Hi Doctors,

Made a serious mistake and engaged in rough unprotected vaginal sex with two different CSWs from West Africa (though this was in Dubai).  They told me they do not have HIV, but I got them to do a lab test for HIV 1/2 the same day and it was negative.  The lab did not offer the Duo test.  Had a few questions:

1.  Can I safely assume they do not have HIV, and hence there is no chance I could have been exposed to it, or would I have to assume they may be in the 6 week window period (where viral load could be very high but no antibody)?  If the latter, is there really point in testing a partner immediately before/after sex as a precaution, or is this a waste of time and money (unless one does a PCR RNA test on them)?

2.  I know you don't recommend prophylaxis for bacterial STDs, but I may not have a chance to visit a clinic due to upcoming travel, and I have 800mg of Cefixime with me.  Would this dose alone be enough to destroy any incubating chlamydia, gonorrhea, syphilis, and other bacterial STDs?  Would I need to test for any STDs after taking this dose?

3.  If I choose to wait for testing of bacterial STDs and treatment (if required) after 4 weeks, would the dose of 2.5 grams Azithromycin and 800 mg Cefixime destroy all bacterial STDs (even though they may have taken hold in 4 weeks)?

4.  Given the negative antibody tests of the partners, do I need to test for HIV at all?

Thanks!

1.  Can I safely assume they do not have HIV, and hence there is no chance I could have been exposed to it, or would I have to assume they may be in the 6 week window period (where viral load could be very high but no antibody)?  If the latter, is there really point in testing a partner immediately before/after sex as a precaution, or is this a waste of time and money (unless one does a PCR RNA test on them)?

Good question.  As you point out, the question you are asking is what is the likelihood of your partners being in the window period- having acquired HIV but not yet having positive tests.  The answer is that it is possible but unlikely that they are in the window period.  They have made it this far practicing commercial sex work and have not been infected yet.  Could they have been infected recently, yes but the chances are low.  

2.  I know you don't recommend prophylaxis for bacterial STDs, but I may not have a chance to visit a clinic due to upcoming travel, and I have 800mg of Cefixime with me.  Would this dose alone be enough to destroy any incubating chlamydia, gonorrhea, syphilis, and other bacterial STDs?  Would I need to test for any STDs after taking this dose?

The single dose of cefixime would cure/prevent most (>90% I suspect) gonorrhea, absolutely prevent syphilis.  It would not prevent chlamydia- cefixime has not effect against chlamydia.  

3.  If I choose to wait for testing of bacterial STDs and treatment (if required) after 4 weeks, would the dose of 2.5 grams Azithromycin and 800 mg Cefixime destroy all bacterial STDs (even though they may have taken hold in 4 weeks)?

These doses of cefixime plus azithromycin would cure nearly all gonorrhea and all chlamydia.   (By the way. 0ver 90% of gonorrhea will become symptomatic within 4-5 days of exposure.  Chlamydia is asymptomatic in about half of infected men.) It would not cure syphilis which requires a longer course of therapy, most often a shot of long acting (benzathine) penicillin.   Statistically, gonorrhea and chlamydia are far more common than syphilis.  

4.  Given the negative antibody tests of the partners, do I need to test for HIV at all?

That's a personal decision- your risk is low but not zero.  Even if one of your partners was infected with HIV, most single exposures do not lead to infection.  OTOH, persons in the window period are more infectious than those with established infection.

I hope this information is helpful.  EWH

Hi Dr.  Hook,

Thank you for your response.  Just had a few follow up questions:

1. The antibody test that was performed on their blood samples was done by ECLIA method.  I'm just trying to get an idea of what the window period for them would be - I know from the forum that the normal window period for antibody test is 8 weeks.  But does ECLIA lower this?  And would most (>95%) have antibodies within a few weeks?

2.  Within 12 hours of potential exposure, I got a widespread red tender/painful rash on the right side groin and lower abdomen which shortly thereafter developed white pustules around the hair follicles - could herpes appear so quickly or is it more likely folliculitis from friction?

3.  Let me rephrase the question - if it were you in my place, would you feel the need to test for HIV based on the negative HIV antibody tests of the partners?

2.  Herpes lesions would not develop within 12 hours of an encounter. The irritation you describe is more likely to be due to local irritation- friction, soap, lubricant

3.  Personally, I suspect I would not be worried.  I might test but only for the reassurance it would provide.  EWH

Hi Dr, Hook,

My last follow up questions:

1.  I did a HIV-1  RNA test at the 20 day mark and the result was Not Detectable.  Is this sufficient testing in terms of HIV, and can I put this chapter to rest and have sex without fear of infecting anyone?

2.  I do not seem to have any STD smptoms (urtheral discharge, etc.) but also am not in a country currently where I can do any further STD testing.  I do have 2 grams of Azithromycin - would it be a good idea to take this to cure/prevent any potential chlamydia and/or NGU?

3.  How many days after the exposure can I do the following blood tests to be sure I was not infected:  (1) VDRL/RPR for syphilis, (2) HBsAg, (3) Hepatitis C antibody. 

4.  What are the specific tests to take to see if I am immune to Hepatitis A and B?  I assume there is no immunization for Hepartitis C?

Thanks!

1. HIVRNA PCR tests are considered virtually conclusive any time more than 11 days after an exposure.  Some experts suggest that persons re-test with a 4th generation, combination HIV antigen/antibody test at 28 days but we have not seen anyone with a negative test after 11 or more days go on to become positive.  I would consider your results conclusive. and see no need for further testing.

2.  While azithromycin has activity against chlamydia, it is not reliable against gonorrhea or syphilis.  In the absence of symptoms, I see no need for antibiotics, including azithromycin at this time.

3.  Hepatitis C is not an STI.  Antibody tests for syphilis, hepatitis B and hepatitis C will all be reliable 6 weeks after your exposure.  Your risk for all of these infections is low.

4.  Antibody tests for hepatitis A and B are available in most laboratories.  You are correct, there is no vaccine for hepatitis C.

I hope this information is helpful.  As you know, this thread will now be closed.  Take care.  EWH