[Question #413] Combo test and Oraquick accuracy

34 months ago
Hi Dr.

On 10/9 I received unprotected oral sex at a topless bar in So. California. The dancer was either Puerto Rican or maybe black. I was drunk but I do remember her asking me if I had any diseases and she was worried about no condom. 

2 days later I got a sore throat with red spots on the roof of my mouth. I went to urgent care 4 days later and they checked for strep it was neg. They said it was viral. 
 About 3.5 weeks later my hemmoroids were acting up and I got an anal fissure which I have never had. I went to the Dr. At 4 weeks, 28 days after, 27.5 to be exact. I asked for a full std screen. She tested for gon. Chlamidia, syphillis, hepatitis and hiv 1/2 p24, I believe she said it was a rapid combo. The lab did specify 1/2 p24 cia or cla. All negative.

7 weeks after (51) days, I went back again as I was extremely paranoid about passing something to my wife. She said I didn't need any more tests if I only had oral but she gave me another rapid combo Hiv 1/2 p24 and referred me to psychiatry, they put me on lexapro for anxiety.

I've been a nervous wreck and 9 weeks after I started getting loose stools only in the am when I wake up and have had headaches and neck pains. It's been 12 weeks going on thirteen for my final blood test at 92 days next month.  

I took a Oraquick from the drug store at  11.5 (81 days) and one at 12 weeks (86 days). I also developed a rash on my butt on the 86th day. I do have hemmoroids, and it is almost gone 2.5 days later. 

What are the chances of HIv? I am also worried about syphillis due to all the rashes? I never seen a chancre but am worried maybe some of her saliva leaked from her mouth to my anus and I sometimes bleed down there. 

Please let me know! 









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

Welcome to our Forum.  I will do my best to help.  You did not get HIV from the exposure, I am confident of this and your test results prove it.  Here are the facts:

1. Most exotic dancers/commercial sex workers do not have HIV (or other STIs for that matter).  The fact that your partner stated her concerns suggests that she is cautious and makes your risk lower still.

2.  There are no proven cases in which a man has gotten HIV from receipt of oral sex from an infected partner (there are a very few cases in which performing oral sex on an infected man has led to infection).

3.  Your test results are conclusive.  The combo tests provide conclusive test results at 4 weeks following an exposure and all tests, including the Orasure are conclusive at 8 weeks (56 days.

As for syphilis, the symptoms you describe are not suggestive of syphilis although the manifestations of syphilis can be quite variable.  Syphilis is actually rarer than HIV at this time, rarely transmitted by oral sex, and 2/3 of the syphilis that does occur occurs among men who have sex with other men- thus your risk for syphilis is very low as well.  I would not be worried about syphilis but if you wish and it would give you peace of mind, a blood test for syphilis at this time would provide conclusive results. 

My sincere advice is to not worry further about HIV or other STIs as a result of your dalliance.  Focus on addressing your guilt and the anxiety you are experiencing.  Working with a professional as you are doing may be helpful as well.  I hope these comments are helpful to you.  EWH

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34 months ago
Dr. Hook,

Thank you for your reply. So to recap you are certain the 4 tests on 10/9 exposure;

11/6 HIV 1/2 HIV P24 AG/CLA 27.5 days
11/30 HIV 1/2 + p24 AG/cla        52 days 
12/28 Oraquick Oral Swab 82 days
1/4      Same Oraquick         86 days 

Is this 100%? Do you think it is safe to resume relations with my wife? 

As for the syphillis, I never had any lesion on my penis, 100%. I examined it daily. I did get a small whitehead on my sac at about 7 weeks but I popped it and it healed 1 day later.

The rash on my butt that I got this Monday 1/4 was after a New Years weekend of drinking and eating a lot of unhealthy food. My poop seemed hot and liquidy and it irritated. I'm pretty sure that caused the rash, it cleared already. This morning and somewhere around 7 /8 weeks I did have a small circle dry skin on my palm. The skin came off and left no mark. I have also had 1 loose stool every morning for about a month. I have been under heavy stress and panic attacks.







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

I am not sure why you repeated your question.  The answer is the same.  You DO NOT have HIV from the exposure you describe, thus there is no reason related to this exposure to be concerned about sex with your wife.  Also, as I said above, the likelihood of syphilis is very, very low and should not be a concern. 

The rash and stool changes you mention are irrelevant to your test results.,  EWH

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34 months ago
Dr. Hook,

I wanted to thank you again for answering my questions. I am ready to put this behind me and your assurance on the reliability of my multiple tests has eased my mind and anxieties. 

I would appreciate it if you could answer my last question and close my thread.   

In your opinion based on your experience what is more important as far as accuracy, the amount of time passed or the type of test. If only one test were available would a combo blood test at 7 weeks as I took or an Oraquick swab test at 12 weeks be better? My hypochondriac tendancies has me wishing I did both of those tests in reverse order.

Thanks again for your help, please close my thread and I hope you have a great week. 




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

This is a repetitive question.  Further testing is not needed and is a waste of time and money.  As far as test performance is concerned, the results of a 7 week combo test and a 12 week Oraquick test are essentially equal.  Both results will give the same answer. 

This will conclude this thread.  EWH

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