[Question #2233] Are my tests conclusive

45 months ago
Hi Dr,
 I am worried and in need of advise from an expert like you.

I am a male. I had an exposure with a female commercial sex worker. It was an unprotected oral sex (receiving) and protected vaginal sex. 

Since then I have done the following tests:
1. nucleic acid application test for HBV, HCV and HIV on day 13 -negative;
2. rapid alere determine ag/ab combo on day 13-negative;
3. Elisa/EIA Ag/Ab test in the lab on day 27-negative;
4. Ag/Ab test (Elisa) in the lab on day 42-negative; 
5. rapid alere determine ag/ab combo on day 61-negative;
6. rapid alere determine std test on day 61-negative;
7. lab std test  such as hepatitis A, B, Herpes 1, 2, chlamydia and syphilis on day 42 -negative

The thing is I got confused because of different answers given to me by the doctors in my country.
I have consulted a general practitioner here and he told me  I can move on after 6 weeks.

I have then consulted an infectious disease specialist but he told me I need to wait for 3 months for conclusive test for HIV and syphilis while my aforesaid tests are good indicator. This doctor profile says he is an expert in HIV.

Given the discrepancies my question to you is:
1. are the tests above conclusive for HIV or do I really have to wait for 3 months?
2. are the syphilis tests conclusive or do I have to retest at 3 months?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thank you for your question.

Your sexual exposure was very low risk for any STD. Condoms work, so the vaginal exposure wasn't particularly risky. Oral sex is safe sex -- not completely free of risk, but with a much lower rate of all STDs than vaginal or anal sex, low risk for all STDs and zero risk for some.

Equally important, or even more so, all the tests you had are very reliable. They show for sure you did not catch any of the infections for which you were tested. 

Those comments cover your two questions, but to be sure there is no misunderstanding:

1) The Ag/Ab combo test is 100% reliable any time 6 weeks or more after exposure. Your ID doctor is mistaken, or you misunderstood. With this test, it definitely is not necessary to wait 3 months for a conclusive result.

2) Similarly, the syphilis blood tests are conclusive any time 6 weeks or more after exposure.

So all is well. You do not need any more testing.  I hope this ifnromation has been helpful. Let me know if anything isn't clear.

45 months ago
Hi Dr. Hunter,

Thank you very much for your reply. Needless to say you and your team are doing the global community a remarkable service. 

I do have follow up questions and they are as follows. My apology for forgetting to include it in my main question. 
1. I have had first dose of hepatitis A or B or both (cant remember exactly which type off hand) on day 26 post exposure. Would the immunization affect the outcome of any of my tests done after that?

2. If your answer to question is negative.  Am i safe to resume unprotected sex with my partner based on the results of my tests?

3. I am glad to accept your opinion which you have repeatedly said is based on science and facts that ag/ab test is conclusive after 6 weeks or more. So the longer the time lapsed the better it is. Now the thing is my latest test on day 61 was a rapid ag/ab test done at community centre. Does it make it less reliable than the lab test done only on day 42. 

3.  I did not misunderstood the ID specialist. That is why it brings me here  for clarification.  If you noticed from my tests there are no gonorrhea tests done. Reason being is apparently i have no symptoms and hence it was not done. The ID specialist have examined my member and also say the same thing ie no need to test. Hence my question is, is this a safe method to rule out gonorrhea?

I am so stressed out and worry about this whole episode. I was thinking to jump on the plane and drop by your to have you diagnose me properly. It was my first time for doing this stupid thing out of frustration. I have an infant still in the crib and hope you understand how much your reply and advise will meant for me.  

I trust i have no more questions after this and i thank you in advance for your time and service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1) Vaccination for hep B could have caused a positive test for hepatitis B survace antibody (HBsAb), if done. But there is no other interference:  the vaccines cannot turn any tests falsely negative.

2) Based on all your lab results, you can safely have sex sith your partner.

3) The negative test on day 61 does not alter the conclusive nature of the 42 test result. It confirms it.

4) So the ID doc apparently believes gonorrhea/chlamydia testing wasn't necessary because the risk was low and no symptoms. That's sort of correct:  condom protected vaginal, unprotected oral, plus no symptoms indeed add up to a very low chance you caught either gonorrhea and chlamydia, hence low risk you infected your partner. However, s/he still thought there was need to test for HIV and other infections that were even lower risk.

You could still have a urine test for gonorrhea and chlamydia, if the negative result would improve your confidence. I really don't think it's necessary, but I also didn't think any of your other tests were necessary either. In any case, do your best to separate your guilt, shame, or anxiety about a sexual decision you regret with the medical consequences of that decision. They aren't the same. Deal with the emotional aspects as you need to, but you can stop worrying about any medical issues from it.

45 months ago
Hi Dr. Hunter,

Thank you for your reply and I appreciate it very much. I have a final question for you doctor.

 What happened was I think during the oral session the female csw have caused an abrasion on the mid part of my penis. The session then goes on to vaginal sex with condom and I am not sure whether the abrasion was covered by the condom. I only realized about the abrasion later when i felt a stinging sensation after the session.  Assuming the condom did not cover the abrasion/nick my question is will this event in anyway change your assessment on my case especially on the HIV transmission?

And doctor after considering your suggestion to have the urine test  in order to increase my confidence,  I did went for urine test for gonorrhea and chlamydia DNA on day 63 (9 weeks post exposure) . These test comes in a package for Trichomonas vaginalis, mycoplasma and ureaplasma lot as well. Results  DNA not detected for all.

And again, thank you for your time and services rendered in this forum. Its been great help to me and I trust to others as well.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
It is a misunderstanding by many persons that any skin defect, no matter how minor, significantly increases the risk of HIV if exposed. It isn't true. This abrasion or nick makes no difference in my reply. But it's a totally irrelevant question anyway:  your test results prove you didn't catch HIV. Therefore, the risk at the time doesn't matter. You could have told me you had mainlined HIV infected blood, and I would still say you for sure were not infected and do not need further HIV testing.

Glad to hear your urine test was negative, but of course it's not a surprise.

That completes the two follow-up comments and replies included withi each questions, and so concludes this thread. Best wishes and stay safe.