[Question #6125] Follow up (additional STI testing)

19 months ago
Hello doctors, I am back on the forum with a new question regarding STI's. My anxiety had me hyper focused on HIV, but now I am realizing I put myself at risk for a number of other infections with my encounter 10 weeks ago (risk event described in detail in prior post) so I am considering a 10-std panel. However, in an effort to save money from testing, I would greatly appreciate if you could assist in narrowing down this list?

- Hep A/B/C: I am almost certain I was vaccinated for Hep A + B but may have to check my records.. I read on earlier forum posts that Hep C is hardly an STD and is not recommended outside of potentially traumatic anal intercourse? 

- Chlamydia/Gonorrhea: Pee does not burn, ejaculation does not hurt, no discharge, though possible testicle aches but I think that may be psychosomatic given the "aches" set in after I had read about STD's causing them ... thanks brain

- Herpes 1/2: No outbreak anywhere (at least not that I have noticed). I have heard these tests are unreliable anyhow?

- Syphilis: Would one for sure notice a "chancre" and would someone who was recently infected always display one? I have noticed nothing odd on my genitals. No sores, no bumps, no redness.

- HIV: No matter the risk, no matter the symptoms, you would NEVER recommend additional testing after a 6+ week negative, correct?

Here's some symptoms that have not cleared up since mono diagnosis: persistent swollen lymph node in my neck for over 2 months (unsure if that is typical of mono, also possible swollen nodes in groin can't tell for sure), fatigue for over 2 months, weight loss (could be due to severe anxious episode before HIV testing). Other possible symptoms: yellow back of tongue with a bad smell/bad taste in mouth, although dentist said it looked normal. I have also noticed I have had more watery ejaculation. Could low libido cause this? My sex drive has been nearly non existent since this event (sickness, anxiety, sex the last thing on my mind after this scare.)
19 months ago
Perhaps worth mentioning the girl said she tested negative for "everything" 2 weeks after our encounter...
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome back, but sorry you found it necessary.

You're overreacting to a low risk situation. Both you and your partner seem to be at low risk of STD, as well as HIV, and you give evidence of a partner with no active, transmissible STD. It would have been wise to use a condom, and in the future, I hope both you and your partner will get in the condom habit. But this really isn't the kind of exposure most people get worked up about and neither should you.

I'm not going to further address HIV. Your mono, or its persistent symptoms, are not due to HIV or any STD (except that the EBV/mono itself may have been sexually acquired). Mono symptoms often persist for a while, as yours have. It means nothing in regard to HIV or other STDs.

You correctly understand the non-risk of viral hepatitis (A, B, or C) for the reasons you state yourself. You have left me nothing more to say.

I agree your genital symptoms are more likely psychological than anything else. That said, the risk of gonorrhea or chlamydia in this situation is moderate, and it would be reasonable for you to have a urine test for both. You can expect negative results:  you have no symptoms to suggest these STDs, and since gon/chl testing is the most common of all STD tests, you cane safely assume your partner's negative test results 2 weeks earlier included both. But it can't hurt for you to be tested as well, for the reassurine you will gain from the very likely negative results.

Syphilis is essentiallly nonexistant in people like you and your partner. If you hac acquired syphilis, you probably would indeed have noticed a painless penile ulcer, and its absence should be reassuring. For conclusive certainty, have a blood test. You're beyond the 6 week window, so a test now will be conclusive. But the chance of syphilis is almost as low in this situation as it is for HIV.

Herpes is very unlikely without obvious symptoms, and the tests are not perfect. The odds of a wrong or misleading test result is a lot higher than the chance you caught it. That's why STD clinics almost never test for herpes after any single exposure. The exceptions are symptoms suggesting herpes or sex with a known infected partner. You meet neither of these criteria.

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

HHH, MD
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19 months ago
Thank you Doctor, I will get Ch/G/Syp tests to get over all of this once and for all. And I really am sorry if I’m being a nuisance. I never once had any formal sex education and greatly underestimated my risk prior to this event, and now am greatly overestimating my risk it seems.

I just know EBV/mono tests are somewhat unstable, and wanted to make absolutely sure that it wasn’t HIV, as my symptoms were completely identical. And the lab telling me to retest at 12 weeks made me really uncertain. (They also make money off additional testing I suppose..)

I know this forum discourages continual posts about the same exposure, but this may also be helpful to readers.. I noticed you and Dr. Hook pushed your 100% conclusive range for HIV testing from 4 weeks up to 6 weeks. Do you ever foresee that new  guidance being shifted further out, or is that biologically impossible? 

Again, apologies if my questioning is inappropriate. I am very thankful for your services and will be much more careful in the future.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
The "unstable" nature of EBV tests comes in only when testing is negative, or in people without actual mononucleosis, primarily in interpreting tests in people who were infected years in the past and might or might not have reactivated disease. It's not a problem in people with actual mono:  in such patients, a positive test result is conclusive.

The tests you have had already make it 100% certain HIV wasn't the casue of your mono symptoms. Many labs, clinics, and doctors continue to recommend testing at 12 weeks, but it is unnecessary. That advice is left over from older HIV tests no longer in use. There has never been a reported case of someone with negative AgAb testing at 6 or more weeks after exposure who turned out to have HIV, except rarely in people who were on HIV drugs for PEP or PrEP. You won't be the first.

The reason for our change in advice from 4 to 6 weeks was based on newly published data. There is no reason to believe that will change again.

I have the impression that your anxieties are leading you to unnecessary web searching, and like many anxious persons, you are selectively finding or focusing on information that reinforces your fears. It's not worth it, and I suggest you stop web searching about HIV, EBV, etc.

Do your best to move on without worry. There is simply no chance you have HIV.
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19 months ago
Thank you so much for your reassurance. I’m convinced that I do not have HIV and you and Dr. Hook saved me from an excruciating few weeks until the 12 week mark.

However I did run into one curiosity  regarding HIV testing. This is purely out of interest, not actual concern for my results necessarily. 

The study you and Dr. Hook cite for the 6 week window period states that antigen is undetectable in all individuals after day 50. It is my understanding that antibodies attaching to antigen is what makes antigen undetectable. Thus, if antigen is undetectable in all by day 50, why wouldn’t all “antibody only” tests be positive at this time? If antigen is gone by then,  because of antibody production,  shouldn’t all tests detect the antibody before the 3 months? Wouldn’t 4th gen combo testing essentially be an antibody only test beyond 50 days? Perhaps you can correct my understanding.

Again, thank you. I’m vowing to stay off the internet for awhile and to move on from this. I understand this will be my last question on this forum.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
That's an excellent question and your reasoning is sound. In fact, the modern (3rd generation) standalone antibody tests almost always are positive by 6 weeks. I'm not sure about the technical issues that makes a small percentage of these tests requring ~8 instead of 6 weeis. It is also true that p24 antigen is absent from the blood (usually after 2-3 weeks and probably almost always by 6-8 weeks). Indeed, after that time there is little if any difference in performance and results interpretation between the antibody and AgAb tests. The importance of the AgAb tests are for testing from 2-4 weeks after exposure; although it takes 6 weeks for 100% of infected people to be positive, the large majority become positive 2-4 weeks after infection, a lot faster than the standalone Ab tests.

I'm glad the discussion has been helpful. Take care and stay safe.
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