[Question #2785] Cocaine sniffing and window period? HHH?

40 months ago

Dear Doctor,

I’m writing these lines because I’m very concerned about myself and my family. I’m currently living with my wife and looking for a baby.

She made her tests and everything was ok, then I thought that it was a good idea for me to make an HIV test since I never did it in my life. I always performed sex either with a condom or in a monogamous relationship, but I still thought it was a good idea.

So the thing is that I made an Insti test (which came negative) but since the test is not sold in my country legally (I bought it on eBay) I decided to make another test in a Lab, which came back negative (I don’t know what kind of test but the results were in 40 minutes, and they said it was the 5th gen with a 21 days window period).

It was all great, but suddenly I remembered that approximately 45 days before the lab test I do some coke with some friends and I can’t remember if I shared a bill or a straw. I think I didn’t, but I still feel bad and guilty. So I decided to make another test at 53 days point from the coke event and came back negative again. 

I want to know if:

1 - Was I ever be in risk for HIV or any other STI for the coke event? Because I see tons of opinions on the internet.

2 - Are my test conclusive in case that I was at risk (Also here lot of confusion, 1 month, 6 weeks, 8 weeks, 12 weeks??)

3- Can I move on with my life, should I test for something else before looking for a baby? Never did IV drugs in my life ever.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

You are correct that HIV testing was a good decision. CDC recommends that every adult (age 13-65) be tested for HIV at least once, even if never apparently at risk. While you're apparently in some other country, that general advice is good in all settings.

The tests you had are highly reliable. Indeed, the HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. The Insti test in one country is identical in all countries and is highly reliable. The only slight issue is that no test is 100% reliable at only 21 days; and the new "fifth generation" test really isn't fifth generation at all; it's a 4th gen test with marketing exaggeration by the manufacturer. However, the tests you had at 53 days -- i.e. m ore than 6 weeks after your last possible exposure to HIV -- are 100% reliable. There are no medical or drug situations that have any effect on test performance, including cocaine use. And that certainly is not a risk for catching HIV.

To your specific questions:

1) There has never been a case of HIV known to have been transmitted by a shared cocaine straw.

2) As I said above, your test results are conclusive.

3) You can safely move on with absolutely no concern about HIV. If you have had unsafe sex in the past and have not been tested for syphilis, you might consider that. Also, you could have a urine test to be sure you aren't carrying gonorrhea or chlamydia. However, without symptoms, it is very unlikely you have any of these. I really don't think you need to be worried at all.

I hope this information is helpfu to you. Let me know if anything isn't clear.

HHH, MD

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40 months ago
Thanks Dr happy to read that. 

Besides my wife an another monogamous relationship (1) I never performed intercourse without condoms (except for oral) is this a risk of any infection (oral sex)?

I did also some coke in the past socially. And maybe sharing the bills in some point. (Most of times no I'm very careful) but just in case that I can't remember if I did:

Do you think I need to test on hep c? My mom told me I'm vaccinated for hep b.

Regarding syphilis gonorrhea and chlamidia: Never had symptoms at all and my wife tested neg for her tests... (I think these are highly contagious?)

Let me know your thoughts. I appreciate your help and patience 

Thanks!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Sorry for the long delay in responding to your follow-up comments.

Oral sex carries some STD risk -- a lot lower risk than unprotected vaginal or anal sex, however, and zero risk for some STDs.

You are not at risk for hepatitis C from any of the exposures mentioned above. Contrary to popular belief, even unprotected vaginal, oral, or anal sex with women is risk free for all practical purposes. The frequency of hep C in the heterosexual partners of infected people is no higher than in the general population, assuming the couple do not also share drugs by injection. The ONLY proved sexual transmission scenario for hepatitis C virus is anal sex between gay men -- in particular potentially traumatic (bloody) rectal sexual events. Otherwise it simply is not sexually transmitted, or so rarely it can be ignored. And for sure there is no risk from oral sex, shared cocaine straws, etc.

It sounds like you ahve been at low risk for chlamydia and gonorrhea, and indeed your wife's negative test results are strong evidence you aren't infected. Not quite 100%, but very close. I wouldn't worry about it.

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