[Question #3667] HIV/STD Testing Conclusive?

35 months ago

Hi,

 

Wish I had learned my lesson from before.  Four months ago, in another moment of sheer stupidity, I had unprotected vaginal sex with a csw in the red light area in Mumbai (very high risk).  I went on PEP within 12 hours and tested with the Duo test regularly during this time (every few weeks).  According to the CDC, the testing guideline is 12 weeks post exposure if one is on PEP.  I tested at 11 weeks and 3 days post exposure with Duo and it was non-reactive. 

 

1.     Do I need to test for HIV again, or is this conclusive and can I put this behind me?

2.     Do I need to test for Hepatitis B or C, syphilis, or any other STD (I did take 2.5g azithromycin and 800 mg cefixime a few days after the exposure), and if so, am I out of the window period for those tests?

 

Thereafter, I have become wiser in terms of safer sex.  A week ago, I had protected oral sex with two different csw’s in the course of one night (again red light and high risk).  The only time it wasn’t protected was when she took off the condom and used her hand, and then re-applied another condom and continued with oral sex.

 

1.     Is there any risk of HIV or STD and do I need to test for this most recent exposure?

2.     As a precaution, I did take 1.5g azithromycin and 600mg cefixime 5 days post exposure.  Would this be enough to cure any incubating STD?

3.     Would the antibiotics affect a gonorrhea/chlamydia test result?  I would imagine that one can get a false positive but not a false negative.  So, if I tested negative,  does that mean I am not infected?  What is the earliest I could test after exposure (and after antibiotics if it makes a difference)?

4.     There is a lab here that offers PCR testing for chlamydia and gonorrhea.  Though the sample required is urine for chlamydia, they normally do the PCR test on a swab for gonorrhea.  They have informed me that they can substitute with urine for gonorrhea as well.  Does this make sense that they can substitute sample type? 

5.     If I were to give the urine samples for chlamydia/gonorrhea, since they are two different tests, I would have to give the urine twice – can I do this during the same void, or do I need to do this on two separate occasions to ensure I get “first” void urine for each sample.  How long do I have to not urinate before giving a sample?

6.     All in all, given both the exposures (4 months ago and 1 week ago), is it safe to have unprotected sex with my wife without any fear of transmitting any STD?

 

Thanks!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum, but sorry to see you found it necessary.

First exposure:

1. Your results are conclusive and there is no need for further testing for HIV.

2. Azithromycin plus cefixime would have aborted or cured newly acquired gonorrhea, chlamydia, or syphilis and there is no point in testing for them. Treatment given that early would not only prevent or cure infection, but would prevent any test from ever being positive. Don't waste any money or time on these tests.

Second exposure:

1) It was completely protected. The condom change, and hand contact, carry no risk at all. Don't get tested.

2-4) There was no need for the antibiotic treatment, but just as above, it would have aborted all bacterial STDs if you had been exposed; and no need nor point in testing at this time.

5) You would have to clarify with the lab, but I see no reason you could not provide a single specimen. But for the reasons above, I suggest you not waste  your money.

6) Yes, you can safely resume unprotected sex with your wife without putting her at risk for any STD from these exposures.

I hope this information is helpful, but let me know if anything isn't clear.

HHH, MD
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35 months ago
Dear Dr. Handsfield,

Thank you for your reply.  I am relieved to note that I do not need any further testing for HIV or any other STDs.  

Would Hepatitis B or C be a concern for the first exposure (I have also read that co-infection with Hepatitis C could prolong the window period for HIV if one took PEP).  Are these even classified as STD's?

Also, as LGV is present in India, I take it you mean that this is included when you say that all bacterial STDs would have been prevented with the medication I took.

On another note, I know there is no way that I can ever tell if I was never exposed to HIV in the first exposure or if the PEP worked.  But, in your experience, is PEP very effective, or is it impossible to say?  

Thanks again for your help and wonderful insight.  God Bless.

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
The exposures described were risk free for both hepatitis B and C viruses (HBV, HCV). HBV is an STD, although the overall risk from sexual exposure is very low compared with blood exposure. HCV, in my opinion, should not be considered an STD. The only population group in which sexual transmission clearly occurs for HCV is men having sex with men who have potentially traumatic rectal exposure -- i.e. the actual risk probably is because of blood exposure. The heterosexual partners of people with HCV have NO increased risk of infection at all. Even after 20 years of marriage, for example, the frequency of HCV is no higher in the spouses of infected persons (assuming they don't also share needles or other obvious blood exposures). Certainly there is virtually never a risk of HCV, or need for testing, after any heterosexual exposure.

Yes, LGV also would have been prevented by the treatments you had. Although established LGV is normally treated with 3 weeks of antibiotics, such prolonged treatment is not needed for prevention.

PEP is believed to be nearly 100% effective. But I don't see how this matters. Your test results prove you weren't infected. Given that, what does it matter if your partner were infected, i.e. if you were exposed?

Thanks for the thanks and your kind comments. 
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35 months ago
Dear Dr. Handsfield,

Thank you for your reply. 

My final question pertains to HSV.  Are HSV blood tests accurate enough to diagnose whether one has been infected with HSV or is it a waste of time and money?  And if the answer is that they are accurate, should one take IgG or IgM, and whats the difference between the two? 

With that, we can close this topic.  Thank you again for your help - your replies have been very informative, comprehensive, and reassuring! Wishing you all the best for the future.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
HSV testing is not usually done after any particular exposure, unless a) there are symptoms that suggest a new herpes infection or b) if the the exposure was particularly high risk for HSV, like sex with a partner known to have a herpes outbreak at the time. The tests are often misleading, and it is especially important to NOT have an IgM test for HSV. 

There are two types of antibody in response to most infections. IgM appears first (1-3 weeks) and then IgG antibody (a few weeks to months). Therefore, an IgM test often is positive before IgG, so positive IgM with negative IgG suggests a new infection; and positive IgG, with negative IgM suggests a longstanding one. That's the theory. However, it often doesn't work this way with herpes. In addition, the IgM test often gives false positive results -- and the last thing you want it to have a positive result that in fact does NOT mean you are infected. For these reasons, STD and herpes experts never recommend IgM HSV testing for their adult patients.

I recommend you not have an HSV blood test. But if you decide to do that, have only an IgG test. You can expect a negative result.

That concludes the 3 replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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