[Question #1829] Test result opinion

42 months ago
Hello there, first off wanted to say thank you again for all you guys do here! As a follow-up, I was hoping you could provide your professional opinion on my test results. As I posted on my first question, I had what I deem a low risk exposure based on numerous threads I have read on your forum. To recap, I had received unprotected oral from a stripper and perform cunnilingus on her for a short bit. I had condom protected vagina and anal intercourse as well. Based on previous threads, and my research, it sounds like my odds for picking up STI's including HIV to be very very low. 

With that said, I did a 10 panel STI blood and urine test at 19 days post exposure. I may have been premature on some of them, but all came back negative as I had expected from Dr. Hooks previous response. 

TESTS DONE:
HIV 1/2 4th Generation
NEGATIVE
HIV 1/2 Antibody
NEGATIVE
HIV Early Detection
NEGATIVE
Herpes Type 1
NEGATIVE
Herpes Type 2
NEGATIVE
Chlamydia
NEGATIVE
Gonorrhea
NEGATIVE
Syphilis
NEGATIVE
Trichomonas
NEGATIVE
Hepatitis A
NEGATIVE
Hepatitis B
NEGATIVE
Hepatitis C
NEGATIVE

Can I feel fairly confident with my low risk exposure and early detection HIV test that I do not have HIV?

Were the syphilis, hep, and herpes test results of negative too soon to tell?

I have had zero symptoms of any sort and it is now 25 days past exposure, is that a good indicator for all STIs?

Thanks again, what you are doing here is a terrific service due to all the misinformation out there!!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome back. But sorry to see you need the additional support, given the extremely low risk nature of your exposure. I quickly scanned your recent discussion with Dr. Hook.

"Comprehensive" STD test panels are not designed to check for infection after particular exposures, but for general screening when someone is concerned about multiple exposures over the years. You were tested too soon for all the blood tests listed.

Trichomonas, gonorrhea, and chlamydia:  assuming these were performed on urine, these results are conclusive. (Some labs offer blood tests, but they are pretty much useless and never worth the expense.) 

Among the blood tests, those for HIV tests come closest to being reliable at 19 days. The 4th gen test is around 95% conclusive; the other two are each in the 90% range. (This is a good example of the waste involved in this particular panel. The combination of the "early detection" plus antibody test is equivalent to a single 4th gen test.)

The three hepatitis tests and the syphilis tests are not conclusive until about 6 weeks after exposure, and herpes (both types) requires 3-4 months. Two of the hepatitis tests were entirely unneeded, another example of financial waste:  hep A is almost never sexually transmitted, since there is no carrier state -- i.e. someone without overt hepatitis cannot transmit it, so unless your partner was jaundiced and ill, there was no risk. And although hepatitis C is sometimes considered an STD, it is almost never transmitted heterosexuallly, only among gay men with traumatic (potentially bloody) rectal exposures. Even the long term heterosexual spouses of infected persons have no higher rate of infection than anyone else (assuming they are not also needle-sharing drug use partners). Hepatitis B often is sexually transmitted, but the chance after a single oral sex and condom-protected vaginal exposure is almost as low as for HIV, i.e. nearly zero.

If you feel you need definitive testing, you'll need a repeat 4th generation HIV test at 4 weeks or more after the exposure, and syphilis and maybe hep B at 6+ weeks. I would recommend against any other follow-up testing at all. But if you insist on herpes, that should wait until 4 months after the event.

I hope this information is helpful. Best wishes--  HHH, MD

---