[Question #4073] HIV and Syphallis Risk

33 months ago
Hi There,

Firstly, thanks for the fantastic work you do and I hope you can answer my questions.....

I'm a usually Hetrosexual male but about 6 weeks ago, after a very drunken night out, I engaged in a sexual encounter with another male. The encounter involved fingering, oral and rimming as well as a very brief moment where I inserted into his anus unprotected( less than a minute and only like three thrusts as I panicked and it wouldn't insert properly) 

I am racked with guilt and anxiety and so a four days later visited an NHS clinic and had a full screening where all the results came back negative. 

After 3 weeks I had a standard finger prick test for HIV which also came back negative.

At 4 weeks I had a Biolytical HIV Insta Test which also was a negative and also a Chalmyida and Gonnoreha screening which also came back negative.

At 5 weeks I had a Syphallis test which came back negative!

The lovely health nurse at the clinic told me that I don't need to come back if i didn't want to and would only need to come back to ease my anxiety but she doesn't expect my results will change and told me it was purely down to me but she said to stop worrying so much.

The question i'm asking is, should I listen to the Nurse and move on with my life? Or am I very still much at risk and need further testing? I'm so confused as to what to do and how much risk i'm still at! 
33 months ago
By the way I don't have any chancres, sores or any rashes that i can find and believe me i've looked! 
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to our Forum.  I'll do my best to help.  I'm please to hear that you were tested- the exposure you describe was not without risk as you did penetrate your partner's rectum with your penis.  While the exposure was likely to be somewhat lower risk because it was brief, there are no scientific data which help us to define the relationship between duration of exposure and risk.  Thus rectal penetration is considered the same, irrespective of duration.  My comments are as follow:

1.  You do not indicate whether you were the one performing oral or analingus or receiving it.  If you were performing oral sex, testing for infection by gonorrhea and chlamydia at the throat is appropriate.  If you were receiving this, simply testing secretions from your penis or your urine is sufficient.  Either way, the risk related to analingus is likely to be very, very low and not a concern.

2.  In the absence of sores and lesions, your syphilis results are conclusive and do not need to be repeated.

3.  I am not familiar with the Biolytical HIV Insta Test but there is a test by Biolytical for HIV called the INSTI test.  If this is the test you had, it is a test for antibodies only, not the more widely used test for HIV antigen and antibody which provides results a bit more quickly than antibody only tests.  Antibody only tests are not considered entirely conclusive until 8 weeks after and exposure.  Combination antigen/antibody tests are considered conclusive at 6 weeks. With either test at 4 weeks the majority of persons with recently acquired HIV would have positive tests (over 90% either way) but not entirely conclusive. 

Thus, to summarize, I see no need for further testing for syphilis, gonorrhea or chlamydia.  While your HIV test is strong evidence that you did not acquire HIV, there remains a small likelihood. To be entirely confident you could ask to have a combination HIV antigen/antibody test done at this time and, when you get a negative test result as I'm confident will be the result, you can be entirely sure you were not infected.

I hope this information is helpful.  If there are any further questions, please do not hesitate to follow-up up for clarification.  EWH
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33 months ago
Thank you Dr Hook,

So to summarise the only risk to rule out now is the HIV risk? You said you are confident you expect a negative result is this based on my 4 week result? 

I’m based in the UK, is the duo test just a normal blood test? 

Should I refrain from having sex until the test is conclusive? 

Very frustrated that the nurse told me that I didn’t have to get retested if I didn’t feel the need! Just to clarify it was the INSTI test I took!

Thanks for your help and sorry for all the follow ups! 
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
You are correct, the only STI that you've tested for that there could be any risk for is HIV.   My sense however is that your risk for HIV as well is quite low.  Personally, I would not be worried but if you desire to be absolutely sure, a duo test at this time would provide a conclusive result.  Thus ,I guess my answer is similar to that of the nurse.  Your risk is quite low but not zero (less than 1% For sure).  There question is just how worried are you.  If you are concerned hopefully testing, will be helpful.  EWH---
33 months ago
Thanks Dr Hook, I think to be sure and safe I’ll get the further test this week.

Lastly, I read online from Dr Handsfield on Medhelp said that “nobody who tested negative at 4 weeks, ever went on to have HIV” I think he was referring to his patients, does this include the test that I did?? 

Thanks so much for your help, this will be the last question and I’ll leave you be :) 
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
You are correct, neither of us has seen someone with your situation have a change in test results.  This may happen but it is rare and I anticipate your test will be negative as well.

Take care.  As you point out this will compete this thread.  EWH
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33 months ago
Thank you Dr Hook,

I just read that the Biolytical Insti test is now considered to be a 3rd Generation test, does that change anything or would you still recommend taking the duo test?
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Third generation tests are antibody detection tests. No change in my assessment or advice.  The thread is over.  EWH
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