[Question #2407] Need Advice

43 months ago
Hello,

Thank you for  this valuable service, it's very appreciated. 

A little over 7 weeks ago was drinking heavily and I had protected vaginal sex with a stripper and unprotected oral sex. Since then, I've  been an absolute nervous wreck. I checked the tip of the condom afterwards and didn't notice any holes or tears, but I didn't examine the rest of the condom. Two days afterwards, I went to a doctor who actually treated me for all bacterial infections without a diagnosis or any symptoms. This included one shot in my arm, one on the top of my buttcheek, and one dose of four pills. 

I took the HIV RNA qualitative test at 14 days and 28 days post exposure and both were negative.  How reliable are these results? Can I consider them conclusive or should I test again with a 4th generation antibody/antigen test? 

At 4 weeks I also took a full STD panel that included HEP (A,B,C), RPR, gonorrhea, clamydia, HSV (1,2), and trich. All test came back negative.

At 6 weeks I retook HEP B and HSV (1,2).  Again, there tests were negative. 

I'm now a little over 7 weeks and need to know what other test I need to take to know I'm 100% in the clear and safe to resume unprotected sex with my regular partner? I did have sex last week with her after I saw Dr. Hook's response to a question asked by another individual who's in the same situation. I believe Dr. Hook advised him unprotected sex was okay after two weeks after gonorrhea and clamydia and no signs of herpes.  Did I put her at risk or are we okay? 

Thank you for your time and response. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome. Thanks for your confidence in our services and your kind words about them.

This was a low risk exposure. Condoms work, so little risk from the vaginal sex exposure; and oral sex is inherently low risk for all STDs. Had I been your doctor, I would not have given you the antibiotics (and would have refused no matter how strongly you asked for them). That said, whatever small risk there was became zero for syphilis (the hip shot, probably benzathine penicillin), chlamydia (1 gram azithromycin, 4 pills), and gonorrhea (the arm shot, ceftriaxone, plus the azithromycin). You also would be protected from nongonococcal urethritis (NGU), from the azithromycin. There was no point in being tested at 4 weeks for any of these infections:  had any tests been positive, they would have been false.

As for HIV, your risk was zero because a) few strippers are infected, b) condoms work and even without condoms the risk is around 1 in 2500, if your partner had HIV, and b) oral sex is risk free for HIV. In any cas, your test results prove you were not infected.

There was also no risk for hepatitis B, and your test result shows you weren't infected.

In theory, you could have acquired genital herpes due to HSV1, from the oral sex, and the negative test result at 6 weeks is reassuring. However, HSV testing is not conclusive until 4 months after exposure. But having had no symptoms to suggest genital herpes, there is no realistic chance you have it. It's up to you whether to have a follow-up test at 4 months. If somehow I were in your situation, I wouldn't feel any need for it.

I agree with the information you gleaned from Dr. Hook's response to another patient:  I think you're in the clear and did not put your partner at risk for anything.

In the future, I would advise you to ignore any potential STD concerns in the event of unprotected oral sex. It should be considered safe sex -- with low risk for all STDs (far lower than vaginal or anal) and zero risk for some.

So all is well -- no further worries. I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD
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43 months ago
Dr. Handsfield,

Thank you for your quick response.

Just to summarize your points:

I do not have HIV, and the HIV RNA tests at 14 and 28 days are conclusive. Being that the RNA test was only for HIV type 1, should I retest with the 4th generation test which includes type 2?

The possibility of any bacterial infection, even if I was infected, is 0% given the the treatment I already received. 

Additionally, the chance of Hep B is 0% and the test at 6 weeks is conclusive.

Lastly, there is a very slim chance I acquired HSV 1 but very unlikely. What about HSV 2? Do you think there's a possibility I acquired it? At 6 weeks, do you know how effective my test was for these two?

Again, I really appreciate your time and response.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
HIV2 is vanishingly rare outside the area in east Africa where it evolved. However, RNA testing is never sufficient for HIV testing. I assumed you also had an antibody test, either 3rd or 4th gen. Those tests detect HIV2, but the main reason for it is to complete your testing for HIV1.

HSV2 is virtually never transmitted by oral sex. AT 6 weeks, the HSV antibody tests probably pick up around 80% of new infections. That does not mean you have a 20% chance of having HSV of either type. It's more like 1 chance many thousand or lower. I wouldn't test again for either HSV1 or 2, if somehow I were in your situation.

All your other understandings are correct.

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43 months ago
Thanks for the clarification.

So the 4th generation test at 7 1/2 weeks (assuming it's negative), plus the two RNA tests I already took, will conclude my HIV testing and I'll know I'm 100% HIV free. Correct? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Yes, the negative result will be 100% conclusive.

That concludes the two follow-up questions and replies included with each question and so ends this thread. I hope the discussion has been helpful. Take care and stay safe.

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