[Question #7071] hiv test conclusive but now hsv1 after dormant for years

9 months ago
Hello ,I did notice that there was a recommendation that 4 weeks was conclusive for 4th generation duo test and that changed a few years ago to 6 weeks as being conclusive. I was able to find out the reason why through other posts here. The problem is I had sex with someone with unknown status and a foreigner about 8 months ago and the condom slipped off inside me. I  tested at 43 or 44 days  with the 4th generation duo  test blood drawn from arm. I am not sure how to calculate days because this happened after midnight so I am not counting the day that it happened. I thought my test was conclusive and my now fiance is actually the one who went with me to get the test results. Now I am extremely worried that because the time for conclusive used to be 4 weeks and now has changed to 6 weeks that the science might evolve and it will change to a later date like 8 weeks. I am terrified because my fiance had tested negative and we have already had sex without protection for months. I feel like I have doomed him and I am so stressed out that I can barely function. 2-to top it all off I was diagnosed with hsv1 years ago, I had a laboratory scraping confirmation done at my first outbreak. After that I only had a few minor outbreaks and and then I would have only tingling or a prodromal feeling rarely. I didn't and don't take suppressive meds just take lysine when I feel that feeling and then it goes away without an outbreak. But now all these years later I am having an outbreak. I mean it feels like one but I have no sores, red patches or anything, but I feel nerve tingling for 4 days now. I wasn't able to get my Lysine right away and finally got it today.  My fear is that this rare outbreak is because now my immune system is compromised because this is one of the symptoms . Do you think the date for the conclusiveness of the 4th generation is likely to change further than 6 weeks. Can I trust my current results?  Is this hsv1 a worrisome sign?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Welcome. Thanks for your confidence in our services.

You really needn't worry. There is no chance you have HIV. Your test was conclusive; there has been no change in the available data on window period for the HIV AgAb (4th generation) blood tests in the past couple of years. A negative result at 4 weeks almost always is accurate, and a 6 week result is always conclusive. There is no reason to suppose the data on this will change. And probably your exposure was pretty low risk anyway. You don't say enough about your partner to be sure, but even if he had HIV, the risk to a female partner from a single episode of unprotected intercourse, with ejaculation in the vagina, is around 1 in a thousand.

Your possible current herpes outbreak isn't a concern in regard to HIV. The recurrence frequency of HSV infections is not elevated in HIV infected persons. Those with advanced immune deficiency -- i.e. those already seriously ill with overt AIDS -- may have prolonged or severe recurrent oubreaks, but even these people don't have increased outbreak frequency. In other words, your current symptoms do not suggest you have HIV.

I know your main concern is HIV, but I have some comments about your herpes as well. I'm not convinced your current symptoms are due to a herpes outbreak. It's possible, but would be more likely if you had visible blisters or sores. If you continue to have such episodes from time to time, I would advise speaking with your doctor to arrange for a rapid appointment on short notice the next time it happens -- to be examined and have a genital PCR test within 1-2 days of onset. Finally, lysine has no benefit. It's not quite in the quackery category, because there is a theoretical basis for lysine -- it mildly inhibitis the virus in lab experiments. But research shows it has absolutely no effect, even though some patients swear by it. If your episodes are confirmed as recurrent herpes, you would do much better to have a supply of valacyclovir on hand:  at the first hint of an outbreak, a single 2 gram dose will take care of it within a couple of days.

I hope these comments are helpful. Let me know if anything isnt' clear.

HHH, MD
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9 months ago
Hello, thank you for your speedy reply. It really helped. However the herpes thing-When I had these symptoms years ago the doctor scraped the lesion and had it tested in the lab. After that I would have these same symptoms sometimes with blisters sometimes not. Now I am really scared what would a PCR test be looking for? I don't even know what that is. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
PCR (pollymerase chain reaction) is the most common kind of test for a potential infectioius organism's DNA or RNA. (The standard HPV testing during pap smears is a PCR.) PCR for HSV the usual test in recent years for direct detection of herpes virus. It's probably what was done when the lesions was "scaped", although if more than 10 years, it might have been a culture. A positive PCR for HSV1 would confirm you're having a herpes outbreak. A negative would be pretty good evidence, although not proof, that something else explains the symptoms you have at the time of testing.

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9 months ago
Hello, I was reading your answers to questions and question number #6937 you told the man that HIV 2 can be detected 6-8 weeks after exposure. I had my contact with a man who could have been exposed to HIV 2 because he travels all over the world. Since I had the 4th generation  test HIV 1/2 at 6 weeks instead of 8 does this mean I should have waited 2 more weeks to test for the proper window period?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Theoretically, you're right -- your test doesn't exclude HIV2 with 100% cerainty. However, even as a world traveler, the chance your partner had HIV2 is very low. If somehow I were in your situation, or if I was advising someone personally close to me, I would not recommend any further testing on account of HIV2. However, if you feel you need a conclusive negative test, you are free to have anohter test.

That completes the two follow-up questions and replies included with each initial question and so concludes this thread. I hope the discussion has been helpful. If you decide to go ahead with another HIV test, stay relaxed as you await the result. There is no realistic chance of a positive result.

Best wishes and stay safe.
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