[Question #4799] Testing anxiety on high risk behavior

27 months ago
10/20/2018 possible unprotected with stripper. 10/23 2.5 days post. Difficulty urinating tested neg for GC treated proactively 250mg ceftriaxone & 2 weeks of doxy. Few days in developed red rash or blotches on upper torso chest and back.. Almost bruised feeling discontinued doxy. 10/25 4.3 days post neg  hiv RNA 10/26 5.5 days blood drawn rapid HIV1&2 AGAB AND RPR syphilis GC urine neg, 10/30 24 days hiv RNA neg, 11/14 hsv1&2 hep abc RPR syphilis all neg, 11/16 26 days hiv 1&2 agab and rpr all neg, 11/27 37 days Hiv rna 1 HIV Rna 2 Hiv 1/2 agab all neg, 12/11 51 days Hiv 1/2 agab hep abc RPR syphillis all negative. All the while thru this I have experienced clearly some anxiety but also swollen tender lymph nodes in groin area and at times burning, tender lymph nodes in arm pit and collar bone. over last few weeks very congested and sore throat with bright yellow mucus. I do live in a state that has bad allergies but not sure this would have any effect. I also take Valtrex 1000mg once daily does this effect testing? If the lymph node pain is unrelated and something else could it have effected this testing? Been treated for Balanitis and hpv.  Is the testing conclusive to rule out HIV 1&2 Syphilis? Conclusive to rule out hep abc? Conclusive to rule out gc? Do symptoms outweigh testing or vice versa.. Is further testing recommended.? Just don't feel well...want to know if I can confidently have unprotected with my current GF and what to do next symptoms are tough. Thanks for your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome back to our Forum.  I'll do my best to help.  I'll answer your questions momentarily but I find myself wondering what is meant by "possible unprotected".  could you please explain.

In answer to your specific questions:
Is the testing conclusive to rule out HIV 1&2 Syphilis? 
Your HIV RNA testing on 11/27 effectively rules out the possibility of HIV, a result which was then conclusively confirmed with your negative tests on 12/11.  Your testing for syphilis and hepatitis on December 11 likewise rule out the possibility of syphilis and hepatitis (I should add that the antibiotics you took would  have cured syphilis if you had been infected).

Conclusive to rule out hep abc? 
Yes, see above

Conclusive to rule out gc?
Yes, and you were treated wih recommended treatment as well. Be confident you di dnot get gonorrhea wither.

 Do symptoms outweigh testing or vice versa.. Is further testing recommended.?
There is absolutely no reason for continuing to test.  To continue to do so would be a  waste of your time and resources.

When symptoms are present with negative tests, the tests are always the winner.  Symptoms tend to be non-specific with multiple possible causes.  

You can be confident that the Oct 20 exposure you describe did not give you any of these STIs which you might then pass on to your GF.  Time for you to put your concerns aside an move forward without concern.  EWH
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26 months ago
"Possible" doc cause I really don't have any recollection of leaving the club but I do know I showed up with a lot of money and woke up with none...I've been around a bit Spend that kinda money something def could of happened...I did quit taking that doxy only a few days in as I developed the rash... and was unsure if it was allergic reaction to 250mg ceftriaxone & 2 weeks of doxy. Both of which I have taking before with no reaction.  Does that sound normal? My question on the testing.... is cdc quoting 90 days and other sites as conclusive on hiv and syphillis and hep.  Does this differ from the testing I received in some way witch makes my testing 12/11 51 days Hiv 1/2 agab hep abc RPR syphillis all negative to be conclusive?  I realize much of your time is answering the same questions over and over... so I apologize.. It is very real when you going thru all this and the anxiety is high. Really would like to put this behind me and try and focus on....Y I am having these lymph node issues... understand what is going on... or at least cross this concern 100% off the list. Thank you for quick response... testing now at 89 days serves no purpose as well correct? Is there anything else std related to be concerned over here? Best Regards.. thank you for your help. 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Thanks for the clarification. The meds you took "proactively" effectively guarantee that you could not get gonorrhea, chlamydia or syphilis from the possible exposure you describe.  

the CDc's estimates are conservative and reflect their need to "never" be wrong.  You are in the clear!  Testing at 89 days would be a waste of time and money.  EWH
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26 months ago
Clarification here... I have only ever received a shot a 250 mg shot of Ceftriaxone... I only took 2 days worth of Doxy and discontinued after developing the rash...I have taken no other medication at all. I was prescribed 2 weeks.. but I QUIT taking it after 2 days.  Does that change or alter your opinion on being in the clear on the Syphillis or GC....  Last question have a great day.  I get you are saying the testing on the HIV 1&2 to be conclusive.  Thank you for your help
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Thanks for the clarification, it was not clear to me how long you'd taken the doxy before discontinuing.  The shot of ceftriaxone still would have had activity to assure that you did not have either syphilis or gonorrhea.  Ceftriaxone however is not active against chlamydia and no one is sure just how little doxy is needed to cure chlamydia.  I note that you mention urine testing for gonorrhea but not chlamydia.  In most labs the two tests are done at the same time on the same specimen.  I presume you were tested for chlamydia as well.  If so, in the context of your negative tests, you can be confident that you did not get chlamydia either.  I really would not be worried at all.

As you know, we provide up to three responses for each thread. This is my 3rd response.  thus this thread will be closed later today.  Take care- please don't worry. EWH
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26 months ago
For good measure... and I am sure you knew I would... tested again at 106 days post possible... 4th gen hiv 1&2, syphilis, hep a, b, c.. all negative. The only remark I will say si the (HSV index) for hep C rose from .04 to .07. Parameters for the testing are that anything below .9 is negative.  Is a hep c rna test warranted or the flucuation is normal and move on. 


Thanks for your help
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Fluctuation of the sort you describe is normal and of no medical significance.  You need to move on without concern.  Closing this thread now.  EWH---