[Question #500] Should i retest?

40 months ago
Hello, 
I am a heterosexual female, healthy, not on any medications and do not have any preexisting health conditions. I also do not have any symptoms. I had multiple unprotected sexual encounters with a male for about a month and a half. Our last encounter was November 27th, 2015. I am not aware of the partners status in terms of HIV (or any other STDs). I did blood work to be tested for all STD's, including HIV using the ABBOTT architect DUO. I also had a pap smear done. My doctor said everything is negative and everything looked fine. At 8 weeks i had another DUO HIV test, which was also negative. I am from Ontario, Canada and have talked to an HIV hotline. They indicated that 13 weeks is the only way to get a conclusive result for HIV. Is this correct? Should i test again for HIV? Also, should i retest for any other STDs at the 12 week mark? I'm not sure how conclusive the tests are for other STDs (ex. syphillis, HPV, etc). I am getting somewhat anxious over this issue because i have gotten numerous responses in terms of window periods. My doctor for example told me the window period for HIV is 6 months and it would not show up even if i had it. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

You can relax. I'm afraid you have found a number of unreliable resources, and it's disappointing that the HIV Hotline is also behind the times. The fact is that the duo test, which is based on detection of both HIV itself (the virus's p24 antigen) and the immune response to it (antibody to HIV) is conclusive any time 4 weeks or more after the last possible exposure.  In addition, the statistical likelihood your partner had HIV is very low, probably under one chance in a thousand -- or maybe as high as 1% (1 in a hundred) if he was bisexual or an injection drug user. Your own doctor appears to be even more misinformed; people used to worry about 6 month window periods with old tests not used the past 10-15 years, but no longer.

As for other STDs:  I hope you had testing (vaginal or cervical swab, or perhaps urine) for chlamydia and gonorrhea. Those are the most likely STDs you might have acquired. Those tests are conclusive from a few days after exposure. Syphilis: statistically extremely unlikley (almost as rare in this situation as HIV), but conclusive at 6 weeks or more. HPV:  no reliable test exists.  A negative pap is fine, but is not in itself a test for HIV. You'll just have to live with the knowledge that we alll get genital HPV, usuallly several infections, during our sexually active lives; and your risk is no higher on account of this particular partnership. Beyond that, I wouldn't recommend any other STD testing at all.

So all is well. If you were my patient (and even if you were someone close to me personally) I would say to stop further testing and go no with your life with no further worries about this past relationship.

I hope this has been helpful. Best wishes to you--  HHH, MD


---
40 months ago
Thanks for your reply doctor. I was just wondering, what about hepatitis?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Thanks for the thanks. I'm glad to have helped.

The risk of viral hepatitis is virtually zero in this situation; I wouldn't recommend testing at all unless you have reason to suspect your partner was a bisexual or an injection drug user. Even then, only hepatitis B is an issue. Contrary to popular perceptions, hep C is rarely sexually transmitted except in gay men who have traumatic (bloody) rectal sexual exposures. (In monogamous heterosexual couples in which one person has HCV, who have had unprotected sex regularly for 10+ years, the prevalence of hep C is no higher in the partners than it is in the general population.)

That said, if you insist on hepatitis testing, it should be 6 weeks for hep B and 12 weeks for hep C.

---
40 months ago
Thank you so much for your response! I did receive the hep B vaccinations so I'm assuming the chance i have it are relatively low. I am however worried i have contracted genital herpes.  I was with my partner for less than 2 months, and we had sex 2-3 times a week. It was unprotected and he was a male. I am aware that transmission from male to female is almost double, but since i am not aware of his status how likely would it be that i may have it? I would consider him promiscuous as he stated he was had close to 15 partners. I did not observe any signs/symptoms from him throughout the time i was seeing him. I also have not observed any S&S on myself. I am also aware that herpes can be asymptomatic. If i were to get an iGg at 11 weeks would that be considered accurate? Would you recommend testing at all since it is so common? I'm really worried because my previous partner before him was a long term relationship and he has never slept with anyone else other than me. We may get back together and i don't know what to do if i have genital herpes.  

I forgot to add, i tested negative for chlamidiya and gonorrhoea. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Glad to hear you were immunized against hep B. Your risk for that infection was zero. Definitely don't test: it will be positive (for hep B surface antibody) because of the vaccine. Also glad to hear about your gonorrhea/chlamydia tests.

I cannot say the risk you acquired genital herpes is zero from the relationship described, but it's very low. It is true that genital HSV often is asymptomatic, but that's often because mild symptoms go unnoticed. People who are especially concerned and on the lookout for symptoms are more likely to not miss them. Accordingly, absence of S&S in your situation is quite reassuring. Testing for HSV in this sort of situation is controversial, mostly because the HSV blood tests are not perfect. They not infrequently give borderline results that require still more testing to sort out the truth (and a lot of anxiety during that process). Also, nearly half of all adults have positive IgG results for HSV1, usually from oral infection and often without symptoms, with usually with no way to know with certainty whether the infection is oral or genital. If you do it, for sure have an IgG test only, not IgM; and I would recommend waiting until 12 weeks after your last sexual exposure in that relationship.


---