[Question #5441] Questions concerning exposure and tests

23 months ago

Dear Dr HHH & EWH: Male 34 yrs old, celibate prior to this act. Based on your advice to others on MedHelp, I deduce that I had practically risk free exposures. In brief they included with same lady: Unprotected Cunnilingus giving, multiple Receipt Fellatio, protected condom penetrations into vagina – condom on at all time, no breaks, she was on periods, did not penetrate for long, did not feel the penetration due to condom, became flaccid, but condom on always. Also extensive lip to lip kissing + nipple sucking. I am keeping the exposure brief and can elaborate more should you need to know more to assess risk.

Tests done: 9 days post exposure - Quest Diagnostics, 4th Gen HIV1/2 Ag/Ab w/ REFLEX; NON-REACTIVE

44 days (and 11 hrs) post exposure - exact test above same lab: NON-REACTIVE; Other STDs also negative/non-reactive

Other details: I suffer from autoimmune conditions and take immunosuppressive medications such as Humira (40 mg pen every fortnight).  In the distant past, I have had to be on low dosages of Methotrexate, Prednisolone and others to control my condition.

1 Are my tests definitive and conclusive and can I go on with life worry free knowing I am not infected and get married?  I read some places that there is Second Window period with Ag/Ab , that tests must be at the 28 day mark.  I also see some places that say 42 day is conclusive.  And I see some places that say 45 day is conclusive.

2 Does my conditions & the medications I take affect the test and the test results - Ag or Ab or both?

3 Do I need to worry about HIV2 at all about which I read scary things - too long to develop Ab and no Ag test for it or can I accept my results and move on with life?

4 Do you recommend any further testing?

5 Would you need more details about my exposure?

7 Net net of the above, how would you advice I deal with the above incident, test results, and life?

Respectfully

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome to the forum. Thanks for your question.

You had a very safe exposure. The greatest potential risk, which still was miniscule, was from receving unprotected oral sex. Absence of symptoms in the next 10 days (discharge from the penis, painful urination, penile sores or blisters) is strong evidence you were not infected. This exposure did ot warrant all the tests you had. The only rational tests would be a urine test (or urethral swab) for gonorrhea and chlamydia, valid any time more than 4-5 days after the event, and HIV and syphilis blood tests 6 weeks after tje evemt. However, if I had been in your situation, I would not have had even these. The risk was nil for all practical purposes -- and it was zero for some of the infections you mention.

Your 9 day and 11 days HIV tests waere meaningless -- too soon. The 45 day HIV test was conclussive. You don't say what "Other STD" tests you had, but at 45 days all probably were conclusive (and mostly unnecessary).

1) Yes, all definitive and no reason not to marry. No worries about infecting a future wife or other sex partner(s) on the basis of the exposure described. There is no such thing as a "second window" with the HIV AgAb test. Either you misunderstood something or found a site with inaccurate information. It is never necessary to test precisely at any particular day. It's just important to wait until 6 weeks for a truly conclusive result. (There's no meaningful difference between 42 and 45 days. The data aren't that precise.)

2) I hope your rheumatoid (or psoriatic?) arthritis is doing well -- imputing from your treatment. Contrary to common misunderstanding, the drugs you have had now or in the past do not raise the chance of catching any infection. They slightly raise the chance of complications or reactivation of some chronic infections -- but no known effect on catching them, including everthing from common colds to pneumonia to HIV and any and all STDs. They have no effect on HIV tests of any kind, regardless of common beliefs and statements you can find if you over-search online.

3) HIV2 is nearly nonexistant in the US (only ~200 cases so far, almost entirely in people who caught it in Africa before immigrating). And the tests you had detect it just fine -- again, despite what you can find online.

4) Do not have any more tests of any kind.

5) No more detail needed.

6 (7) No worries at all. Move on and do not give the sexual exposure another thought.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
23 months ago
Dear Respected  Dr. HHH:  Thank you very much for your responses.  I might not have been clear.  Clarifications below and some questions, sir...
1. I did not have 11 day test.  I had a 9 day and 44 days and 11 hours (i.e. 44.5 day) test.
2. On both days, 9 and 44, I tested non-reactive for HIV1/2 AgAb Fourth gen, negative (non-reactive as the case may be for) Syphilis, Gonorrhea, HSV1/2, and Chlamydia.  Gonorhea and Chlamydia were through urine tests.  All these tests were performed on both days.
3. I had read from medhelp based on your responses there that oral sex and frottage were only theoretical risk. Has that assessment changed over time now?
4. Now this event is 50 days in the past.  The 44 day post exposure was last Wednesday - May 22 2019.
5. Yes sir, in one of the posts you had disabused that the second window notion was an urban myth
6. Yes sir, I am doing alright and there is some relapse of RA based iritis.  But, I suppose that is due to psychological stress from this event and nothing else.  Thank you for asking, sir.
7. So sir my condition and medications have no bearing on the test results or the risk of catching any STD or HIV.  Is that right, sir?  I understand that it can reactivate other conditions due to general fighter T cell suppression. I am trying to eat healthy and exercise. Of late, the mental stress has had a toll on me. I was looking for you and Dr EWH and was so thankful that I found you here today.
8. Can I take my tests as conclusive and definitely non-reactive and that I am not infected for sure sir?
9. Thanks for clarifying about HIV2 sir. Online info is scary despite plethora of yours and Dr EWH's clarifications.
10. Also sir, the 44 day test result overrule any exposure history or risk. Is that right sir? Just using your earlier 28 day statement against the new guideline.
11. Thank you sir, I will go on and get married and forget this incident if I can have your final blessing to do so?
12. My gratitude to you.  Also kindly express the same to Dr EWH.  Both of your words and resources give so many anxious folks mental reassurance and clarity.

23 months ago
Dear Dr. HHH:
In my response to your response sir, I forgot to mention the following:
13. I had nude frottage for some time, although the time period of nude skin to skin contact might have been 5-7 minutes.  I do remember rubbing penis and head against the vulva and clitoris, but I never penetrated her without condom, sir, and even condom based penetration was brief and I did not feel it due to the condom and flaccidness.  When I mentioned lady, I meant the woman was a woman (36) slightly older than me (34).
14. I tested all the tests I had mentioned at the 44 days (and around 11 hour) mark.  On the 9th day, I misspoke, I tested all of these except HSV1 and HSV2.
15. Sir, so should 42 or 43 or 44 or 45 day  HIV1/2 AgAb testing all be considered fully definitive and fully conclusive requiring no further testing?  And do these have same degree of conclusiveness as 50, 60, 70, 80, and 90 days HIV1/2 AgAb tests?  I also ask this for my edification sir.  Among all the tests I did, as expected, my biggest concern and worry was for HIV1/2, sir, given what it means for family for which I am the sole provider.
16. Based on your guidance - I am going to forget this incident and move forward with life without worry of any sort for any STDs including HIV1/2 and get married and look forward to starting a new chapter and family.  Would you agree sir?
Thank you, Dr. HHH.  
23 months ago
Dear Dr. HHH:  I understand you are super busy, sir.  Could you please take a few minutes to answer my questions?  Sorry for the many points.
17. Does my exposure (also including nude frottage without insertion - penis vulva and penis labia rub - very brief and not rough) also constitute overall nil fo practical purposes risk for STDs and HIV1/2 sir?
18.Given I tested at 44 days and some change hours and not post 45 whole days, does that still constitute fully definitive and conclusive result as far as HIV1/2 is concerned?
19. Also, does the 44th day 4th Gen AbAg test non-reactive, overrule any exposure history (even if someone's exposure was the worst and highest risk, i know mine was practically no risk) or any / all symptoms sir as far as HIV1/2 is concerned?

Thank you for being kind to answer my questions and also indicating that my health conditions and medications do not affect the test results in any way and nor do they affect the risk of catching any of these STDs including HIV.

Respectfully.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Sorry for the slightly delayed reply.

The AgAb (combo, 4th generation, duo) HIV blood tests are among the most accurate diagnostic tests available for any medical condition. If done sufficiently long after the last possible exposure, the results are 100% conclusive. It is also true that these test results are not affected at all by any other medical condition or medications. Your results PROVE you do not have either HIV1 or HIV2. You do not need any more testing. And because the results are conclusive, the level of risk at the time of you exposure(s) doesn't matter. However high the risk was (it was little or zero for most of the ones you ask about), you didn't catch the virus. Do your best to stop worrying about it.---
23 months ago
Thank you, sir.  I will move on.  Just confirming, 44 days is fully definitive and conclusive?

Thank you for your service, sir.  Words can't express the gratitude I have for your opinion, evaluation, and answers.  Deepest respects.
23 months ago
And sir, at 44 days, like for HIV1/2, my other STDs negative and non-reactive test results (shphyllis, gonorrhea, chalmydia, HSV1/2) are also definitive and conclusive?  Please forgive me,  I do not mean to bother you.  I will move on after this.
Have a good day, sir.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Already answered in my reply immediately above. Will it help to hear it a second time? All your results are conclusive.

That ends this thread. I hope the discussion has been helpful.
---
---