[Question #6115] Final follow up to previous question

18 months ago
Hello Dr,

First i would like to thank Dr Hook for answering my previous question.

Having read allot of the post's on the site I must say i find it interesting that when some people (myself included)have a possible exposure  which leads to anxiety or guilt or both they/I become super scientists and the attention to detail and self examination that takes place afterwards and linking it to possible std diseases is very frustrating.
Also interesting is the need for a direct q&a with one of the experts on this forum even though similar questions have been asked before and answered, i guess that people/myself feel that our situation is unique and will be the first...

Does Dr know of a forum similar to this one that can assist with the psychological side of these std related events.

I have read on previous postings about hang nails but never knew what it was until i checked it out today and as luck would have it i think i have one on the finger i used in my event, i checked it and the piece of loose skin on the side of my nail is intact(not infected) and put some alcohol gel on it and experienced no burning or stinging which is a positive.

Combining this with my low grade eczema(only epidermis pealing) does the risk opinion change or not? 

I would also like Dr's opinion on hiv testing time frames please, i know that this forum recommends 6 week or more for definitive results which i have seen on other sites as well and then ofcourse there is the 12 week/ 3 month version and here and there even testing up to one year later....

I looked at the website of our lab here in my country and they use the 4th generation Elisa Hiv 1&2 test and state that a test has a window period of 18 to 21 days but that one should test at 6 weeks and if there was an exposure in the past 6 weeks at 12 weeks again. I also called them but got a different answer the person said at 3 weeks is good indication and 6 weeks is definitive which is what the forum says so i reckon 6 weeks should be definitive?

I am up 
18 months ago
Sorry for next message something happened and could not type in previous box, i am up to date on my hep a &b vaccinations do they offer sufficient protection? 

I am 45 and my wife 40 neither of us have the hpv vaccine, can we still get it? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome back, but sorry you found it necessary.

The forum is set up to limit the length of questions. You're supposed to stop writing and compress to fit the allowance, not spill over into a follow-up field. But you haven't gone far over the line so we won't make you start over, which is the standard response. It is clear you are not at risk (re-read Dr. Hook's replies).

I imagine there are forums for psychological and mental health issues, but I am unaware of any that address these issues specifically for HIV or STDs. You might look at thebody.com (HIV related).

Cuts, nicks, or hang nail in theory might increase the risk of HIV or other STDs from fingering, but there are no reported cases in which it was believed to have happened.

I agree entirely with Dr. Hook's comments in your previous thread and neither hang nail, eczema, nor anything else you mention changes our opinions or advice.

Previous advice about 3 month testing was based primarily on older HIV tests that no longer are used. Many physicians, clinics, and public health resources have retained 3 month advice either because they don't understand the newer tests or have a conservative, legall-driven perspective, preferring to err on longer intervalse from an over-abundance of caution. But the scientific data and most truly expert resources support 6 weeks for the standard antigen-antibody (4th generation, duo, combo) HIV blood tests.

That said, I disagree the AgAb tests are conclusive at 2-3 weeks. I suspect you are confusing the AgAb tests with direct testing for the virus in blood, i.e. PCR for HIV RNA. Those tests often are positive within 10 days and are nearly conclusive by 2-3 weeks. But most experts also recommend AgAb testing at 4-6 weeks. However, nobody recommends testing at all for the zero risk kind of exposure you had.

New HPV infections are uncommon after age 40 and probably there is no need and no value in you or your wife being vaccinated against HPV, certainly no need because of the type of contacts you describe in this an your previous thread.

I hope these comments are helpful. Do your best to move on. Try to separate your apparent guilt, shame, and/or anxiety over a sexual decision you regret from STD/HIV risk fromt htat event. They aren't the same. There is no STD/HIV risk, period. Believe it.

18 months ago
Hello Dr. Handsfield,

Thank you for your reply and detailed explanation! 

I assume you might have read the whole thread between me and Dr. Hook?

  I do not doubt Dr Hooks opinion as i know he is like you a leader in this field.

The reason for this last post is that i had an argument with my GP in regards to this and his viewpoint, i will take your and Dr Hooks opinion over his every time in this regard, he classified this event as low risk and did not recomend any prep or testing either but was going on about the hiv virus and other not dying or becoming ineffective soon after coming into contact with the environment and living for up to between 6 to 8 hours outside the body, is this not in controlled conditions like in a lab using specialized equipment etc?

Also i became ill this morning, diarrhea,nausea, heartburn and broke out in a sweat, but the sweat was more prominent in my facial area, and had heart palpitations, but no heavy or difficultly breathing, as this was a no risk event and these symptoms are 5 days after the event i will attribute it to some standard bug i picked up in the normal course of life, only reason i mention this is for me to show myself that i can figure it out myself and not come back here every week with symptoms and wanting to check it with you, agree with my assessment? 

As this is my 3rd post i would like to say that I will take all previous and forthcoming advise you and Dr Hook have given and will be giving  to heart and thank both you and Dr. Hook for your time and this forum.

And wish you all the best for the future!

Thank you!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
It's not our job to mediate disagreements between users' doctors and our own perspectives. All three moderators stand on our expertise and advice. Beyond that, I find your question confusing; Dr. Hook's advice was clear.

As for your symptoms, since it was impossible for you to acquire HIV from the event described, and because of their timing, it is not possible they are due to HIV from that event. And your symptoms are not typical for a new HIV infection either. They are most suspicious for a garden varity viral infection, perhaps with a touch of the physical manifestations of anxiety. Keep working with your doctor if you remain concerned.