[Question #6515] Testing Accuracy

14 months ago
Hi Doctors,

I actually paid for my question before I read many of the existing threads.  Now that I've spent some time reading, I kind of feel silly because I probably could have got my answers without even paying, but anyway I already have so here it goes.

About 16 weeks ago, I (a male, age 35) had some heavy frottage play with another male.  Just touching, rubbing, etc, no hand jobs, blowjobs, etc......There were a few times when my uncovered penis "grazed" his anus, however, I know for sure there was no penetration of any kind.  I believe (from reading other threads) this to be a "no risk" situation, but since I hadn't found this site 16 weeks ago, I panicked and had some pretty high anxiety over this situation, which drove me to take (3) 10 Test panels from an online service (stdcheck.com @ quest labs)  I also realize (after more reading), some of the tests were superfluous, but the 10 test panel is basically the same price as a couple of single tests if you buy them individually. 

My Tests were:

1. HIV1/2 by 4th Gen
2. Gonn and Clam by NAAT
3. Syphillis by RPR
4. HSV 1 and 2 by IgG (Herpeselect)
5. Hep A, B, C

I took these tests at 4 weeks, 10 Weeks, and 15 Weeks, and each time the results were:

HIV1/2--"Non Reactive"
Gon and Clam--"Not Detected"
Syphills---"Non-Reactive"
HSV 1 and 2---both less than .90  (Normal range)
Hep A, B, C---all non reactive

Direct questions:

1.  Per reading other threads, there was no real reason to test, but did anyway, can you please confirm whether testing was even warranted after this exposure.
2.  I'm guessing the accuracy of these tests at 15 weeks has reached its maximum, but if indeed this situation DID warrant any testing, is there any more tests to take at any later times, or is this last test past any "window periods" needed for these infections.

Thanks!

J
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your confidence in our services, and for reading other questions similar to your own. Too bad you did it after posting -- indeed you have correctly predicted my replies.

As you have found, STDs in general, and HIV in particular, are not so easy to transmit. Indeed, these bacteria and viruses evolved -- were selected, in genetic/evolutionary parlance -- to require direct exchange of mostly genital secretions or blood, and in prety large amounts, in order to be transmitted. For example, even with direct injection of HIV infected semen into the vagina or rectum, the large majority of events don't lead to transmission. Largely for that reason, the non-penetrative, largely superficial contacts you describe are risk free for all practical purposes. Such exposures don't allow enough contact of infectious virus or bacteria with susceptible cells and tissues.

1. Was testing "warranted" after these events? Sure -- but for reassurance purposes rather than medical need or actual risk. Many people are more reassured by negative testing than by expert opinion based on biology, probability, and statistics. That said, one round of testing would have been smarter; I would say (and you may now agree) that three was excessive. 

2. The urine NAATs for gonorrhea and chlamydia reached their maximum performance by 4 weeks (actually, within a week); after that, spontaneous cure comes into play, so later testing can miss infections what were acquired but now are gone. All the blood tests achieve maximum performance by 4-6 weeks, except HSV, which requries 12-16 weeks. The bottom line is that you are at or beyond all "window" periods and your resulte are conclusive for all the infections for which you were tested.

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

HHH, MD
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14 months ago
Understood.  Thank you for your prompt reply.  As I read some other threads seems like some folks are most assured by test results, by me personally, feel the most assured by the combination of the test results as well as advice from experience of many years like you have provided.....appreciate this.

Last comment/question---so you would say in regards to the HIV tests, that there is virtually no chance that the 4th Generation tests I took with Quest at the intervals below could have "missed" any infection?  Just checking once more because I'm ready to enter into a new relationship and want to be confident that the HIV results are accurate.

Thanks! 

J

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Thanks for the thanks.

There has never been a reliable report of an HIV antigen-antibody (AgAb, 4th generation) blood test that missed an HIV infection more than 45 days after infection. You can be entirely confident about not having HIV.
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