[Question #7020] With respect

9 months ago
Good day Dr
I really read alot in this forum and thanks for you for your efforts to make the people feeling good and relaxe ..and sorry for my English language if it’s not good.. 
I am 38 years old man for first time I had sexual relations with two sex workers in 6 & 8 June 2019using a condom, and I do not know about condom condition and expire
and oral sex without condom 
June 14
Tests done: 
33 days, a third generation hbsag and hiv1&2
34 day 4th generation
41 days  fourth generation
56 days  fourth generation
All negative 
Then home tests from Amazon for hep B, C and hiv after 6 months are negative
 home test from iCare hep B, c, hiv, syphilis , herps 
Wondfo home hiv test 1&2 after 6 months negative 
Oracwick twice after one year negative.
My questions 
1- Is hepatitis B test after 33 days of sex and 27 from oral conclusive?
2- test of hiv 50 days conclusive?
3- What is the enough time for ab of type 2 to produce?
4-i read alot of studies about window period but I didn’t find good article for exact time of antibody production they but it in range of 6-12 weeks 
is there any studies for hiv antibody 1&2 can detect the exact time for production? 
5- if we assume the time not enough for antibody type2 is 
Oraquick conclusive?
6- is syphilis comes always with symptoms (chancr) i mean if there is no symptoms no need for analysis?
7- my cbc blood test show increase in wbc 13800 it should be in range 7000-11000 in the same time i did hiv test when i see high wbc count , is neg hiv test roll out relation between high wbc and hiv ?
8- my wife and girlfriend faces same delay in Menstrual period about 3 months which makes me feel anxious why this happened and they didn’t happen before for them can you explain that?

9 months ago
Sorry before one year from the  exposure I suffered from renal colic is there effect on lymphocytes and wbcs counts ?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Welcome to the forum. Thank you for looking at other discussions with issues siimilar to your own.

My first comments are:  First, condoms work. The condiion of the condom and expiration date are not important. If the condom does not break wide open, protection is complete. Second, the tests you had are highly reliablte, and you can trust the negative results. To your questions:

1) Oral sex rarely if ever transmits the hepatitis B virus. And your negative HBV tests are conclusive by the times you were tested.

2,3) Yes, those HIV test results are conclusive and prove you did not catch HIV. Antibody to HIV2 develops by 6 weeks, i.e. before 50 days.

4) With older HIV tests (not used for nearly 20 years), it sometimes took 3 months for antibody to be detectable. With the tests now in use, antibody is detected within 6 weeks. The tests you had (4th generation) usuallly are conclusive by 4 weeks and always by 6 weeks.

5) Oraquick is never conclusive. 1-2% of infected people never develop positive results. Happily, you had other tests that were conclusive.

6) Most syphilis causes obvious symptoms, especially a chancre. Howeve,r some cases have no symptoms.

7) No STD causes the high WBC count you had. Usually that result is from a non-STD bacterial infection.

8) Some STDs can cause increased vaginal bleeding or bleeding betwee periods. No STDs cause delayed menstruatioins. Your wife's and your girlfriend's delayed periods have nothing to do with HIV or any STD, or form your sexual exposures.

From all you have said, it seems clear you have no infection from the sexual events last year and need not worry.

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


9 months ago
Thanks again for your DR , 

1- why Oraquick miss 1-2% of cases?
I saw some approval studies its talk about 89-93% sensitivity, so if someone repeats a test 2-3 times after it may decrease missed percentage...
2- is renal stone can cause increase WBC ?
3- is there any need for syphilis test ?
4- for kits test is it sensitive esp. which is CE marketed  ? 
I hope my questions clear ( sorry for my eng. language if it’s not good)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
1) The Oraquick oral fluids test detects antibody in fluid secreted around the teeth. Antibody levels in those fluids are much lower than in blood. And the test also uses an older kind of antibody test, not the 3rd generation antibody measured in most blood tests. It just doesn't work as well. A negative result 2-3 times may or may not pick up some infections. A laboratory-based blood test is required for a 100% conclusive result.

2) A renal stone will not cause a high WBC count, unless the stone has led to a urinary tract infection.

3) A syphilis blood test always should be done in any person at risk for STDs.

4) Sorry, I do not understand. Try again, maybe with an online translation program.
9 months ago
Thanks again 
I understand your answer is that the oraquick is not accurate if used alone because it tests oral fluids that do not carry antibodies at a sufficient rate and time for everyone, but in my case to rule out any change in the result after 50-56 days I decided to do this tests after a sufficient period of about a year, because the idea of three months is still in control of my thinking 
So my question was according to  the old recommendations that say antibodies appear at 99.99% in 3 months. 
And that an 8-week period in which the antibodies appear 95%, so there is 5% chances of those whose antibodies are delayed, and the home analysis device, whether oraquik or rapid analysis devices that give accuracy at least 90%. 
Here is a delay rate of antibodies 0.05*.01 = 0.005% I hope my idea is clear to you.
I understand that the idea of the presence of antigen  in the test of the fourth generation gives a near-definite result within a month of exposure due to its appearance before the antibodies and decreases its percentage after the appearance of antibodies type 1, but the second type will be the fourth generation just like the third generation because our dependence will be on antibodies and I did not see a study showing the superiority of the fourth generation over the third generation in the speed of the capture or detection of antibodies!
I mean, why we don't say 3rd generation  gives a definitive six-week antibody result ?
I fully trust your information and consider the judgment in such a matter to be my responsibility to my wife and girlfriend , i am afraid that they will be harmed because of me, while 60-70% globally still recommend a three-month period?
When the first and second generation of analytical devices appeared they talked about 3-6 months definitive analysis and in the year 2000 they talked about a period of three months definitive and so far most opinions give 3 months sufficient period based on the different response of the immune system and not to the accuracy of modern devices  
2- is oral sex can transmit syphilis?
3- this question wihich isn’t clear for you no 4 in in my last reply 
I mean blood test kits in home which is marking in Europe (CE) is this rapid test sensitive?
4- is syphilis give symptoms like hair fall from all head area and eyebrow because i see some fall in it ?
Thanks alot for you sir
Actually i read alot here and I know all visitors here they concern about type 2 hiv antibody and all agree in type 1
9 months ago
I forgot one point , I searched in CDC website they put statement  most but not all people will show  conclusive results within 45 days why it’s not 99% ?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
1) The data on test performance are not as precise as the offical numbers indicate. In fact, 3rd generation tests probably are 100% conclusive, or very close to it, at 6 weeks. On this forum, I usually describe the 3rd gen window as 6-8 weeks, but it rarely if ever takes 8 weeks. However, many official agencies take a conservative stance in their advice and still say 3 months. There's no scientific basis for it, however. Similarly, few official agencies advised 6 months even for 2nd generation tests. Most said 3 months, which was our view on this forum. Of course there has not been any change in how soon infected people develop antibodies. More recent tests are more sensitive, i.e. more effective in detecting antibody when present in small amount.

2) Yes, oral sex can transmit syphilis, although not as frequently as vaginal or anal sex. An educated guess is that 20-25% of syphilis in men who have sex with men is from oral sex. It's probably lower for heterosexuals, but not rare.

3) Sorry, I don't know exactly which tests are marketed and approved for home self testing in Europe. In general, all currently used blood tests are highly acccurate and conclusive by 6-8 weeks (unlike the oral fluids test), and I would assume this applies to those available in Europe.

4) Hair loss indeed can occur in syphilis, but very rarely as the only symptom. I suppose it could include eyebrows, but unlikely to be the only site. The only way to know conclusively if you have syphilis is to have a blood test.

5) CDC takes a conservative stance to be safe. Most people tested for HIV are not as careful or as concerned as you are, and often they have no clue when they might have been exposed to HIV. And as you probably know, we (the US) are a very letigious society, and legal advice is often to be very conservative with advice about HIV test timing. However, I have never seen a valid scientific report of anyone who had HIV in whom it actually took more than 6 weeks for either a third or fourth generation test to become positive, with one exception:  when people take anti-HIV drugs for post-exposure prophylaxis, if PEP doesn't work, the time to a positive test may be extended a few weeks.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.