[Question #141] Anxiety about testing

42 months ago
About four months ago I had a regretful broken condom incident with a massage girl, whereby half way through I discovered the condom was broken. The unprotected exposure was somewhere between a few seconds and a minute before I noticed and changed the condom.

We have both tested negatively  for HIV, her after 5 days, 2 months and 3 months with Rapid test and me 1 month after PEP completion with 4th gen lab test.  I am no longer worried about HIV due to us both being tested. (1) Am I correct to not be worried?

However, I became extremely worried when I realised that I hadn't been vaccinated against Hepatitis B (only Hep A).

I went to London and had an instant Hepatitis B test after 4 months of exposure, which was carried out by a GP, which was also negative, and a 4 month instant Hepatitis C test which was also negative.  I have also had a negative rapid syphilis test and negative lab gonorrhea and chlamydia tests.

Do you believe that any further testing is necessary? If I had a lab test for hepatitis B or C, what are the chances of them being positive?

Thanks for any answers

41 months ago
Also can you advise whether the analytical sensitivity of the rapid HBV tests (99%) as opposed to 100% for lab tests would make any difference in my case - ie 4 months post exposure
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your question.

First, you are correct that you should no longer be worried about HIV. You were overtested and most experts probably would not have prescribed PEP in this situation, or would have stopped it once your partner had her negative HIV test at 5 days. But in any case, for sure you don't have it.

Second, while I certainly understand your concerns about viral hepatiits, you are more concerned than necessary. Hepatitis B virus (HBV) can be sexually transmitted, but much less commonly than most STDs. There are no specific data on transmission risk for any particular unprotected vaginal sex exposure, but as a rough guess I would estimate no higher than one chance in several thousand, if your partner was an HBV carrier -- which most likely she was not. (Was she tested, as you did for HIV? If done and negative, you have no worrie dfo rsure.) As for HCV, it isn't properly considered an STD at all. The only proved sexual transmission scenario is between gay men having potentially traumatic anal sex. In heterosexual men and women, HCV is no more common in people with a hundred versus 3 lifetime partners and no higher or lower in those with or without other STDs.

Therefore, we don't do routine HBV or HCV testing in my STD clinic unless the risk is much higher than a single unprotected sexual exposure. And for sure I would not have recommended either HBV or HCV testing for you. That said, your test results are definitive. The rapid test reliability of 99% versus lab-based testing probably is about right. Combining that estimate with the low pre-test risk, the result is conclusive and you don't need any further tests.

My last thought is that you don't mention other STDs, e.g. chlamydia, gonorrhea and syphilis, the risk of which was far higher than for HIV or hepatitis. Presumably you were tested for them and negative. If not, I would recommend it at this time.

Bottom line:  All is well in regard to HIV, HBV, and HCV, and probably for all STDs. I hope these comments have been helpful. Best wishes and stay safe!

41 months ago
Thanks so much for your helpful reply, which is certainly reassuring. My huge anxiety was because I was lead to believe that the risk of transmission of HBV was 1 in 20 for Hepatitis B for the male from vaginal sex from looking on the internet. Are you saying that this is definitely not the case and the odds are much much higher? Also the prevalence of HBV is high (5%) in the country where I had my exposure. Why is it that they say HBV is 50 to 100 times more infectious that HIV if there is still only a 1 in 1000+ chance from sexual intercourse? 

Unfortunately because it was all done at a distance through a third party I didn't get any info on her HBV testing and now there's not enough time to find out.

Yes I have twice tested for chlamydia & gonorrhea and had a rapid test for syphilis so they were no longer a concern so I didnt mention them
41 months ago
Hi This is where I got my information about the risk of transmission of HBV. Is this wrong?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Sorry for the delayed response. As it happens, some emails have been exchanged just today about how easy it is for the moderators to miss follow-up comments on older threads and possibly improved alerts when they come in.

The transmissibility of HBV varies widely with the stage of infection and other aspects. Certainly the overall risk is nowhere near 5% (1 in 20), and I don't see that figure in the WebMD link you provided. I imagine it could be that high if the infected partner had acute hepatitis B. But the large majority of chronic carriers have much lower levels of virus in their blood. In fact, the higher the prevalence of HBV in a country (and 5% is certainly on the high side), the higher the proportion of those with non-acute chronic carrier states, i.e. relatively low blood levels. My guesstimate of under 1 chance in a thousand (actually, I said one in several thousand) might be too conservative. OTOH, you also have the negative test result 4 months later. From that alone, I would say there is no realistic chance you caught HBV, even if the risk had been far higher than it probably was.

Glad to hear you were tested for gonorrhea, chlamydia, and syphilis. I would have put hepatitis B as also "no longer a concern".

My final advice is that since you're obviously concerned about HBV, you get immunized against it. Even if you plan on no further sexual events like the one describe, such plans often disappear in a puff of blue smoke when temptations arise. Why not protect yourself in the most reliable way available?

Apologies again for the delay in responding. Best wishes and stay safe.