[Question #207] Looking for some advice - new question, got help

36 months ago

Dear Doctors,

I wanted to thank you for your advice to get some psychological counselling. I have gotten a lot of help over the past month and have one final question for you.

As you may recall I had a “no risk” (receiving handjob with vaginal fluids with open genital warts and fingering a vagina with a hangnail) exposure (Q 111 and 116) and was subsequently tested for HIV first with an RNA test at 10 days followed by multiple DUO tests all the way out to 6 weeks (4 or 42) days post event. 

I was thrilled to think that this is all conclusive and I am without a doubt HIV negative. I was thrilled and moving on with my life. I conclusively accepted that I was negative. However, in the 7th week, the corona of my penis (I am circumcized) has a small red spot on it and is a little swollen and sore. My doctor said it was from overuse. It could not have been sexually related as I had been abstaining from sex with my regular partner and came clean with her and was concerned. This immediately made me fearful of genital herpes and I have gone for a herpes select test at 6 weeks and am waiting on the result. I am just wondering if contracting herpes can have any effect on HIV test results or if a duo test at 25 and then 41 or 42 days is conclusive without a doubt as far as HIV is concerned. I am just worried because I read a lot about herpes relationship with HIV and I did not think I was at risk for herpes and I understood I was not at risk of HIV but my mind plays tricks on me - I could really use your advice on this. Do I need any more HIV testing regardless of these genital or any other type of symptoms?

Thank you so much for your help I am not committed to a monogamous relationship and promise you will never hear from me again. 

36 months ago
Doctor,

Basically all I am asking is could either acquiring herpes from this event or already having asymptomatic herpes or any other STD or condition could affect my HIV results and 25 and then 41 or 42 days (quite certain it was 42.) on the DUO. I am waiting on herpes select but I know I did not have herpes prior as this was my only "exposure" and my herpes select test was negative 10 days after when I did an RNA test. 

Even my psychologist said it was a reasonable question seeing as I am so worried about it and really have calmed down my fears. He just said I need to accept your medical professional answer and not continuously question it. Thank you so much doctor. 
36 months ago
Docyot in my original question I meant to say I am NOW commited to a monogmous lifestyle and understand I can not andle any transgressions due to my guilt. I just need to know if it is even remotely possible that any of the the STD testing I have had out to 6 weeks could possibly not be conclusive. I was already completely relaxed about HIV and was not even slightly concerned until these penile symptoms occured. Do I need another test to prove to myslef that HIV is not the cause regardless of the results of the herpes test?
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Thanks for letting us know that you were working with a psychologist to address (successfully from the sound of things) to address your concerns regarding your past low ( or even no-) risk exposure.  Implicit in your question(s) is that the lesion you noticed might be herpes.  While I cannot completely promise you that the lesion was not herpes, you were examined by a clinician who felt it was not.  Further, for herpes to present six weeks after an exposure is extraordinarily uncommon.  My own sense is that what you saw was most unlikely to be herpes and you should not worry about this.

Even if it was herpes, there is NO reason to worry that this would change you HIV test results in any way.  Believe your test results.  There is no reason for you to retest for HIV.  Further, I would strongly urge you to not even think about blood tests for herpes.  For persons in your situation the currently available blood tests for herpes have too high a false positive rate to be reliable.

I hope these comments are helpful.  I also hope you will share this response with your psychologist.   EWH
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36 months ago
Thank you so much for your reply Doctor Hook. I was starting to regress and was considering running to a walk in clinic to get another HIV test. Doctor the lesion actually presented itself approximately 4 weeks post exposure and the swelling shortly after. It has not subsided much in the past 2 weeks. 

Herpes would have absolutely no impact on HIV? From what I understood it is next to impossible to catch herpes from a handjob with vaginal fluids? 

I came clean with my fiance and she will accept even if I have herpes. Understandably she can not accept HIV and I would not even want her to. This is the main cause of my anxiety. Is it literally impossible for the tests to not be conclusive at even 41 days? Although I am quite sure it was 42.

Have you ever seen a case where herpes affects HIV test results? Or can I be 10000% confident in my status? Sorry for being annoying Dr. I am sure there are some repetitive questions here. Did I have a risk of herpes and you are sure I do not need another HIV test as these symptoms started to be severe after my 6 week test. Thank you so much. 
36 months ago
Doctor I was just wondering perhaps if you could explain why my results are conclusive that would help me tremendously. A 10 day RNA test and then several DUO test out to 6 weeks. I have seen in the past you have written that a DUO is conclusive at 4 weeks. Just to get a little clarification on why it is conclusive and herpes would not make a difference. I am just worried because of my lack of understanding. My mind says logically if I can get herpes from this exposure (potentially) why is HIV impossible? 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Larry.  You are falling into the "rabbit hole" you have been in before.  "What if" and "have you ever" questions serve no purpose.  Our answers on based on reading the research and years of experience.  Your results are conclusive.  Believe them.  

YOUR RESULTS FOR HIV ARE ARE CONCLUSIVE.   This statement is based on many published research studies.

There was no risk of herpes from the exposure you describe.

You may ask one more, and only one more, question if you wish.  If the question is again repetitive, my response will state that.  Please try to work with you psychologist on this.  EWH
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36 months ago
Doctor I completely understand what you are saying I do not want to fall down that rabbit hole again. I am so tempted to order another test - just to prove that my symptoms can not possibly be because of this. I am just so concerned. I think it might really help me if you could explain to me why a 6 week duo is 100% conclusive in spite of herpes? Have you ever seen one change? What do regulatory/govt agencies say? Thank you again for your kindness. All the very best. 
36 months ago
Doctor the fact that you do not think I need any testing really helps me and I can accept my results as conclusive. If you could answer my previous question I would be really grateful. Do you have any other idea what could be causing a swollen corona? I have been prescribed fucidic acid and hyrdrocortisone cream and it is not helping substantially. Just to confirm what you said it is highly unlikely to be herpes and HIV is IMPOSSIBLE? All the best. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Sigh.  You are in the rabbit hole.  This is the final reply to this thread.  Research studies of high risk persons, of whom a large portion of participants have had herpes show that 4th generation tests performed beyond 4 weeks nearly (99.9%+) completely reliable.  I. Your case, following.your NO RISK exposure, you can be completely confident of your results.  Your risk of being struck by lightening while reading this is higher than you risk of HIV.

As suggested by your own doctor, I suspect your "swollen" corona will be either due to excessive examination by you or your noting abnormalities which are actually normal and went unnoticed before you went down your rabbit hole.  Further, repeat application of topical substances (like fusidic acid) can be irritativd.  I suggest you stop.

This will complete this thread.  EWH
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36 months ago
Thank you Dr Hook. I understand. I will try to calm down and not go for another test. If I can't and do test again I understand that the test is guaranteed to be negative and I am just wasting money but perhaps wasting this money will be worth it if it gives me conclusive peace of mind and I am able to move forwards. Thank you for your assessment and time. All the best. - Larry