[Question #6968] Gay - STD/HIV Testing - High Risk

11 months ago
Hello Doctors,

I am a Gay male.  I had unprotected sex with another male ( I am always safe, I just messed up).  I was the receiver (bottom).  I do not know his STD status.  I have not had any other encounters since.

5 Days after the exposure,  I went to Urgent Care, to get tested for everything.  They sent me to Quest Diagnostics for the blood work and urine test. Negative for syphilis, chlamydia, gonorrhea, hepatitis C & B.  I asked about a followup HIV test and the doctor said comeback at the 6th week mark.

44 Days later I got tested:
HIV 1/2 Antigen/Antibody 4th Generation with Reflex - Result: non-reactive.

I asked when I should comeback for a follow up, and the doctor said in 6 months to make my results conclusive.

I told him that I thought the HIV 4th generation is promising at 45 days, right? He had to look and see what type of test I even took, so that made me uneasy, plus with his recommendation of 6 months. 6 months seems like an old recommendation (based on my hours of reading online).  There is so much conflicting information online, so I am here seeking your help...


1. Based on my encounter and my 44 day test result, should I test again for HIV, if so when?

2. What other STD tests should I do and when would be the best time for those tests to be considered conclusive?



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Welcome to the forum. Thanks for your confidence in our services.

I'm happy to confirm your understanding about the HIV antigen-antibody (AgAb, 4th generation) blood tests. Indeed they are conclusive by 45 days; on this forum, we round that down to 6 weeks. Sorry your doctor apparently is behind the times (or has been:  perhaps your conversation has started to bring him up to speed). I am unaware of any expert agencies or individuals who ever recommended 6 months as necessary, at least not since the very first HIV antibody tests of the sort not used for 20 years or more. Some resources stick with 3 months out of an abundance of caution, but to my knowledge there have been no reliable scietnific reports that the AgAb test has taken more than 6 weeks bo become positive, with the exception of persons who were taking anti-HIV drugs as pre- or post-exposure prophylaxis that failed (which itself is very rare).

So my advice is that you do not need any further testing of any kind. If you remain nervous about it despite this reassurance, another AgAb blood test would confirm you are not infected.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
---
11 months ago
Thank you Dr. Handsfield for the rapid response. 

I can now relax about the possibility of HIV. 

Just to verify, I got tested for Herpes & Syphilis 5 days after encounter with everything else. All negative. 

I only tested for HIV & Hepatitis C at the 44 day mark. (non-reactive) 

As far as retesting for Herpes and Syphilis? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Indeed you can relax about HIV. Sorry I forgot to address the other STDs you asked about.

Urine testing cannot detect rectal gonorrhea or chlamydia, the highest risk STDs in this situation. You need a rectal swab -- and if you performed oral sex or rimmed your partner, a throat swab for gonorrhea. (Chlamydia uncommonly infects the throat and would be optional, but chlamydia testing is usually automatic with gonorrhea tesitng.)

Five days is meaningless for HSV and syphilis blood tests, which require 3-4 months and 4-6 weeks, respectively. Syphilits tesitng indeed makes sense, but HSV testing does not. The blood tests are far from perfect, and in absence of anal symptoms (sores, blisters, pain) it's very unlikely you were infected. 

Hepatis C wasn't a risk with non-traumatic anal sex (i.e. if no bleeding). Hep C has been oversold as an STD, when in fact it is rarely sexually transmitted at all. OTOH, everyone should have at least one hep C blood test somewhere along the line, so it's fine you were tested. Your negative result at 44 days was conclusive. Same for HIV, as discussed above.
---
11 months ago
Thank you for the additional information.  I have never been tested with a swab for anything.  All blood work or urine. 

I did develop a cough around the time I was tested for HIV (which of course triggered my anxiety until the results came back negative). 

Doctor proscribed me Zithromax. Took it for 7 days. So if I did contract rectal gonorrhea or chlamydia, do you think that would have cured it?

11 months ago
Correction: Azithromycin ( Zpack) for 7 days was what I was given. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Acute HIV doesn't cause cough. The description "flu like" is meant to convey headache, fever, often muscle aching, and sore throat -- but not cough. HIV also doesn't usually cause nasal congestion, runny nose, etc.

It's a bit difficult to judge azithro for gonorrhea or chlamydia in this situation, because the dose and duration you had would not be used and have not been studied. Most likely it would have cured either one if you were infected. However, information in the last 2-3 years is that azithro is not reliable for rectal chlamydia, with a 10-15% failure rate. But that's with 1 g single dose; hard to know whether it would be more reliable with more prolonged treatment. As for gonorrhea, 5-10% are enitrely resistant to azithromycin, with substantial geographic variability -- more reliable in some cities, states or countries than others. And again, the difference in dosing. So the odds are strong that a) you didn't catch either one and that b) if you did, it probably would have been eradicated. But these probabilities still leave a small chance you were infected and still are. You might consider seeing a doctor or clinic for rectal swab testing in a rew weeks. (Not sooner than 3 weeks after completing the azithromycin.)

That completes the two follow-up exchanges included with each question. I'll leave the thread open for a few hours in case you have a final brief comment or question, then close it. I hope the discussion has been helpful.
---
11 months ago
Well, I definitely got more information than I expected!

 As a gay man, a lot of questions on here are from low risk, heterosexual encounters.  I hope other gay males who are in my shoes reading this would also benefit from what I have learned: seek swab testing for mouth and rectal encounters, 4th generation ag/ab hiv tests are conclusive at 6 weeks (try to calm down and move on with your life if negative at this mark), testing over symptoms (which weren't even hiv related), and testing windows for other stds. 

I appreciate your responses and the service you have provided Doctor Handsfield.  The anxiety has been extreme and today I am finally relaxed and more focused on my studies again, thank you again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
For what it's worth, we get many questions from gay men -- by proportion of the male population, they're probably even over-represented. Anyway, thanks for the thanks. I'm glad to have helped -- that's why we're here. Best wishes and stay safe.---