[Question #4138] HIV testing window and result feedback needed from Dr. Hunter Handsfield

84 months ago

Dear Sir,

Only God knows how much I browsed and searched to touch base with you, and finally landed up here with hope to get an answer from you.Sir,I(Male 34 years) got engaged in an act of protected sex with a spa girl on 17th July 2018.After the act I was so tensed that I took the spa girl for blood test in a lab on 22nd July'2018(Since the spa girls provide alike services to others as well).Her reports came back negative for HIV 1&2(4th generation combo duo,ECLIA),VDRL (NON REACTIVE),HBsAG (NON REACTIVE),HCV(NON REACTIVE) but still I was tensed based on window period concept that I googled in internet.Now come my turn I have been tested negative with HIV (1&2)& p24 antigen DUO test-4th generation (ECLIA)and 4th Generation HIV (1&2)& p24 detected combo Ag/Ab CMIA(Abott Architect) on 10th day/15th day/18th day/22nd day/28th day from the date of protected sex. Various users in medhelp like TEAK and some nurses stick to the 3 month principle. Dr Brian from http://www.thebody.com (also recommends 3 months for conclusive result),seeing all these I get so much tensed as the matter of testing window is never constant based on feedback from all expert, so I decided to finally land up to the ultimate person, that's you.Your posts gave me some hope, hence asking you the same.

Question 1)

As I read your articles you vouch that a HIV 4th Gen (combo duo)test is conclusive 100% at 28 days?Is this still hold true or do I have to repeat my test any more, please advice?As I ask different doctors in different forum some say to wait for 3 months/some say to wait for 6 months and some for a year before to test. In some places in health tap I see you mentioned as 6 weeks as well in some post.So is 4 weeks conclusive for me or I have to take for 6 weeks as well?I have not taken any PrEP and only take BP medicine.

Question 2)

What is the window for syphilis testing?Is it one month or more?

Question 3)

Will you advice me any further STI test to do as well like VDRL/HBSAg/HCV/HSV looking at my case?

84 months ago

Also I did urine routine and culture for gonorrhea and chlamydia as prescribe by one doctor since I was felling burning sensation in tip of my penis(no discharge /no ulcers in penis) .Not sure if that is the right procedure to identify this infections?Looking forward to you. The routine report came fine for all parameters with Puss cells only 2-3 hpf where as normal range was 0-5 hpf. Not sure how to attach report here in this forum.

84 months ago

I again forgot to mention teh act was a protected insertive vaginal sex and nothing else.There were no oral or no anal sex.

H. Hunter Handsfield, MD

84 months ago

Welcome to the forum and thank you for your confidence in our services. I'll try to help.

Congratulations for using a condom: that alone provide excellent protection against HIV and other STDs. Even without a condom, the risk of was low: even among the highest risk "spa girls", at any point in time most have no transmissible STD, including HIV. Third, your partner was tested for several infections, including HIV, proving she was not infected. Could she have been in a window period? Yes, but the odds are very low, and once you knew her test results, it was unnecessary for you to be tested.

You have been seriously over-tested, and the first few blood tests were too soon. However, the negative results at 28 days are almost conclusive and highly reliable. Advice to test at 3 months or later is old news, based on blood tests for HIV that have not been much used for over 15 years. The antigen-antibody ("due", "4th generation") blood tests are usually conclusive by 28 days and always by 6 weeks after exposure. Some advisors are overly careful in advising 3 months, and others simply have not caught up with the modern technology of HIV testing. To your specific questions:

1) 28 days was our standard advice, but about a year ago an authoritative scientific review showed that in rare cases, it takes 42-45 days for the AgAb tests to turn positive. Since then, our advice on this forum has been to allow 6 weeks for conclusive results.

2) Syphilis blood test window is 6 weeks, no change in the past several years. Some of the newer tests, e.g. EIAs and related technologies, may be conclusive by 4 weeks, but more research is needed. For now 6 weeks is the safe interval.

3) I would have recommended a urine gonorrhea/chlamydia test, but I see in your follow-up question you have done that. Otherwise, you were over tested. Have a final syphilis and HIV test at 6 weeks, but no other testing of any kind. The risks of other infections were much too low to make testing worthwhile.

In the meantime, stop panicking and worrying so much!! Almost certainly you have no infection from the exposure a few weeks ago.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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H. Hunter Handsfield, MD

84 months ago

There is no need to attach any reports or photos in this forum. We do not examine such materials. And by the way, your result of 2-3 white blood cells (pus cells) is normal.---

84 months ago

Thank you Sir.

The doctor just recommended normal routine urine and culture.He said not to mention anything about names gonorrhea and chlamydia.Will that work Sir, or I have to again retest urine specifying those names?

Also Sir what are my chances that the 6 weeks test will be negative as well for HIV and VDRL?

84 months ago

Sir can you please answer my last question.Sorry if I am too anxious.You can well understand my situation

H. Hunter Handsfield, MD

84 months ago

Patience, patience. The moderators are not on call 24/7. We attempt to answer questions within 24 hours, but this is not a site for urgently required information.

Actually, I do not "well understand [your] situation", not after the reasoned, science based reassurance you now have had, probably from your own doctor and also in my comments above. We don't expect much of forum questioners, but we do expect sober, thoughtful responses to our replies and to believe the science. Please re-read my comments above and concentrate this time.

You said you have already had a negative test for gonorrhea and chlamydia. If not, you should have one now. If you did, I see no need to repeat it; the initial result is conclusive. I doubt a standard urinalysis and culture test will find anything, but you should trust your doctor and follow his or her advice.

It is almost 100% certain that your HIV and VDRL tests will remain negative at 6 weeks.

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84 months ago

Sir apologies.I didn’t mean to disrespect any one,actually I am very tensed.Sir I’ll surely test on 6th week and let you know the result.Sir my urine RE and CS report came as negative.Can you please guide me what is the name of specific gonnoreah and clymadia urine test so that I can get this done in a lab near my place in India.Also out of curiosity would like to know about a comment of yours first post where you have written “knowing on her test results being negative it was unnecessary for me to get tested”,that was so reassuring Sir,could you please explain why it was unnecessary for me?That will help me to understand better,with all due respect and protocols per this forum,I’ll open a new question for further info/queries,it will be great if you could answer this one last time to me in this thread.

Thanks a lot in advance Sir.

H. Hunter Handsfield, MD

84 months ago

"...explain why it was unnecessary for me?" Your sex partner had a negative test, meaning she was not infected. You could not catch an infection she did not have!

And you also used a condom. For those reasons, it would be a waste of money for you to be tested for gonorrhea and chlamydia. And it might be quite expensive in your country. But if you insist on testing, ask your doctor or a laboratory about having a nucleic acid amplification test (NAAT) for these infections on a urine sample. India is a medically sophisticated country and these tests probably are easily available, especially if you are in a major metropolitan area.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please DO NOT ask another question about this exposure and your STD worries. There is no additional information you can provide that would alter the answers you have already received, and repeated anxiety driven questions are discouraged -- and often are not answered (and with no refund of the posting fee). Instead, carefully re-read my comments above.

I hope the conversation has been helpful. Good bye.

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