[Question #6411] Testing clarification

14 months ago
Hi Dr,
I'm from Malaysia working in Indonesia. I did a horrible mistake by having protected vaginal intercourse with local CSW on 10/7/2019. It lasted only for less than a minute. It was dark and I'm sure the condom remains intact when I withdraw my penis after coming inside her. Since then, my life is no longer the same. I am so worried about contracting HIV or any other STIs.
Below my testing history:
July 19 (9 days post-exposure): I did HIV-RNA and HIV Ag/Ab Combo (CMIA Method). Both test negative. I also tested for Chlamydia and Gonorrhea using swab tests. Both negative as well.
August 8 (28 days post-exposure): I did another HIV Ag/Ab Combo (CMIA Method). Tested negative. I also tested for Syphilis and I received RPR 1:2 and TPPA negative. The doctor told me it's false positive and I'm not sure why but he said it's better to get 1 shot of penicillin to be safe. I took the shot.
August 13 (34 days post-exposure): I went back to Malaysia and tested at a reputable STD clinic. I tested again for Chlamydia and Gonorrhea using urine tests, PCR negative. HIV 1 and 2 Ag/Ab ECLIA Principle. Negative. Herpes Type 1 and 2. Both negative. But for syphilis, the RPR was again 1:2 and TPPA negative. The doctor said I need three penicillin shots for 3 weeks and I completed the treatment. The doctor in Malaysia asked me to return in 3 months' time to test again for Syphilis and HIV. She also told me that I can resume sexual intercours
October 3 (84 days post-exposure): I went back to Indonesia and I tested again for HIV 3rd generation (SD BIOLINE METHOD). Negative. Hepatitis B and C negative. Syphilis RPR was negative and TPPA still negative. The doctor concluded and told me I don't need further testing for anything.
November 15 (128 days post-exposure): I tested at the Malaysia STD clinic again for Syphilis and HIV. HIV 1 and 2 Ag/Ab ECLIA Principle. Negative. But for Syphilis, RPR reactive again at titre 1:1 and TPPA still negative. The doctor told me I don't have to worry and said 


14 months ago
Sorry, I had some issues with my browser and I couldn't complete the question below. The doctor told me I don't have to worry and asked me to re-test in six months' time to make sure the titer remains the same and concluded I don't have syphilis. I'm really confused about her assessment. Now she suspecting that I might have an autoimmune disorder. My questions: 
1. Do I need to test for HIV again? Is it conclusive? 
2. Do I have syphilis or not? 
3. I resumed having sex with my usual partner. Am I risking her into anything? This is my biggest fear. I resumed having sex with my partner after 1 month completing the syphilis treatment.
4. I don't have any symptoms except that I have small dark bumps on my back and hip. Nothing on genitals. Also, I was admitted into Hospital for typhoid last month and now recovering. Past few days, I'm having something like light-headed or dizziness and I noticed my vision is no longer the same. It's kind of blur. Is this neurosyphilis? 
Let me know.
Thank you Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your confidence in our services.

The doctor(s) you saw have given you correct advice. Based on a single condom-protected exposure, you have been way over-tested! To your specific questions:

1) Your HIV test results are conclusive -- indeed you were tested later than necessary. The tests you had are conclusive by 6-8 weeks after exposure.

2) Your doctor is correct:  you do not have syphilis. You had a biological false positve result on one of your RPR tests, but the negative TPHA proves you don't have syphilis.

3) Based on the low risk nature of the exposure plus the tests you have had, there is no chance you have any STD from the event described and it is entirely safe to continue sex with your regular partner. You will not be putting her at risk.

4) The symptoms you describe are entirely consistent with recovery from typhoid fever. (I'm glad you're doing well!) And no STD causes the things you describe.

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

HHH, MD
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14 months ago
Hi Dr.
Thank you very much. Just one last question.
The doctor in Malaysia asked me to repeat the test for syphilis in May next year. Do you think it's necessary? She wants to check again for syphilis or any possible autoimmune disorder. Is this necessary? I'm really worried sick thinking about syphilis. I really want to put this behind and move on. 

Let me know.
Thank you very much dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Repeating the syphilis test would be wise, but not because of worry about syphilis itself. Biological false positive results with RPR or other related syphilis blood tests sometimes indicate an underlying autoimmune disorder. That's unlikely if you are otherwise healthy, but it's not unreasonable to follow up to check it out again:  better safe than sorry! However, retesting isn't needed because of any chance you actually have it, if you have no more potential STD risks going forward. If not, there is absolutely no reason to be "worried sick thinking about syphilis". Don't give it another thought -- and be thankful you have a wise and caring doctor!---
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14 months ago
Hi Dr.
Thank you very much for your clarification. Just few last questions:
1. Past few days I noticed vein around my penis is enlarged. No pain or whatsoever. Just that it feels uncomfortable to have the vein enlarged. Is this anything related to STI? I went to normal clinic here and the doctor told me not to worry about anything and he said its normal. I told him I tested for STI and everything negative. He said then there's no need to worry. But the vein popping out makes me feel down a bit. In my mind its again pointing to STI.
2. I have like isolated red dots here and there on my body. First it appears as red dot, then once I scratch it turns into black and remains there. Are there anything I should be concerned with?
3. Have you seen anyone having TPHA negative after exposure and then turn to positive later on? My RPR is low but I dont know if it will become higher or lower in few months time. It's just that because I went through a lot of penicillin shots, I was convinced that I contracted syphilis but then the doctor now saying that I didnt bave syphilis at all.
 For the testing, I will go ahead and follow your advise to test again in May. I'm feeling okay and I never had any serious health issue before. Anyway I'll test just to be sure.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
1. If your doctor says it's normal, it's normal. Certainly no STI causes prominent appearing veins. I'm sure you're just more sensitive about all this and that nothing has changed.

2. Also not an STD symptoms and suggests your anxiety is making you more aware of minor variations in your skin. Everybody has scattered "red dots" (usually small hemangiomas, sometimes called "blood vessel moles", although they aren't moles at all).

3. In people with syphilis, TPHA actually becomes bositive before RPR does. There is no possibilty you have syphilis or that your TPHA will become positive.

That concludes this thread. Best wishes and stay safe.
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