[Question #687] PCR Test

53 months ago
Dear Sir or Madam, 

I am a male. I had an encounter with a female prostitute six days ago. The physical contact was limited to massage, prostate stimulation with a finger, anal stimulation with a rubber strapon, and very brief handjob. She put on gloves for massage, although I could not determine whether they were used or new. For strapon sex, she put on a condom, although I did not see whether it stayed on until the end when I ejaculated. The place itself did not look very sanitary and obviously the strapon was used on other males before (although at least not in 1-2 hours prior to being used on me )

After the act, I immediately was overriden by concern (mixed with guilt as this was my only sexual act with someone other than my wife in many years) and anger at myself for engaging in a risk activity outside of wedlock.

To put a lid on my concerns, which have taken a form of anxiety. I want to do the following: PCR test for HIV/HBV/HCV at 12 days followed by fourth gen HIV test at 4 and 8 weeks and some HBV HCV test. 

My question is in relation to the PCR test. How common are false positive results?  I haven't been able to find consistent information on this topic other than that false positive results are a possibility and am trying to balance the risk of false positive vs my risk exposure.

Thanks!
Igor
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Thanks for your question. I'll try to help.

The main problem here, it seems to me, is reflected in the second paragraph of your question:  guilt and anxiety over a sexual decision you regret, leading you to overreact. Try to separate your emotional concerns from the medical issues and risks; they are not the same. You really were at no risk for any of the infections for which you intend to be tested. You are about to spend a lot of money on tests that are entirely unnecessary, and which no STD/HIV expert would recommend in this situation.

To expand on the actual risks, neither HIV nor any other vial infections have ever been known to be transmitted by fingering, sex toys (e.g. the strap-on device), hand-genital contact, or massage. And despite the possibly unsanitary setting, I would expect the sex worker washes her intimate equipment between clients. HCV isn't even an STD, despite what some sources imply:  the only definite sexual transmission is among men having traumatic sexual practices with other men. (The heterosexual partners of persons with HCV have no higher rate of infection than anyone else.)

That said, false positive HIV PCR tests are very rare. In itself, that's not a reason not to be tested. I have no direct experience with PCR tests for HBV and HCV and cannot comment on how well they detect new infections or how often they might be falsely positive. 

In summary, if I put this in personal terms, if I had somehow been in your circumstance, I would not be tested for any of these infections or any other STD, and I would continue unprotected sex with my wife with no fear of infecting her. If you go forward with testing at all, I would recommend you have a single 4th generation HIV blood test 4 weeks after the event, and perhaps an HBV test panel (HBsAg, HBsAb, and HBcAb) at 6-8 weeks. And for sure no HCV testing.

I hope these comments have been helpful. Best wishes--   HHH, MD


---
53 months ago
Dr. Handsfield, thank you for the detailed response! I do realize my psychological issues are distorting how I access the risks, will work on that. I got a bit anxious after reading in some guides that using shared sex toys is viewed as potential risk activity. Although my guess is this guidance relates to situations where a "transfer" from one partner to another happens immediately/without time lag. Then I read about HBV surviving for a while in the air, and that increased anxiety. I even imagined her vaginal fluids somehow getting on the strapon as an extreme scenario.

I plan to see a therapist in the next few days about my anxiety issues. I had some before, this occasion just highlighted that I need help dealing with them.

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Good luck with the anxiety issue and therapy for it. I would also suggest you lay off the internet. You have cited some clearly zero to microscopically low risks. Like many anxious persons, you probably are being drawn primarily to information that inflames your fears and missing the more reassuring information that also is there.

---