[Question #3918] Hiv risk and STDs risk
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85 months ago
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Hi, I had an exposured with a girl with protected vagina sex and unprotected oral sex. At the mid of it, the girl start menstruate and the blood is all over my penis covered by condom, I take out the condom quickly so I didn't sure that my condom was broken or not. And I scare her blood or secretion will cause me at risk with my improper taking out the condom.
I did a test 1 MONTH after and here is the result:
Syphilis Serology (Modified VDRL) : Non-Reactive, Non-Reactive
*HBsAg (CMIA) : Non-Reactive, Non-Reactive
*
*HIV Ag/ Ab Screening (CMIA) : Non-Reactive, Non-Reactive
Herpes Simplex Type I IgG : 0.25
Herpes Simplex Type II IgG : 0.13
Chlamydia IgG : 0.3
* Syphilis TP (CMIA) : Non-Reactive, Non-Reactive
At this moment, it's already 2 months after the exposure (the test was 1 month after exposure), I think I don't have any sysptom related. I just have some small white dots on my penis head and it's don't become worst or greater until now, I seem like Balanitis as the information I got from website.
Therefore, my question are what're the risk am I dealing with my condition now? Should I take a gornorrea test since I don't take before?
Thank you.
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H. Hunter Handsfield, MD
85 months ago
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Welcome and thanks for your question.
Sex during menstruation does not increase the risk of HIV transmission compared to sex without exposure to menstrual blood. And you used a condom, so you were fully protected. And as you may know, there is virtually no risk of HIV from oral sex, even unprotected. The chance is nearly zero that you caught any of the STDs for which you were tested.
You were tested too early for conclusive. It takes 6 weeks for conclusive results on the HIV Ag/Ab and syphilis (both blood tests. It takes up to 16 weeks for conclusive HSV test results. HBsAg is is never 100% by itself; conclusive testing requires both HBsAg and HBsAb (antibody) -- and ideally HBcAb (core antibody) as well.
Blood tests for chlamydia are pretty much useless. Definitive testing must be done on urine or a urethral swab, testing for chlamydial DNA. Gonorrhea testing also would be wise.
Your penile symptoms don't really sound abnormal. If you are confident the "white spots" are not normal for you, you should be examined professionally. But no STD is a likely cause, and probably they are not new -- and not related to the recent sexual exposure.
Don't get me wrong: except for chlamydia, your current test results are highly reassuring. The large majority (95-98%) of newly infected people would be positive by 4 weeks. Just not quite 100% conclusive.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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85 months ago
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Thank you Dr. HHH for your reply. I am glad that you are the person who reply my question, because since my last exposured I was very anxiety, you are the doctor that I following and reading your great opinion and explanation in the forum will give me peace of my mind.
I still have some questions :
1) You claimed that "The chance is nearly zero that you caught any of the STDs for which you were tested.", I not that clear about why my chance is so low? Due to the nonexistent of sysptom and exposured I had?
2) Actually, I went to tested after 1 month was based on your opinion on the other forum, which you are no long active over there, I didn't realize you are in this forum at that time. [The window period is changed to 6 weeks due to the CDC found a very little group of person was detected after this period, however, we doubt that MAYBE the person confused about their actual exposured date and given the inaccurate day time. ] Therefore, for my case, I can think myself 100% reliable for my negative test after 4 weeks, and just to retest again after 6 weeks in order to conclusive the result due to the CDC guildline. Is it proper for me to think like that? Am I misunderstanding something or information what I studied?
3) Do I need to retest Syphilis again due to my situation?
4) I am sorry I forgot to tell that I did a medical check up also after 1 month exposured, it's included HBsAg and HBsAb, which came back the result of not detected and 0 IU/L, could it be conclusive already?
5)" Don't get me wrong: except for chlamydia, your current test results are highly reassuring. The large majority (95-98%) of newly infected people would be positive by 4 weeks. Just not quite 100% conclusive."
It's means that I can no worry about all the stds and hiv except Chlamydia and gornorrea right?
Thank you.
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H. Hunter Handsfield, MD
85 months ago
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1) The reasons oral sex are low risk are ocmplex. They have to do with low rates of many oral STDs (e.g. chlamydia), the mechanics of sex, and likelihood that significant numbers of bacteria or viruses will have access to the urethra. The reasons for low risk for condom protected vaginal sex are obvious. Whatever the reasons, probably fewer than 1 in a thousand persons would be expected to acquire an STD after an exposure like yours.
2) We long recommended 4 weeks as conclusive for the AgAb (4th generation) HIV blood tests. However, about a year ago a comprehensive review concluded that 6 weeks is necessary with the AgAb (4th generation) HIV tests to assure 100% conclusive results. Test performance is excellent and usually conclusive at 4 weeks, but 6 weeks is best for absolute confidence in a negative result.
3) "Need" is relative. The chance you have syphilis, based on both the exposure and current test results, probably is under 1 in a million. From a strictly medical perspective, I would say no further testing is needed. But if you're going to remain nervous without a 100% conclusive test result, you should be retested. It's your decision, not mine.
4) To the best of my knowledge, those results are conclusive.
5) Yes, you correctly understand.
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85 months ago
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Thanks for your reply again Dr. HHH. I went for blood test again after the 2 MONTHS exposured. Here is the new result.
Syphilis Serology (Modified VDRL) : Non-Reactive, Non-Reactive
*HBsAg (CMIA) : Non-Reactive, Non-Reactive
*
*HIV Ag/ Ab Screening (CMIA) : Non-Reactive, Non-Reactive
Herpes Simplex Type I IgG : 0.32 (0.25 past result)
Herpes Simplex Type II IgG : 0.25 (0.13 past result)
Chlamydia IgG : 0.5 (0.3 past result)
* Syphilis TP (CMIA) : Non-Reactive, Non-Reactive
1) Am I conclusive for the hiv and syphilis results?
2) I am quite worry about the hsv 2, I realised that the index was increased from 0.13 to 0.25. I know the result is still negative but this is a 9 weeks test, I worry the index number will keep increase to positive when I retest again on 12 weeks.
3) About the Chlamydia, the lab I went to do not provide the urine or a urethral swab, I still do the blood test because it is a combo set with the other STDs check. The result I get now is still negative also. Will this negative result assume that my chance infect to Chlamydia even lower? Or can be conclusive?
4) I did a gornorrea swab test too. My result are, Gram stain :No gram negative diplococci seen and Culture :No Gonococci isolated. I did the test at 2.30pm and I piss 1 time in the morning. When I swab around my urethral orifice, I feel like I see nothing on my cotton swab. Will my improper of taking the sample affect my test result?
5) I am worry about the genital warts too, although I know it's common. Due to my exposured, is my risk high to get HPV or genital warts? I had my first vaccine after 1 month of exposured, will it help?
Thank you.
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H. Hunter Handsfield, MD
85 months ago
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1) Your syphilis and HIV test results are conclusive.
2) The change in index value is meaningless. The same specimen tested 10 times would give 10 different numbers, anywhere from 0.1 to 0.9. All results below the cut-off are equally negative. The chance of HSV2 from such an exposure is virtually zero, but if you feel you need to have a definitive test result, repeat it again after 16 weeks. In the meantime, you can safely assume you were not infected.
3) Your negative chlamydia blood test is good evidence you have never been infected with chlamydia anytime in your life.
4) Those gonorrhea test results are conclusive.
5) Genital warts can appear up to a year after exposure. Your vaccination makes no difference: vaccination does not prevent infection from exposures before the first dose. Still, don't worry about it. The chance of warts after a single condom-protected exposure is very low.
That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. You can go forward with no worries about this exposure. Best wishes and stay safe!
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