield, MD
12 months ago
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Yes, I missed that you've had a positive HSV2 antibody test. My apologies.
Some aspects of your symptoms could go along with herpes, but others -- such as onset a month after the sexual exposure, plus lack of typical herpes outbreak symptoms go against it. So does the duration of your current symptoms. With the type specific HSV antibody tests, there is no cross reactivity between tests for HSV1 versus HSV2 antibody. However, more information is needed in order to accurately interpret your HSV2 test result. Was it a truly type-specific test? (Your doctor or clinic, or the lab, can provide this information; or the trade name of the test that was done.) If so, what was the numerical result? Many officially positive but low values are false.
Your situation is complex, and we are not a source for detailed or complex clinical evaluation. I'll be happy to comment one more time about your positive HSV2 test result if you can provide the details. But beyond that, all I can do is suggest you continue to work with your doctor(s). If you have not seen an infectious diseases or STI specialist, that would make sense. But for now, I continue to believe your symptoms/illness are unrelated to the sexual exposure you have described.
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