[Question #12005] Questions
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11 months ago
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I am from Brazil and I am doing this through Google Translate. I am a man, bisexual, and I had a relationship 7 days ago with another man. He is a male escort.The relationship consisted of kissing, mutual masturbation, he licked my ass (rimming) and gave me a blowjob. No penetration! These are the facts and I am not going to add "what ifs" here. I just want to clear up some doubts and congratulate you on the great work you have done, helping so many people with quality information and a lot of responsibility.
1 - I understand that the risks involved here would cause me symptoms between 2 and 7 days (chlamydia and gonorrhea). After 7 days I have not had any symptoms. Is this a good sign, right?
2 - Regarding syphilis, after 2 and a half days of this relationship, I went to the emergency room. There I was able to talk to a doctor and report what had happened. She told me to stay calm but that she would give me antibiotics. I was prescribed an injection of Benzylpenicillin Benzathine, at a dose of 2,400,000 IU (8ml). I took one in each buttock (this was 2 and a half days after intercourse). If I had come into contact with syphilis with this medication, would it have aborted the infection? In this case, I don't even need to do any tests, right?
3 - I know that HIV is not transmitted through oral sex but I plan to take an HIV PCR RNA test with a detection limit of 20 copies per ml on day 11 after this relationship (next Friday) plus a 4th generation Hiv Test. I read the following message on the website www.vdh.virginia.gov/content/uploads/sites/10/2021/02/Provider_Messaging_2019_Final.pdf: "If the initial screening test is non-reactive/negative, a confirmatory antibody-differentiating test is not necessary. This testing interpretation is valid and reliable when the provider performs the screening test at least 11 days from suspected HIV exposure." The initial test mentioned is the 4th generation. Do you agree?
1 - I understand that the risks involved here would cause me symptoms between 2 and 7 days (chlamydia and gonorrhea). After 7 days I have not had any symptoms. Is this a good sign, right?
2 - Regarding syphilis, after 2 and a half days of this relationship, I went to the emergency room. There I was able to talk to a doctor and report what had happened. She told me to stay calm but that she would give me antibiotics. I was prescribed an injection of Benzylpenicillin Benzathine, at a dose of 2,400,000 IU (8ml). I took one in each buttock (this was 2 and a half days after intercourse). If I had come into contact with syphilis with this medication, would it have aborted the infection? In this case, I don't even need to do any tests, right?
3 - I know that HIV is not transmitted through oral sex but I plan to take an HIV PCR RNA test with a detection limit of 20 copies per ml on day 11 after this relationship (next Friday) plus a 4th generation Hiv Test. I read the following message on the website www.vdh.virginia.gov/content/uploads/sites/10/2021/02/Provider_Messaging_2019_Final.pdf: "If the initial screening test is non-reactive/negative, a confirmatory antibody-differentiating test is not necessary. This testing interpretation is valid and reliable when the provider performs the screening test at least 11 days from suspected HIV exposure." The initial test mentioned is the 4th generation. Do you agree?
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H. Hunter Handsfield, MD
11 months ago
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Welcome. Thank you for your question and for your confidence in the forum -- and for your kind words about our services.
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You describe a zero risk sexual event -- or so close to zero that I would have recommended against even testing for HIV or other STIs and would not have advised the syphilis prevention treatment. More on that below; now to your specific questions:
1. The symptom times you cite are for urethral infection -- but for that you definitely were at zero risk. In theory, analingus (rimming) could have risked anal gonorrhea or chlamydia -- but that risk is probably on the order of one in many million. And time to symptoms for rectal infection are less clear, and most rectal gonorrhea and chlamydia cause no symptoms at all. Therefore, you cannot rely on symptoms as a clue. However, the chance is so low that you really needn't worry about it. Still if you remain concerned, you could have a rectal swab for testing for both infections.
2. As implied above, I would not have advised the syphilis treatment. However, I have no personal knowledge of the frequency of syphilis in partners like yours or in Brazil. If your doctor believed the risk was high enough to warrant preventive treatment, that's fine. But I'm inclined to doubt it. In any case, that treatment was 100% effective in preventing syphilis from taking hold. (It even would have cured established infection several weeks later.) Accordingly, there is no point in testing for syphilis: even if possibly exposed, the blood test could never become positive.
3. I see no need for HIV testing. But here too, it might be reasonable if your doctor agrees, based on local HIV epidemiology. However, nobody in the world has ever been known to be infected by the exposure events you describe, even with known infected partners. For many years, follow-up AgAb testing at ~6 weeks was advised following negative RNA/PCR at 11+ days, and for a long time that was our advice on this forum. However, with increasing experience of several years, we now know follow-up testing isn't really needed. That said, many experts still advise it -- and in the face of conflicting opinions, many people opt for it. But that's a personal decision. Since you were at zero risk, I don't even advise the PCR test.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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11 months ago
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Good evening! Thank you for your quick response!
1 - In fact, given the very low risk you mentioned relation to rimming I don't think it's necessary to test. I read in some answers that the greatest risk in this case is for the person doing it.My main concern was regarding receiving oral sex. But after reading many, many questions here on the site, I believe that the chance is also small enough to worry about. All of this is because I'm married to a woman and I was worried about passing something on to her. Maybe next Friday I can test for chlamydia too.
2 - In fact, the doctor didn't "advise" me to take this antibiotic. I asked for it and she agreed. My question was whether, in case I had contact with treponema, this injection at this dosage would protect me. From what I read here, I believe it would, right?
3 - I believe that the tests are becoming more and more reliable and sensitive. I understood that you do not advise me to test, but sometimes it brings peace of mind. I read a long time ago that there is (or was) a 2% incidence of false positives in the quantitative HIV test. This worried me, although I understand that this issue should be resolved over time. Can the antibiotic I took interfere with the HIV test (both the PCR and the fourth generation?).* Can you tell me if this test (PCR) still has high false positive rates?
I am going to test it in one of the best laboratories we have in São Paulo, and talking to a doctor, he told me that test (HIV viral load) is very sensitive 7 days after the supposed exposure - but I understood that in my case I have nothing to worry about right?
1 - In fact, given the very low risk you mentioned relation to rimming I don't think it's necessary to test. I read in some answers that the greatest risk in this case is for the person doing it.My main concern was regarding receiving oral sex. But after reading many, many questions here on the site, I believe that the chance is also small enough to worry about. All of this is because I'm married to a woman and I was worried about passing something on to her. Maybe next Friday I can test for chlamydia too.
2 - In fact, the doctor didn't "advise" me to take this antibiotic. I asked for it and she agreed. My question was whether, in case I had contact with treponema, this injection at this dosage would protect me. From what I read here, I believe it would, right?
3 - I believe that the tests are becoming more and more reliable and sensitive. I understood that you do not advise me to test, but sometimes it brings peace of mind. I read a long time ago that there is (or was) a 2% incidence of false positives in the quantitative HIV test. This worried me, although I understand that this issue should be resolved over time. Can the antibiotic I took interfere with the HIV test (both the PCR and the fourth generation?).* Can you tell me if this test (PCR) still has high false positive rates?
I am going to test it in one of the best laboratories we have in São Paulo, and talking to a doctor, he told me that test (HIV viral load) is very sensitive 7 days after the supposed exposure - but I understood that in my case I have nothing to worry about right?
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H. Hunter Handsfield, MD
11 months ago
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Thanks for the thanks.
1) But please forgive me: I missed that you received oral sex. My comments about gonorrhea and chlamydia should have recognized that. First and very important, chlamydia is no risk at all, despite lots of misleading information online: there have been very few if any documented cases of chlamydia transmission mouth to penis. Gonorrhea is a definite risk, however. On the other hand, almost all urethral gonorrhea causes very obvious (and painful) symptoms within 2-5 days. Absence of symptoms is strong evidence you were not infected. Still, many people in your situation opt for a urine gonorrhea test for reassurance. (Chlamydia testing is automatic when gonorrhea testing is done -- even though not necessary in your situation.)
2) Already answered: 100% reliable in either preventing or curing syphilis.
3) False positive HIV PCR tests are exceedingly rare -- now a lot lower than 2% chance. Correct, nothing to worry about. (Perhaps you'd also like to know that in the 20 years of this and our preceding forum, with thousands of questions about HIV risks, nobody has yet been found to be infected. You won't be the first. In other words, our assessment has never been wrong! If and when it happens, surely it will be from a genuinely high risk exposure (think unprotected anal sex between men).
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11 months ago
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No need to apologize, Dr. Just one last question asked earlier: are there any medications (in my case, the antibiotic and an anti-inflammatory that I am taking for another reason) that could interfere with the HIV viral load test or the 4th generation HIV test?
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H. Hunter Handsfield, MD
11 months ago
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Nothing can interfere. Except for anti-HIV drugs, there are no medications (nor any medical conditions) that have any effect on the reliability or timing of any of the modern HIV tests.
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That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.