[Question #4352] Follow-up to question #4268 - Syphilis and HIV

82 months ago

Hi Doctors,

I just wanted to follow up on the advice I received last time from Dr Handsfield about getting a final HIV test 6+ weeks after my exposure (protected receptive anal, unprotected receptive oral with a man who turned out to have gonorrhea and syphilis). I was on holiday when I last got in touch with you, and am back home now, but work travel commitments have left it tricky for me to schedule in a blood test (the sexual health clinics are understaffed and appointments are limited).

Because of this and my wanting this to be over, I attended a late night drop-in clinic where I was given an INSTI rapid HIV/syphilis finger prick blood test - this was done about 14 weeks post-exposure, and came back negative. The counsellor there told me that I could consider my results conclusive.

I have now been tested with a 4th-gen rapid test (I think the Alere?) at 4 weeks, and the Insti at 14 weeks. My main question was whether I would be able to move on from this exposure now, or whether I still needed further testing (i.e. the lab-based blood test) for the sake of increased accuracy/certainty?

Edward W. Hook M.D.

82 months ago

Back to the forum. On this occasion I'll be answering your question. In preparing to answer your question I reviewed your earlier interaction with Dr. Handsfield and agree with all that he said. Presuming that the condom remained intact, your risk for HIV was vanishingly low. Your recent, 14 week, INSTI HIV fingerstick test confirms that you did not get HIV. The INSTI Fingerstick assay is an antibody test for HIV and provides entirely reliable results at any time more than eight weeks following exposure. You're 14 week test result is absolutely reliable and there is no need for continuing concern or additional testing. It is now time for you to move forward from your exposure with no further concerns. I hope that my reply will help you to do that. Take care. EWH ---

82 months ago

Thanks Dr Hook. I am almost certain the condom stayed intact. I had assumed the 14-week test would be conclusive, but wanted to check seeing that Dr Handsfield had recommended a lab test...I assume this was due more to the timing of my question and what test would have been reliable at that time.

Thanks again for all the work you do on this forum, it really is greatly appreciated.

Edward W. Hook M.D.

82 months ago

Correct, different tests become conclusive at different times with combination HIV. Antigen/antibody tests being conclusive first, at 6 weeks after exposure. At the time of your recent test however (14 weeks) all tests would be conclusive. Take care. EWH. ---