[Question #6914] Are my test conclusive?

9 months ago
Dear Doctors
I am 31 years old male and uncircumcised.  I had UNPROTECTED vaginal and oral sex (giving and receiving) with a Hungarian CSW in UK London.  It was a stupid thing given she engages in unprotected vaginal sex with other clients too.  It was a high-risk situation and she was not a high class escort.  It was actually a cheap and dangerous encounter.  The CSW later told me she takes cocaine and other drugs.  I was drunk and I am now filled with guilt. 

I got several visible HPV warts on my pubic area/base of penis shaft after 3-4 weeks which have been frozen by my local GUM private clinic.  I waiting it clears.  I had no other symptoms.

Exactly 30 days past my exposure I was tested Negative for HIV I/II (latest 5th Generation test - antibodies/p24 antigen), syphilis, Hep B, HSV I/II, gonorrhea, chlamydia, ureaplasma, gardrenella, mycoplasma, and trichomonas.  My warts are being treated now.   My questions:

1. Except for HPV which is being treated, should I be worried and do any further testing for HIV or any other STIs including Hep B?   Are my tests conclusive?  Can I move on?

2. I have now in a relationship with an old love interest (no sex yet) and looking forward to getting married in September 2020 if the lockdown is still not on.  She is divorced and tested negative to all STDs too.  I have disclosed my HPV status to her already.  We did not have sex yet.  Can I have unprotected sex with my partner (soon to be wife) after my HPV clears up and not worry about transmitting any HIV, Hep B and other STIs?  We are looking forward to settle and form a family in the near future.

I thank you beforehand.  
Yours Respectfully
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Welcome to the forum.

I agree this was a pretty high risk situation, assuming your beliefs about your partner's sexual lifestyle and practices are correct. That said, your test resuls show conclusively you didn't acquire any of the infections for which you were tested. To your quetions:

1) Visible genital warts generally don't show up sooner than 2 months after exposure, and often not for several months or a year. While it is conceivable your warts appearing at 3-4 weeks were acquired during that exposure, it it unlikely. Assuming you have had other sexual exposures in the last couple of years, those are a more likely source of that infection.

2) Sex with your new partner certainly will be safe for the infections for which you were tested. HPV is more difficult to know. In general, most experts advise waiting a few weeks (some would say 3 or even 6 months) after warts clear up, either on their own or with treatment. It is a fair bet you still have HPV, even without visible warts, and it takes time for the immune system to clear the infection. On the other hand, if your partner has been vaccinated against HPV, probably she is immune to your infection:  the HPV vaccines cover both HPV types that cause ~90% of genital warts. Even if not vaccinated, she could well have been infected with these types previously, and many persons at possible risk for HIV decide to procede with sex and let nature take its course -- knowing that most HPV infections cause no visible problem or, if they do, an unpleasant inconvenience, but not an important health risk.

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

HHH, MD
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9 months ago
Thank you for your answer doctor.  I confirm my partner is vaccinated for HPV for some time now - she had Gardasil 9 vaccinations course.  In any case we are not meeting or engaging in any sexual activity anytime soon due to lockdown.  We will wait for at least 4 months after the HPV clears up to have sex.  I had sexual encounters from a couple of relationships before but that was last year in December.  So the HPV can be from before too I guess.  Thank you very much for the explanation on HPV.  It really helps put things in perspective.

One follow up question.  So I understand correctly that my HIV (duo combo test 5th gen test), syphilis, hep B, etc.. done at 30 days post-exposure are conclusive and I can move on safely from these?   Is there any need to do any further HIV testing?  Or can I move on from HIV?

Thank you very much.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Since your partner has been vaccinated, for sure there is no problem in having sex with her:  no need to wait!  Almost certainly she is protected from the HPV type causing your warts.

Your warts are from one of your past sexual exposures, not the most recent one.

The HIV antigen-antibody (AgAb, "Combo") tests are nearly conclusive (98-99%) at 30 days; it takes 6 weeks for 100% certain results. You should be highly reassured by that result, and if I were in your situation, I would not feel a need for another test. But if you feel you must have a 100% conclusive result, you'll need another test at 6+ weeks after the event.
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9 months ago
Thank you very much Dr. Handsfield.  This has been really helpful for me.  Take care and stay safe.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Thanks for the thanks; I'm glad to have helped. That's why we're here.---