[Question #6354] Tests

18 months ago
Hello,
Relating to my previous posts, regarding my massage parlor hand job, i was well aware of my heightened anxiety. More for reassurance i went for a panel of tests and consultatiin again so i could move on. HPV threat was as both doctors said misunderstood by me. These tests were 23 days after the incident. 
All tests negative and mainly conclusive I have was told. These tests included HIV RNA - undetected, HIV p24 antigen and antibodies - negative, T. Pallidium IgG and IGM Ab (Elisa) negative, VDRL/RPR - non reactive, HSV-2, igG and antibody (Elisa) less than 10 u/ML unlikely infected with HSV-2 (lower than 20 unlikely infected with HSV-2. Also negative for everything in the urine test. I know i need to move on but some final questions if possible.
Firstly, am i 100% in the clear from a briwf handjob from anything? I know HIV was impossible anyway,  testing doctor said as much but i needed for psychological reasons. As aforementioned my wife is pregnant.
My only lingering doubts are syphillis - testing doctor said my results were accurate after two weeks - can i move on? Was this a zero risk exposure anyway? Is the test and timing conclusive?
Secondly herpes - for Terri perhaps - hsv 2. I have childhood coldsores - certain to be hsv 1 as i have tested negative for hsv 2 in the past. I know it is recommended by Terri to wait 12 weeks, igG is fine for Hsv 2 I believe. However, when i asked my doctor he told me less than 10 u/ML is indicative of no recent infection and a handjob is no risk.  Test paper said less than 20  would be negative. Borderline 20-30 would be the recommendation for repeat test at 4 weeks. Greater than 30 U/ML would be positive according to my test. Would such a low value at 23 days be indicative? Is a handjob truly a zero risk? When i had a test 5 years ago apparently my value was less than 2 but the test values were less than 2.0 ru/ML bit less than 16.0 was considered unlikely infection and 16- 22 borderline. Over 22 was positive. Is there a dif

18 months ago
Just to add is there a difference between ru/ml and u/ml?
I am in the edge of moving on here but feel i need these questiins cleared up.
Finally, will be traveling to Europe over xmas and one private testing center claims hsv 2 test can be done as early as 14 days for early detection or 28 days. Thinking of going for syphillis ans hsv 2 again but it would be 7-8 weeks after - this would be ideal time as i will be away on business. Another 4 weeks will be difficult and hard. Should i let go based on my 'exposure'? Thanks once more.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome back, but sorry you found it necessary. As Dr. Hook said in closing your last thread, repeated anxiety driven questions are not permitted, and I would put both your previous questions and this one in that category. So this will be your last, OK?

The tests you describe are not quite conclusive. For the reasons you already know, it made no sense to be tested at all. But if you feel you still need conclusive results, you're not there yet. Nearly so (~98%) for HIV, but for truly conclusive result you have another AgAb test at 4+ weeks. Syphilis blood tests require 6+ weeks, HSV 12-16 weeks. (Your doctor is wrong about syphilis test reliability at 2 weeks.)

Your question "am I 100% in the clear" repeats questions asked and answered previously. Yes, you are. If you need more info, re-read the previous discussions.

I don't understand your questions about your HSV2 test results. If your index value was below the cut-off, for sure the result was negative. But as noted above, it takes up to 16 weeks after acquiring the virus for HSV2 antibody to be detectable. Usually not that long -- most newly infected people have positive results by 6 weeks, but in some cases it takes longer.

I don't know what "ru" means compared with "u". Probably nothing important, but check with the lab that reported that result.

Your closing questions are answered above. I can't do anything about the times that testing is or isn't convenient for you.

If somehow I were in your situation, I would never have been tested for anything, and my advice is that you don't need any more testing to know you weren't infected. But that's up to you. Let me know if anything isn't clear.

HHH, MD
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18 months ago
Hi Doc. Crystal clear. I accept this is my last thread. I am also aware that this is psychological for me. You state this is my last post. I accept. I hope i can have my follow up.
Couple of ones. Can you explain why either syphillis or hsv 2 is impossible to be acquired from a hand job? I have no symptoms for either. What percent hsv or syphillis symptoms?
Could you give a prediction about how accurate my hsv and syphillis tests would be after 23 days? How accurate after 8 weeks? Final questions. Thankyou.
18 months ago
Very final question. Does no syphillis lesion mean no chance of transmission. I took doxycycline - over the counter - and i understand your no risk assessment. Slight concern is i did have brief sex with my wife unprotected one week after incident. I have no lesions whatsoever. So my final question is no lesions no transmission. I ask because although i took the antibiotic could i have infected her. I qpologise for my anxiety. I am trying to move on.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
I didn't say herpes or syphilis are impossible to transmit by hand-genital contact, only that there are no known cases, which is different. Clearly one can envision circumstances that could result in transmission. But since it happens rarely if ever, the basic assumption is that the hands rarely carry enough infectious material to successfully inoculate the exposed tissues. (Contrary to popular impressions, almost all infections have quantitative thresholds of exposure necessary for succesfful transmission. "Just one virus" never does it, with perhaps a very few exceptions (e.g. maybe rabies or ebola).

Syphilis on exposed surfaces probably always causes obvious symptoms; asymptomatic acquistions generally involve hidden sites (e.g. rectum, vagina). Herpes can be asymptomatic, but this probably depends on astuteness of the observer. Many or most asymptomatic infections probably are in people who just don't pay attention or notice minor symptoms. Anxious persons constantly on the lookout probably usually have symptoms. In any case, combining an exposure not known to transmit plus lack of symptoms comes to nearly 100% assurance you weren't infected. I already gave my estiamte of HIV test performance at 23 days -- see above. As a guesstimate, probably 80% of new syphilis would be detected by blood test around that time. Standard tests for both infections are 100% conclusive by 8 weeks.

But in the event you had incubating syphilis, it would have been aborted by taking doxycycline, assuming you took it for more than 4-5 days. No antibiotic has any effect on herpes or any other viral infection.

Absence of visible lesions makes syphilis transmission extremely unlikely, but this may not be true for herpes. 
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18 months ago
Thanks Doctor. Very much appreciate your patience with me. Logic is setting in. For what it is worth, i applaud your work on thia site and am grateful for both your and Dr Hook's advice. Thankyou.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Thanks for the thanks. I'm glad to have helped. My final advice is that next time such fears or anxieties kick in, you can read the discussions we've had so far. Most if not all further concerns likely have been addressed.

Best wishes and stay safe.
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