[Question #12023] Test after 67 days for Unprotected Oral MSM

10 months ago

I received an unprotected oral sex (MSM sex worker) in Southeast Asia two years ago. The exposure involved receive oral sex and skin-to-skin contact only, no ejaculation.

Tests conducted:

1. 27 days post-exposure: Negative for HIV (ab/ag p24), Chlamydia, Gonorrhea, Syphilis, Hep B, and HSV-2. Positive for HSV-1.

2. 67 days post-exposure: Negative for HIV, Chlamydia, Gonorrhea,Syphilis (RPR), and Hep B.

3. 1.5 years later: Two OraQuick tests both negative and negative for Hep B.

I’ve had no symptoms (e.g., chancres or rashes) and resumed sexual activity after the second test. However, I recently realized that the 67-day test might not have been conclusive for Syphilis/HSV.

My questions:

1. Is the 67-day test conclusive for Syphilis/HIV/STDs?

2. Do I need further testing?

10 months ago

The 2nd test after 67 days was a lab test by Labcorp.

Test used for HIV was ab/ag p24, Syphilis (RPR, Rfx Qn RPR/Confirm T), both negative. I did not test for HSV this time.

CDC guidelines for Syphilis is 90 days, so I worried about false negative with my 9.5 weeks test for Syphilis.

Edward W. Hook M.D.

10 months ago

Welcome to our forum. Thank you for your questions. The exposure described was very, very low risk. HIV has never been proven to be acquired from receiving oral sex and as a generalization receipt of oral sex is low risk for acquisition of other STI. You have tested more than necessary and your testing conclusively proves that you do not have any of the STIs you Have tested for. My advice is accept your test results and move forward without concern. There is certainly no reason for additional testing.

The CDC guidelines are overly conservative in terms of when they state that tests for Syphilis are conclusive. You can be confident that you do not have syphilis at this time. EWH.

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10 months ago

Thanks Dr. Hook, quick follow up:

1. In this case, I (Male) received unprotected oral/fellatio from a MSM sex worker in riskier region. Does it change the recommendation of no further testing on any STDs?

2. Given I did not test HSV1/2 in 2nd/ 67 days test. The only test for HSV1/2 on day 27 is much shorter than 3/4 months HSV window period. Do you see risk of HSV 2 and pass to partner?

3. Have you seen/aware negative Syphilis result at 9.5 weeks turn positive?

4. Do you recommend men after 35 to get HPV vaccine?

Edward W. Hook M.D.

10 months ago

1. No change in my assessment or suggestions

2. No

3. No

4. This is a personal choice. There are no meaningful side effects from the HPV vaccine. It will not harm you. I would get the vaccine

EWH

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