[Question #4207] A few question's about various things, this will help me and others struggling

84 months ago

Hello Dr's thank you for helping me last time. I am still having anxiety (but am taking meds) over my exposure but am very curious about these other topics.

When is a DNA PCR test needed for HIV tsting? Is there a strain or medical condition as to when generation 3 or 4 will not do.

Is it possible for the 4th generation test to miss an infection after the "window period"? Or several times after?

Are Antigens always detectable during early infections?

Delayed servoconversion? Is it a myth?

How good is the Alere Determine 4th gen. Rapid test? Does it still detect Antigens even though there was an issue when they first arrived?

Do medicines like flonase which might immunosuppress affect the 4th generation test?

Do any auto-immune diseases affect testing? Antibody production , antigen production or false negatives etc.

If someone catches oral Gonorrhea/ Chlamydia would that be cured by the normal antibiotics or is there another procedure?

What are the chances of spreading Gonorrhea or Chlamydia via penetration in one exposure? 50% 100% ?

If someone catches Syphilis via penetration (vaginal) would the chancre/sore be present on the penis or will it travel elsewhere?

How safe is unprotected oral sex?

Thank you very much for your time. I've had these questions in my head and was hoping to get clarification.

H. Hunter Handsfield, MD

84 months ago

Welcome back to the forum. Sorry I can't review your previous thread(s). There is a glitch in the search function. If you can provide the previous question number(s), I'll be able to see them, in case it might influence my responses here. But as I look at your question, probably it wouldn't make much difference.

Yes, HIV antigen is always present and almost always detectab le in early HIV infection. Delayed seroconversion is a myth; it was an occasional problem with earlier HIV blood tests, but to my knowledge has never been shown to happen with the modern antibody tests (3rd generation) or antigen-antibody tests (4th generation).

The Alere test is as good as all others, extremely reliable. You are correct that there was a brief time when the antigen component of the test was not working reliably, so the test functioned more like a standalone antibody tests. Mind you, that was excellent, just not quite as good as intended. In any case, the manufacturer corrected the problem and my understanding is that it's working as intended.

There are no medications or disease that are known to have any effect on HIV test reliability or time to positive results. That was always pretty much an urban myth, based on theoretical concerns that never proved to be a problem in real life. In any case, to my knowledge there have been no reports of any interference with the AgAb (4th gen) tests, including by the most potent immunosuppressive drugs or chemotherapy. Same for all known illnesses, including those associated with immunosuppression or autoimmunity.

Some of the standard treatments fail to cure oral gonorrhea more often than genital or rectal infection. That's one reason ceftriaxone is now the mainstay of treatment. Even for pharyngeal (oral) infection, treatment failure is rare.

The only study that ever specifically addressed gonorrhea risk after a single exposure estimated the risk at around 50% for male to female transmission from unprotected vaginal sex, and around 10% in the other direction, i.e. female to male.

Transmission of syphilis (also herpes and HPV) generally requires that the organism be massaged into the exposed tissues. Therefore, initial lesions usually are at sites of maximal friction during sex, such as head of the penis, vaginal opening or labia minor, the anus, etc. Chancres, initial herpes, and initial HPV rarely if ever show up at more distant sites.

In general, oral sex is safe sex, with low risk for all STDs and virtually zero risk for some. The three most common STDs for the insertive (penile) partner in oral sex are gonorrhea, herpes due to HSV1, and nongonococcal urethritis (NGU), which sometimes may be due to entirely normal oral bacteria. (That's only a theory, not yet proved.) However, even these are relatively uncommon, probably under one chance for every 1,000 exposures. (That also is an educuated guess; no data exist.)

Be aware that all are generalizations, with potential exceptions depending on details of exposure, partner risk, etc. But I hope these comments are helpful.

HHH, MD

---

H. Hunter Handsfield, MD

84 months ago

Typo above: female to male transmission risk, roughly 20% for unprotected vaginal sex, not 10%.---

84 months ago

My original question was #4155

I am having trouble believing my results and wonder if I should get a PCR test.

My main worry is what I mentioned before about my wife developing swollen lymph nodes. They were extremely big and on both sides of her head. Also her last period was long. Usually 5 days and last time was 8. I dont know if that's a symptom. That has kept me up at night.

So basically the flonase wouldn't affect the test.

Thank you for the answers I was worried I asked too many questions.

I know I tested a lot.

How can one tell between Gonorrhea and Chlamydia? I'm guessing from your answer Gonorrhea really is they one to worry about catching orally.

Again thank you very much for the answers.

84 months ago

Sorry both sides of her face by her ears and lately I've had pain in both my feet.

I apologize for my annoying questions but I appreciate your help.

H. Hunter Handsfield, MD

84 months ago

That you are "having trouble believing [your] tests" is an emotional/psychological problem. Correct, you have been seriously overtested. It is not normal to remain unconvinced after the repeated, reasoned, science based reassurance you have had and generally indicates an underlying issue, such as guilt over a regretted sexual choice. I suggest you seek professional counseling about this. You're never going to gain confidence you aren't infected by still more tests or by hearing the same reassuring responses again and again on this or any other forum or from any other HIV expert.

As discussed in your other thread, enlarged lymph nodes alone never are from HIV, and flonase would have no effect on HIV test results. Clues to gonorrhea are more pain on urination and thickier (yellow, pus-like) dischage; chlamydia less painful or no pain and less discharge, cloudy not pus-like. However, these are only clues. The only way to know for sure is to be tested and to believe the results.

---

84 months ago

Thank you Dr. Handsfield.

Please let me explain myself.

I am honestly not trying to be an annoying person. Those questions about STDs other than HIV were questions I just wanted answers for because I could not figure those things out in the "research" I had been doing. Especially the difference between chlamydia and gonorrhea.

Now with me doubting my tests. I am scared that I am that one rare person who has to take a PCR to find out he has the virus (if such a thing exists I dont know) because my antigen and antibody levels were too low for the 4th generation test to find it.

Also when it comes to my wife's lymph nodes. Please let me explain. I've never seen them get that big, tender and it hurt when she moved her neck. In fact I've never seen them at all until I started googling hiv symptoms and HIV was the number 5 reason for that to happen. I understand that there are many causes for that but I had nothing else to go by. No fever, she didn't feel sick, no headaches. I freaked out and whenever I think about how I've tested negative I go back to that.

Every little thing I notice scares me. I've known her for 14 yrs and her period has always been 5 days. Last month it went 8. That also freaked me out. I'm just trying to exlain why I have been so anxious.

Yes, I am feeling extremely guilty. I also am trying to rationalize something I don't understand. I'm not usually this "irrational".

Thank you very much for all your help.

H. Hunter Handsfield, MD

84 months ago

With this additional description, it is even more apparent your wife's possible lymph node enlargements are not due to HIV.

I believe you should consider discussing all this with your wife. She'll tell you she feels fine and probably would be willing to have an HIV test to reassure you. Or professional counseling, especially given your "every little thing" statement.

Otherwise I have no further comments or advice and that concludes this thread. Please do not ask another question along these lines. Repetative anxiety driven questions are not permitted and a new one would risk being deleted with little or no reply. We are not inclined to keep repeating the same advice in different words, and there is no new information you can possible think of that would change our opinions or advice; and such questions have little educational value for other users, one of the forum's main goals.

Good luck to you.

---