[Question #58] HIV and STD prevention

39 months ago
Hello Dr. Handsdfield,

I do live in Brazil and 2 weeks ago, I met a girl and we did some sexual games like rubbing penis and vagina, but at one moment she simply put everything inside and made some strokes. Well, this was enough to turn on the red light and cause me a very high level of anxiety of course. I know her for some time, and I know she's a luxury escor girl and she said she takes care of herself with regular tests and protection (ha!) but honestly who on earth will know for sure what she does. So, resuming, I had an unprotected penetration.

Two days later, I decided to go to my urologist doctor for a PSA check and told him what happened. He noticed I was very inconfortable with what happened and prescribed 1g of Zitromax to block any eventual bacterian DST and told me to do an HIV test at 15 days. He said the modern Ag/Ab+P24 tests would work at this time. I'm vaccinated against HEP-B, but he also asked for an HEP-B test to verify if the vaccine worked. Mu doctor also did an detailed examination during this examination looking for small cuts on my penis and found nothing. One week later I visited him again and he did another examination using a chemical reagent looking for fungi and eventual HPV lesions. No sign of problems of any kind at this second time.

What's your practical opinion about this? Would the 15 day 4th gen HIV test be useful ? I've heard that the best time would be at 4 weeks Any advice ?

Until now I dont feel any symptoms at all. Nothing but anxiety of course.

Thank you for your attention

Anthony



Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

Welcome to our forum.  I'll be pleased to comment.  The risk for acquiring any STI, including HIV from a single sexual exposure is low and, in the situation that you describe your risk is now close to zero.  I say this for several reasons including that you and your partner discussed whether or not she had a STI (good job, many people do not ask these questions) and she said no and that she does get checked regularly.  Most people tell the truth.  in addition, the brief nature of your penetration and the fact that you took azithromycin soon after your exposure (we do not routinely recommend this but, having taken the medicine does reduce your risk for gonorrhea, chlamydia, and syphilis) also may it unlikely that you acquired an STI.

As for the accuracy of the HIV test at 2 weeks, while a test at that time would detect most recently acquired HIV infections, to be completely confident, a four-week test is preferred.

Those are the facts.  Personally, if I were you and given the information you have provided, I would not worry further and see no need for more testing.  I hope these comments are helpful to you.  EWH

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39 months ago
Hello Dr. Hook,

First of all, thank you for your answer. You know the problem, thousands of people asked thinks like this every day. I really appreciate your dedication and patience.

If I understood well, a test at 15 days may be very indicative but may not be reliable to the point to be sure. Of course it's all about anxiety, this thing is really scary and seraching the internet for answers is sometimes not a good idea, you know.

May I ask you if the most usual symptoms of a HIV / HPV / Herpes / Hepatitis would appear on the 2nd-3rd week after exposure, at least on people with strong immunological system ? I'll not enter the DST spiral paranoid neither bother you with stupid questions ad nauseum.

The problem is that I may have to travel in one week and return after 40 days, and I'm afraid to not be possible to test at 4 weeks. Would a test at 3 weeks be a waste of time , although the "corret" is at 4 week ?

Anthony.



Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

Symptoms of common STIs, like herpes, gonorrhea, non gonococcal urethritis or syphilis would typically have occurred by the 2nd or 3rd week after exposure. further, you have been tested which is more reliable than looking for symptoms. 


If you feel the need to test further, a repeat test at 3 weeks using a 4th generation, combination antigen/antibody test of the sort you desribe would provide further assurance that you did not get HIV from the exposure you describe.  EWH

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39 months ago
Finally I can post here. There is something wrong with this website, getting many errors with different browsers and computers...

Hello Dr. Hook,

I didn't made the HIV test at 15 days, it was just a question about its viability and since I may have to make work travel before the recommended 28 days, then I asked if the 21-23 days test would have a reasonable precision. You already answered, at 28 days would be much better and conclusive.

Now, just in doubt between doing the test at 21-23 or later when I come back, maybe 45-50 days.  It's that old anxiety case, you know.

I really admire your patience dealing with so many questions about this. 





Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Thanks, I am pleased I could help.  EWH
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