[Question #3166] Need help

39 months ago
(Hello. If possible, I would want my question to be answered by Dr. Hunter Handsfield, please. Thank you!) 

Dear sir, I am female, 21 years old. I have been with a boyfriend for some time (and he's tested lately HIV positive). I have never had any sexual intercourse with him (I am still a virgin), but we only had oral sex (blowjobs & cunnilingus; last time being a year ago), had genital rubbing (last time being earlier than 15 September); and kissed (last time 28 October). 

Since I've learned that he's positive, I've done three different tests because I was very worried, and this worrying was more intense because I also got HPV from him (which gave me genital warts, that I still have), and a specific bacteria called staphylococcus aureus. In the three tests I did in all I tested negative (the first I did on 4 November; the second 28 November; and the last 11 December, 44 days after last kiss). The last test I did was a duo antibody/antigen test and it reads: test name: Ac.anti HIV duo; result: 0.09; unit: IU/ml; Reference <1 Negative, >1 Positive; Result in words: negative. Given all the information above, I have these questions: 

1) Is it possible for me to get HPV and the other bacteria, but not get HIV, given the same circumstances? 

2) Please interpret what does the reference above "result: 0.09" mean; does it mean that it's close to being positive?  

3) I am experiencing a number of symptoms: vomiting;  my periods stopped this month after two days (the usual time being 4 days); my stomach feels very empty; I have tonsillitis in my throat and white tongue.

4) Given the fact that I had before mouth sores (and maybe he did too; he only smoked pot and not hard drugs) is there a chance I may have gotten the HIV by kissing?

5) Given the aforementioned dates of contact I had with him (and the time that passed to do the tests), can the tests I did be considered 100% sure? Do you recommend to do another test in the future (if yes, when)? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your confidence in our services. It is only by chance that I am replying and not Dr. Hook. Users do not have the option of choosing the expert who responds to their questions.

Congratulations for your responsible approach to HIV prevention in light of your partner's infection. So far you have not been at risk:  HIV is not transmitted by kissing, genital rubbing, or hand-genital contact, and is not known to have ever been transmitted by cunnilngus. There is a very small risk for transmission by fellatio (penis to throat), but low enough to be considered zero for practical purposes. (One estimate, by CDC, is 1 in 10,000, which is equivalent to giving BJs to HIV-positive men once daily for 27 years before catching it might be likely.) So based on your exposures so far, you really didn't (yet) need HIV testing.

It is quite atypical for you to have acquired HPV and genital warts while still a virgin. Some HPV infections may be transmitted by genital contact without penetration, by oral sex, or perhaps even by hand-genital contact. Also, if HIV infected persons have begun to have serious suppression of immunity, their HPV infections may blossom and be more transmissible than normal. There is no medical proof this happens, but it seems likely. In any case, I will assume the diagnosis is correct and you indeed have genital warts. If so, they can be effectively treated and you should do that. Let me know in a follow-up comment if you would like advice about the kinds of treatment available.

To your specific questions:

1) HPV is MUCH more easily transmitted than HIV. So the answer is yes:  it is definitely possible to catch HPV but not HIV from a partner infected with both. This is especially so given the low HIV risk for the exposures you have described. By the way, having a positive test for Staph aureus means nothing. Staph is not sexually transmitted; it's carried on the skin and in the genital area by many entirely healthy people. If you're not having symptoms of staph (e.g. folliculitis, absecess, boils, etc), you can disregard it.

2,5) Your HIV test was totally negative, and 44 days after the last exposure is enough time for a conclusive result. The numerical results don't mean anything as long as the number is below the cut-off value for a positive test, i.e. under 1.0 for your test. But anyway, 0.09 is far below that value. You do not need any further HIV tests based on these exposures. 

3,4) These are very nonspecific symptoms -- i.e. can be caused by innumerable health conditions, mostly very minor. They are not strong indicators of HIV; and the blood test results always overrule even highly typical symptoms. See a doctor if you remain concerned about them, but based on all you have said, I see no reason to be concerned about them. 

The priority going forward is to assure you don't become infected through vaginal or anal intercourse, assuming you continue your relationship with this partner. Even here, prevention can be nearly 100% assured. The most important thing is for him to be in treatment for HIV, by an expert doctor or clinic. HIV infected people on effecitve anti-HIV drugs are non-infectious for their partners, even with unprotected sex. However, I stress "effective" treatment:  blood tests need to be done to confirm his HIV infection is well controlled. Until you know for sure that is the case, you can be nearly 100% protected by consistent condom use during vaginal or anal sex. (If you and your partner find condoms unacceptable, then you should continue to avoid vaginal and anal sex.) The very best approach is for you to be evaluated and treated as a couple, i.e. for the doctor/clinic to advise both of you on all steps to prevent transmission.

I hope these comments have been helpful. Let me know if anything isn't clear.

HHH, MD

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39 months ago
Thank you very much for your invaluable and precise answers and advices. 

I.

Yes indeed, I am very interested to hear about the best possible treatment for my HPV. Thank you very much! 

II.

I also have a question in relation to the last test I did that I previously mentioned (the Ac.anti HIV duo test): when I went to do this test, the nurse who administered the test was a bit unprofessional, telling me at the beginning that this test would take 2 hours to complete. After she took my blood from the arm vein, an hour passed and then she gave me back my results. I want to know, what is the usual time for this kind of test to be administered? Could she have done any mistake regarding this, i.e. was it possible for her to give me back the results before the test did it's job?   

III. 

I had a very fragile immunity all my life. Could this somehow be reflected on the tests I did: could having a weak immunity make my antibodies mechanism also weak, making them unable to show properly on the HIV testing? 

Thank you, sir. Have a nice day! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
I. Sometimes the best treatment must be done in a doctor's office, e.g. cryotherapy (freezing), cautery, or application of things like podophyllin resin or trichloroacetic acid. Prescriptions for self treatment include podofilox (Condylox), sinecatechins (Veregen), or imiquimod (Aldara, Zyclara). The best choice varies from case to case, which is why you should see a doctor.

II. These details make no difference. The tests are basically fool-proof, and you can rely on your result. There is no reason to suppose the nurse would give you the result before it was conclusive. But when you establish care for HIV prevention (and for your partner to be treated), you can speak with the doctor about having a lab-based blood test to confirm your negative result.

III. I'm not sure what you mean by "fragile immunity". Most people with frequent colds, for example, have entirely normal immune systems. In any case, there are NO immune problems -- no matter how mild or severe -- that have any effect on HIV test reliability. In fact, there are no medical conditions of any kind that make HIV testing less reliable. Don't worry about this!

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39 months ago
Thank you! 

Last thing, I'd want to ask you in more detail about the risks of transmission of HIV by kissing: 

In the time I've been with him I had an overall bad oral hygiene, with delicate teeth gums, some bad teeth, and one large mouth sore just under the lower lip. Given these, could I've possibly contracted it by kissing? 

I broke up with this person so I don't plan on being tested together with him for any purposes. Still, should I make one conclusive test on my own to be 100% sure, or based on all this data you can conclude with 100% certainty that I don't have HIV? (If yes, when should I do this final test?)  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Don't worry about details like dental health etc and kissing as an HIV risk. If you think about it, such dental problems are very common, so there must have been billions of kisses between HIV infected and uninfected persons in which one or more had such problems -- and still no known cases of HIV transmission by kissing. Nobody can say the risk is zero, but it's in the same ballpark as the chance of being struck by a meterorite!

With a negative duo/combo test moret han 6 weeks after the last exposure, you have already had condlusive testing. But if you would like still further reassurance, you are welcome to be tested one more time. If so, have a lab-based test, not a rapid while-you-wait test. Then you won't have to worry about the technique used by a nurse or perhaps other lesser trained person.

That concludes this thread. Best wishes and stay safe.
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