[Question #4092] Maximum Window Period

33 months ago

Doctor,

I'm male, married. Exactly 36 days ago I had a brief unprotected encounter with a female (gave/ received unprotected oral; PIV sex, I ejaculated outside, sex was 5-15 minutes in duration.) I’m uncircumcised.

Female was middle aged, Caucasian, married. Took place in suburban AL. No outward signs of infection but I was very drunk.

At 17 days post I was tested for Chlam/Gon/HSV 1&2/Syph/HEP ABC/HIV RNA, all NEG (odd because I was certain I had HSV 1). Online ordered through Quest.

Symptoms:

- Non-specific general tingling but I'm certain it's anxiety; when I'm not thinking about it I don't notice it

- Very mild balanitis symptoms (have had this before, red swollen foreskin/glans) at 33-34 days post. Treated with clotrimazole 1% and cleared almost immediately. Nothing else, and I inspect very frequently.

- My current plan is to retest for everything (only diff. will be p24 test instead of RNA) at 6 wks + 3 days and 11.5 weeks post.

My questions:

1- Approx. how reliable is the negative RNA result at 17 days post?

2- At what point can I be certain I’m clear? I’m currently traveling and will return home exactly 12 weeks post encounter. I obviously can’t infect my spouse with anything.

3- I know HSV testing without symptoms isn’t recommended, but at what point is the result reliable?

4- Is it worth adding Trich to my next test?

5- Is there any way to get precautionary syphilis treatment without going to my provider?

 

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to our Forum.  I'll be glad to comment.  Thanks for your detailed yet concise description.  I'm not sure what you mean by "PIV sex".   The encounter you describe was low risk- your partner was in a low risk demographic group, most people do not have STIs and even when they do, most single exposures do not lead to infection.  Your 17 test results absolutely eliminate any possibility that you had gonorrhea, chlamydia or HIV.  The absence of any HSV lesions likewise makes this most unlikely,  The other STIs (syphilis, hepatitis) are very unlikely but have not yet been definitively ruled out although repeat testing at this (6+ weeks) will accomplish that.  In answer to your specific questions:

1- Approx. how reliable is the negative RNA result at 17 days post?

Highly reliable.  There is really no need for additional testing. 


2- At what point can I be certain I’m clear? I’m currently traveling and will return home exactly 12 weeks post encounter. I obviously can’t infect my spouse with anything.

See my comments above.


3- I know HSV testing without symptoms isn’t recommended, but at what point is the result reliable?

If persons know to have acquired HSV, testing is reliable at 12 weeks. 


4- Is it worth adding Trich to my next test?

Probably.  Asymptomatic trichomoniasis does occur in men and while unlikely, is if anything, more likely that STIs such as syphilis or gonorrhea.


5- Is there any way to get precautionary syphilis treatment without going to my provider?

Not that I would recommend.


I hope this information is helpful.  My sense is that you are in the clear.  I hope that this information is helpful to you.  EWH

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33 months ago

Doctor,


Follow-up: 


1- Believe I had HPV with warts before (24 yo, 36 yo now) but cleared it. Never formally diagnosed. Wife has had multiple checks, never positive for HPV. Concern about reinfection?


2- PIV = penis in vagina 


3- Balanitis symptoms? Had milder symptoms before, not this bad. This only persisted 2 days, cleared immediately with antifungal. Possibility it's linked to an STI?


4- Irregular patches of darkened skin: Noticed 3-4 patches of slightly darker tan skin (I'm white), maybe a little lighter in the center, on the shaft, near the base. Approx 1/8-1/4 inch, varying. Very faint. Possibly preexisting, not sure. Seem to disappear if skin is stretched. Not raised/firm/itchy or anything just discolored. Watching for any change in size. Not caused by masturbation; that has become rare. Assuming they ARE new, would random light brown/tan splotches be indicative of any other infection, or more likely a pigmentation issue? If not, do you have any idea of cause/recommendation?


5- Other tests I should consider aside from Trich after an unprotected encounter? Need to be comprehensive. Cost isn't an issue.


6- Syphilis: I ask about treatment because of timeline. I return home at 12 wks post. If syphilis testing is positive at 6, treated at 7, is 5 weeks sufficient to treat, retest, and be clear/safe?


7- HSV test is included again at 6 wks anyway. I know I'm grasping, but what % reliability would you put on a 6 wk HSV test with no visible symptoms? 


I will save my second follow-up for after my 6 wk testing. Thank you for your prompt response and patience.

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago


1.  The present of past warts or HPV would not meaningfully change your risk for infection.
2.  Thx for the clarification.
3.  No link to STI.
4.  I doubt that these are new and most likely reflect your own hypervigilance.  Even if new, there are no STIs that would cause such changes.
5.  No need for other tests.  Some might recommend a urine test for Mycoplasma genitalium which is being investigated as a POSSIBLE pathogen but data are lacking in your situation.
6.  If follow up syphilis test were positive (it will not be) the infection can be treated and rendered non-infectious within days of starting therapy. 
7.  >80%. ball park estimate.


You really are worrying more than is needed.  EWH
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32 months ago
Dr. H,

Just got the results of my 6 wk tests. 4th gen HIV AB 1&2, HSV IGG 1&2, Syphilis; all NEG. Trich test isn't back yet. This has helped my nerves quite a bit but wanted to follow up.

1- HIV: 6 wk AB and 17 day RNA = All clear, yes? Any chance of seroconversion beyond this?

2- HSV 1/2: Both 17 day and 6 wk tests NEG. No symptoms aside from general tingling and the balanitis. However I didn't get the actual index values. Still curious about no HSV 1 infection. Pretty sure I've had it (oral) a while. Possible it missed HSV 1 twice? Understood about 6 wk HSV being about 80% reliable. Is it worth testing again before 11.5 weeks per my plan? Say 8 weeks?

3- Balanitis/Candida: The balanitis still has me concerned. It began aprox. 30 days post with 2-3 days of increased smegma, flared badly for 2-3 days (red, patchy glans, red, irritated, swollen foreskin, possibly red spots but nothing resembling a blister), and reacted immediately to the clotrimazole cream. However, some faint redness remains, and if I don't reapply the clotrimazole 2-3 times daily, the glans becomes extremely dry and almost has a slight dry film. Still some red spots from irritation. Foreskin has returned to normal. Going on day 14 of treating it. Any possibility this is HSV linked having lasted this long?

 I know there is a possible link between balanitis/HSV, but my question is how? Is balanitis caused by HSV simply due to irritation from sores on the glans? Is there a difference between this being possibly fungal or bacterial?

4- Trich: Haven't received results. If positive, what is the recommended treatment?

Thanks again for all your help Dr.
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
1.  These results are conclusive.  No HIV, no need for further testing.
2.  Yes, the current test could miss HSV-1 twice.  Personally I see no need for additional testing which will just increase your chance of having a falsely positive test result. That said, little to be gained with an 8 week test. 
3.  No, this i snot HSV.
4.  Results will be negative.  If they were positive treatment with metronidazole would be recommended therapy.

This is my 3rd response to your questions.  As per Forum guidelines, this thread will be closed later today without further replies.  I really think you are over testing and hope that you will soon believe your test results and that you did not acquire any STI from your dalliance so that you can move on. EWH
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32 months ago
Thanks Dr.