Dear Doctor,

October 22nd 2019 had unprotected oral sex with a CSW from AFRICA (she sucked my penis) and I ejaculated in her mouth - it lasted about 45 seconds. Only activity and nothing else.  

12th Nov 2019 i.e 20th day post exposure took below test :-

HIV AB & AG Elisa Test  : Result = Negative (looks to me as 4^th Gen , but the lady in Lab said its 3^rd Gen)

HIV PROVIRAL DNA QULATATIVE – By Nested PCR Method : Result = Negative (Reliance Life sciences Lab)

HIV-1 DNA DETECTOR – By Nested PCR Method : Result = Negative (SRL Lab)

HCV PROVIRAL DNA QULATATIVE - Real time PCR : Result  = Negative

HBV PROVIRAL DNA QULATATIVE – Real time PCR : Result = Detected

Further below test on 16^th Nov 2019 since HBV DNA PCR was detected

HBV PROVIRAL DNA QUANTATIVE – Real time PCR : Result = 110 IU / ML Detected

25^th Nov i.e 35^th Day post Exposure took below test

HIV AB / AG CMIA Method 4^th Gen = Negative

HBSAG Serum = Negative

ANTI-HBC Igm Serum = Negative

All of the tests were done from reputed labs in Mumbai India.

My questions and concerns as below and the biggest of which is Risk of HIV :-

A) HIV PROVIRAL DNA test was told just screens for HIV-1 strains , any chances via this exposure to have exposed to HIV-2 strains ?  

B) Is my HIV status conclusive or any further testing needed specially after HEP B came positive and route of transmission is same for both HIV and HBV. 

C) I have also noticed  Multiple tiny spots  on the foreskin of penis & 1-2 spots are also there just on the opening of Urethra  since this incidence – what could it be ?

D) Coming back to HEP-B , I would want to understand is there any possibility that the HBV Qualitative test was false positive and further HBV Quantative could also be false negative ?

E)I was vaccinated for HEP-B in 1982 does it means I will be able to fight off the infection by my self ?

Looking forward to your reply eagerly.

Best Regards

D)

a)  

Welcome to our Forum.  I'll be glad to comment in response to your questions.  In doing so, I would like to start by pointing out that this was a low risk event for HIV.  There are NO proven instances in which HIV has been proven to have been acquired as a result of receipt of oral sex.  While less well studied, the sense is that the acquisition of hepatitis virus infection (C or B) through receipt of oral sex is rare, if it ever occurs.  As for your specific questions:

A) HIV PROVIRAL DNA test was told just screens for HIV-1 strains , any chances via this exposure to have exposed to HIV-2 strains ?  

As mentioned above, there are no documented cases of HIV acquired in this way.  While I understand that HIV-2 is seen occasionally in India, it is most unlikely that you were infected in this way and my advice would be not to worry.  If you wish for a more definitive test result, the best test would be a 4th generation HIV test, which includes testing for antibodies to HIV-2.

B) Is my HIV status conclusive or any further testing needed specially after HEP B came positive and route of transmission is same for both HIV and HBV. 

I see no need for further testing for HIV related to the exposure you describe. 

C) I have also noticed  Multiple tiny spots  on the foreskin of penis & 1-2 spots are also there just on the opening of Urethra  since this incidence – what could it be ?

I have not examined you.  I find myself wondering if these "spots" may have been there before and simply not noticed.  What you describe does not sound like herpes or syphilis and this is too soon after your exposure to be due to HPV.  My advice would be to have a trained professional take a look.

D) Coming back to HEP-B , I would want to understand is there any possibility that the HBV Qualitative test was false positive and further HBV Quantative could also be false negative ?

You have Hepatitis B DNA detected on two occasions, Oct 12th and 16th making it very unlikely that this is a false positive test.  This level of hepatitis B viremia however is very low, close to the limits of detection for the test.  If levels remain low you may have inactive chronic hepatitis B infection which is not a danger to you or you may have very, very early hepatitis B infection.  Your testing was done a bit early to be sure and repeating your tests would be helpful.  My advice would be to repeat the quantitative hepatitis B proviral DNA test.  IN ADDITION, I would suggest getting additional tests for hepatitis B- a Hepatitis B surface antigen test as well as antibody tests for both hepatitis B surface antigen and for hepatitis B E antigen.  My suspicion is that these tests will be negative and, other than for periodic repeat tests every 6-12 months) would not worry further

E)I was vaccinated for HEP-B in 1982 does it means I will be able to fight off the infection by my self ?

Please see my comments above.  My guess is that you are not at risk and your body will control any hepatitis B which might be present.

I hope this helps.  EWH

Thank you for the additional information. Before I answer your follow-up questions, a few comments.  Your exposure in Dubai makes it less risky.  In addition, HIV-2 is virtually non-existent in Dubai. STIs are quite unusual among commercial sex workers in Dubai.  The additional test information is helpful and ands further proof that you were not infected with HIV, including HIV-2 or hepatitis C.  There is no need for further testing for either HIV (including HIV-2) or hepatitis C related to the exposure you described.

In answer to your specific questions:

A.  Stop playing word games. Combined your test results prove that you did not get HIV from the exposure you described.  no medical reason for further testing.

B. As noted above, the fact that the exposure occurred in a Dubi massage parlor makes it far less risky than if it occurred in India.

C.  I suspect that further evaluation will show that no treatment is needed for hepatitis B.  Most persons with hepatitis B live a long, uneventful life.

d.  Hepatitis B is now preventable (with vaccines) and treatable.  I suspect further progress will be made towards a cure.

E.  I do not need to review your lab results.  We have no mechanism for this. 

Take care.  EWH