[Question #5473] HIV/STD

20 months ago
On 13-Mar-19 I had protected vaginal and protected oral sex with someone who I know through dating website in New Zealand.
On 31-Mar-19 I had protected oral sex with another women(sex worker).

On 26-Apr-19 I had Rapid HIV & Syphilis Testing from "https://www.bodypositive.org.nz/". That was one kit that check for both HIV and Syphilis. I assume it was antibody only testing.


I have no fever or symptom until last last week. On 1-June I had fever with blocked nose/cough also some burning feeling on passing urine
and I could see yellow spot on my underwear. The fever was 100 degree and just lasted for one day it was gone after taking paracetamol.


Could you please suggest on my HIV testing. Was that reliable on 26-Apr-19 or i need further testing of any kind?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome to the forum. Thanks for your question.

The overall frequency of HIV is low in New Zealand, to my understanding, and your exposures were condom protected (including oral -- which isn't even recommended by many experts since STD/HIV risks are pretty low from oral sex, virtually zero for HIV). I'm not familiarwith the specific test package you had. I'm not sure I would assume the HIV component was only antibody testing, but even if it was, the results may have been conclusive. For sure the syphilis test was conclusive: all tests detect all infections by 6 weeks.

All things considered:  very unlikely partner had HIV, plus condom use, plus these test results add up to no realistic possibilty you have HIV, and for sure you don't have syphilis. I see no need for further testing. However, if you find the HIV test was NOT an antigen-antibody (AgAB, due, 4th generation) HIV test, then you could consider doing that to be even more certain. A clinic or doctor in New Zealand, or the lab you used, probably could sort this out in more detail than I can.

I hope this information is helpful. Best wishes.

HHH, MD
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20 months ago
Hi,

The test they performed was "INSTI Multiplex HIV-1 / HIV-2 / Syphilis Antibody Test". 
I went to my GP a week before and he said you don't need HIV testing as it is very rare in New Zealand and i used condom and already did a finger prick test for HIV. For the penile discharge and UTI like symptoms here are the test results:

SPECIMEN: Urine
Chlamydia trachomatis RNA: Not Detected
Neisseria gonorrhoeae RNA: Not Detected

SPECIMEN: NON MID STREAM Urine
Culture: Growth of Escherichia Coli

My GP treated me for E-Coli for a week with Augmentin 500 dosage three time a day and now i am feeling well.

Here are my follow-up questions:

1) Do you agree with my GP that i don't need any further HIV testing? (The test was INSTI Antibody only at 6 weeks after protected vaginal sex and 4 weeks from protected oral)
2) Can E-Coli be passed like from the events i described ? As i meet the women in March and E-Coli symptoms only appear on 1-June. Or this E-Coli infection was unrelated to sex events i had.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
1) I agree with your GP on this. I see no need for further HIV testing.

2) You had a urinary tract infection (UTI) due to E. coli. I'm glad your symptoms are clearing up -- Augmentin usually isn't used, since many E. coli strains are not suceptible to it. But apparently yours was.

UTIs can be sexually acquired in men, but primarily through anal sex -- because the rectum and feces naturally contain huge numbers of E. coli and other UTI-causing bacteria. Other cases result from urinary tract instrumentation, e.g. someone who has been hospitalized and had a urinary catheter. But apparently no anal sex and no instrumentation, so this has to be considered an unprovoked UTI. It probably is unrelated to your recent sexual encounter. In the absence of a clear predisposing factor like anal sex, UTIs in men normally should lead to evaluation for other predisposing factors, like prostate infection (also not an STD issue), kidney stone, or anatomic abnormalities. You should disucss this with your GP, including consideration of referral to a urologist for evaluation for such underlying factors. (You could print out this paragraph to discuss with your GP -- my perspectives as an infectious diseases specialist.)

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