[Question #11874] Chances of having any STDs?

11 months ago

Hello, I was here a couple days ago and spoke with Dr. Edward Hook MD regarding my chances of catching syphilis or HIV from my most recent encounter (question #11861 & 11777). It is currently day 37 from my latest encounter which was unprotected vaginal and oral sex with a female and her husband (husband and I made no interaction whatsoever). From about day 10, I have experienced the following symptoms which still persist today including: fever (99 to 99.7), headache, nausea, sore throat (feels like globus sensation), swollen lymph nodes around the neck/ear, and most recently (last night at day 36) somewhat symptoms of night sweats. The symptoms have come and gone throughout the day for over 4 weeks now.

My tests include the following:

- HIV RNA (labcorp) at 11, 14, and 21 days = all negative / non-reactive.

- HIV Ab/p24 Ag with Reflex (4th gen test)/(labcorp) at 32 days = negative / non-reactive.

- Full Panel STD test (labcorp) at 32 days = all negative / non-reactive

Based on this info, how likely is it that I contracted an STD (mostly HIV) from this encounter?

11 months ago

I've saw that both Dr. Hook and Dr. Handsfield believe that the combo of hiv rna taken at 2+ weeks post exposure & 4th gen hiv test taken at 4+ weeks post exposure is 100% conclusive. But, I've also read from different sources saying that nothing is 100% conclusive until 6 weeks. I also do have ezcema and allergies (have taken dupixent for ezcema a month prior to interaction), which I'm not sure may affect the testing results or my symptoms. As far as I know, dupixent is not an immunosuppressant. Other than that, I am a relatively health 20s male who had covid a month prior to the interaction.

Can these facts somewhat affect the test results that I received? When I was swab tested for herpes (prior to being negative), I was also prescribed valacyclovir which I only took for 2 or 3 days. Can any of these affect test results or my immune system (suggesting that I am an outlier and can indeed have hiv regardless of negative tests)?

Edward W. Hook M.D.

11 months ago

I’m sorry that you were having so much trouble. Moving forward following the encounter over a month ago that you have focused on. The additional information you provide in no way changes my assessment or my advice. You are more than proof of you do not have HIV or syphilis. You need to look for another cause of the symptoms you are experiencing, perhaps mononucleosis or some other community acquired viral infection. I see no reason for continued testing or concern. EWH. ---

11 months ago

Thank you Dr. Hook. Your words of affirmation has helped me in trying to stay positive, but my symptoms keep telling me otherwise. Can of the additional facts such as Dupixent for eczema, having ezcema in general, steroid topical creams for eczema, or the fact that I took valacyclovir for 2 - 3 days prior to any of the HIV RNA or 4th gen hiv test cause any delayed seroconversion? I understand that if my symptoms were caused by acute HIV I shouldn't attribute them to it, but was just wondering what my actual chances were that I am, one of the few, who have delayed seroconversion?

Also, I understand that delayed seroconversion can yield false negative results for antibodies test, but can the same be applied for HIV RNA tests? To my understanding, since the RNA test detects for the virus itself, can delayed seroconversion also cause false negatives even after 21 days?

Lastly, how reliable is a negative HIV RNA test at 2+ weeks (21 days) & a negative 4th gen hiv test at 4+ weeks (32 days) in order for conclusiveness? I read one story about a fellow who tested negative for HIV RNA at 18 and 30 days, but went on to become positive at 8 weeks....but not sure how plausible or true his statement is.

I apologize for the repetitive questions...if I didn't have symptoms I would be more calm, but everyday is pretty much the same and general no improvement (if anything somewhat getting worse). Can all this be attributed to stress/anxiety?

Edward W. Hook M.D.

11 months ago

Sigh! This is a repetitive question. I’ve already told you that the additional information, including your eczema, your topical steroids and the valaciclovir that you didn’t need but took did not change my opinion. Why are you repeating the question?

Your question about delayed serial conversion serves to confirm that you’ve been unable to stay off the Internet. Delayed seroconversion is an Internet myth which does not exist.

You are question about the accuracy of an HIVRNAPCR test taken at 21 days in combination with a four week fourth generation test, which is also negative is also repetitive. The answer is not going to change no matter how many times you asked the question. You have unequivocally proven that you did not have HIV. I cannot comment about the fellow who had multiple negative, HIV RNAPCR tests who then went on to turn positive at eight weeks. It certainly sounds like something else that you found on the Internet. I have never heard or seen of such a case.

Given the symptoms you describe I suspect you do have some sort of non-STI viral illness. As I suggested the syndrome describing resembles mononucleosis. I also suspect that you were profound anxiety over this situation is amplifying you were symptoms.

Please remember you have one more follow up remaining. After that no further questions will be accepted from you regarding this exposure. EWH .

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11 months ago

I appreciate your forwardness and I apologize for the repetitive questions. I guess i'm just trying to explore as many/detailed options as possible since my symptoms have progressively gotten worse. Please find my last follow up questions:

- If i was possibly in the anomaly group where antigen/anti-bodies are not formed yet (got a 4th gen hiv ag/ab w reflex test at day 32 from exposure), then would the HIV RNA test still be able to detect if I was HIV positive? I'm guessing that since the amount of detectable antibodies are based on how your immune system responds, can the HIV RNA test also be affected by this (i.e. giving a false negative due to low viral loads at 11, 14, and even 21 days)?

- By 21 days, is HIV viral load typically high enough (in the millions)?

- Since my symptoms have progressively gotten worse at week 5 (101 fever, random spurts of intense body heat, waking up in the middle of the night, night sweats) from exposure, can this potentially be the "actual" acute hiv starting, minimizing the accuracy of my previous tests? For theoretical sense, I guess I'm asking if an acute HIV happens at 5 weeks post exposure, then would the hiv rna tests at 11, 14, and 21 days still be considered conclusive/accurate? How long do people with acute hiv usually have symptoms for? I've seen that mono can lasts for weeks/months (similar to my case), but can the same be applied for acute hiv?

I understand that this is my last question regarding this exposure, so I would really appreciate all/any feedback that may help to alleviate my worries from an expert like yourself. Would you describe my chance of contracting an HIV from this interaction as less than 5% or literally 0%?

11 months ago

Also the couple that I interacted with has stopped communicating with me ever since "verbally" letting me know that the wife's tests came back all negative for all STDs (this was a week again). This has added more to my stress as maybe they were finally experiencing symptoms just like me and were potentially infected prior to our interaction, and thus cutting off communication to not be "blamed."

Also if HIV RNA tests are conclusively accurate at 11 - 14 days, how come it is not enforced more for people to utilize this test? I really want to trust my negative rna results, but having a hard time as my symptoms are progressing.

Thank you so much.

Edward W. Hook M.D.

11 months ago

Final responses to your questions. There should be no need to return to the Forum since you don't seem to listen or appreciate the information provided. Should you return, your question may be closed without a response and without return of your posting fee.

- If i was possibly in the anomaly group where antigen/anti-bodies are not formed yet (got a 4th gen hiv ag/ab w reflex test at day 32 from exposure), then would the HIV RNA test still be able to detect if I was HIV positive? I'm guessing that since the amount of detectable antibodies are based on how your immune system responds, can the HIV RNA test also be affected by this (i.e. giving a false negative due to low viral loads at 11, 14, and even 21 days)?

Yes, in the very unlikely circumstance that a 4th generation test was negative at day 32, and HIV RNA PCR test would still be positive

- By 21 days, is HIV viral load typically high enough (in the millions)?

Yes

as you've been told repeatedly, if you had symptoms related to HIV, your test would be positive. you have repeatedly proven your symptoms are not due to HIV. Instead of wasting your time trying to prove that you have hiv, which you do not, you should be traying to find out what is causing your symptoms. symptoms of hiv rarely last longer than a week or two

your risk of having hiv is virtually zero.

If you have harassed them with the sort of repetitive, anxiety based questions that you have come to the Forum, I would stop communicating as well

HIV RNA PCR tests are far more expensive and are far more expensive than 4th generation tests.

This completes this thread. EWH

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