[Question #2783] Testing result questions

41 months ago
Hi doctor, 
  So 6 weeks ago I had an encounter with a female working at a massage parlor. I received protected oral sex from her. One concern I had was that the condom I used sitting in my glove compartment throughout the summer. Now I don't know her status at all but I did have a full std panel done through stdcheck.com at 27 days post incident and everything came back negative. They use the 4th generation duo hiv test. My question is do you recommend either testing ? I know there are some differences in opinion as to when tests are conculsive. So I didnt know if I needed to repeat the panel at 12 weeks to be considered 100% conculsive. I terms of symptoms I haven't had any fevers I did have a little rash under both armpits, but I believe it was a reaction benzoyl peroxide. Thank you in advance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your question.

Condoms don't leak unless they break wide open. The notion of microscopic pores that might allow infectious agents to pass is an urban myth:  almost certainly it doesn't happen. Poor condom storage (like a hot glove compartment, several years old, dried out due to torn or open packaging) or oil based lubricants may weaken latex and lead to rupture. But almost certainly they do not increase the risk of disease transmission if the condom remains intact.

Further, you weren't at risk fo HIV anyway. It has never been proved to be transmitted by oral sex, i.e. mouth to penis, even without a condom. On top of that, it is statistically unlikely a partner like your massage worker has HIV.

A skin rash of the sort you describe, by itself, would never be due to a new HIV infection.

Finally, the antigen-antibody ("4th generation") HIV tests are nearly 100% conclusive at 4 weeks (and no, there is no measurable difference between 27 and 28 days). The recent change on this forum to advice that the Ag-Ab tests aren't conclusive until 6 weeks reflects newer understanding that it rarely can take that long. But almost 99% of newly infected people have positive results by 4 weeks. Anyway, as noted above, you could be 100% confident you didn't catch HIV even if you hadn't been tested at all. (If somehow I were in your shoes, I definitely would not have seen any need for an HIV test.)

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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41 months ago
Thank you for the reply Dr. Handsfield. So just to clarify is the time for antigen-antibody test considered conclusive after 6 weeks ? Also why would my partner be statistically unlikely to have HIV, this is one of those asian massage parlor that part take in "Happy endings", Should one not be concerned about visiting establishments like that especially if only hands are used. Also can you clarify what the best time to get conclusive results of other STD test are  (chlamydia,gonorrhea,Herpes 1&2, hepatitis A B & C, Syphilis) the 10 panel test i took covered all of these didn't know if 4 weeks is too early for these tests. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Yes, conclusive at 6 weeks and almost conclusive by 4 weeks.

HIV remains more uncommon in heterosexual sex workers (which I would consider your massage partner to be) than you might think. On average across the country, less than one in 1,000 such women have HIV. There is no risk from hand-genital contact.

Assuming the gonorrhea and chlamydia tests were done on urine, those results are conclusive any time 4-5 days or more after exposure. (Chlamydia/gonorrhea blood tests are useless at any time.) HSV1 and HSV2, 3-4 months. Viral hepatitis and syphilis, abou6 6 weeks. However, except for gonorrhea and chlamydia, all of these are too low risk for testing to be necessary after a single exposure of this kind.

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41 months ago
Thank you again for your reply. Now i know that test results are the the best way to know if you have an HIV and i know you said that i don't need to worry but i was wondering what symptoms you need to look out for. I have read that the three most common symptoms are Fever, Rash, & Sore throat. One think that i have read is white coating on tongue, which i do have a sort of white/grey coating especially in the morning and after i eat something. I might be overthinking this, but i appreciate any calming advice you have. I was all set to get re-tested this week cause i was nervous that the results were not conclusive, since Stdcheck.com said that results are only 100% conclusive at 12 post exposure. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
We do not examine clinical photos on this forum. It comes too close to practicing medicine from afar, which we cannot do. The images will be stripped from your last post. Having not been able to avoid seeing them, however, I'll just say it doesn't change anything:  from your description previously, plus unavoidability of seeing the red bumps, HIV would never cause a rash like this. Even if it could, the blood test always overrules all other considerations:  no matter how high the risk of exposure at the time, and no matter how typical the symptoms, negative tests like your prove HIV isn't the cause of any symptoms you have. If you would like still further reassurance, have another Ag-Ab blood test again, now that you're beyond 6 weeks from the exposure. You can count on another negative result. And by the way, no other STD is a possible cause of such a rash either. Beyond that, if you want a conclusive diagnosis of the rash, you'll have to see a doctor in person -- or perhaps find a dermatology website where the moderators are willing to examine and comment on images like yours.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. I hope the disucssion has been helpful.
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41 months ago
Thank you for your help and sorry about the photo, i saw the buttons for uploads so thought i was allowed.