[Question #7265] HIV and Syphilis testing reliability

5 months ago
Exposures are as following:

March 17,2019 - Lap Dance from Latina Stripper with penis out, some grinding may have been involved. No sex was involved I was scared of the situation and 1 week later started 1 week course of doxycycline. Because of antibiotics , I developed Balanitis that I have not been able to get rid of to this day. Tested for all STDs on the 14th day , all negative except HSV1, My wife gets recurrent oral outbreaks, may have gotten it from her, I don't know. Testing was to soon from the exposure to develop a positive HSV result .Fast forward 7 months later I developed an open sore on my foreskin , below my penis glans. I start to suspect I contracted Syphilis from the exposure so I did a 10 panel test, with RPR as the test for syphilis, all negative except HSV1. It clears up in 2-3 weeks, I moved on from this event.

August 1,2020- Protected oral for 6 minutes from Latina Stripper. Condom was on from start to finish. No penetration, or ripped condom I suppose as I would have noticed . On day 29 from my last exposure I notice an open sore right below my glans on my foreskin, it was on the same place as last time but on the opposite side, Sore would ooze a bit, and was mildly painful to touch.  I went to the doctor which said it did not look like a chancre but to test anyways. I test for everything  at exactly 45 days, all Negative. Again except for HSV1 tests were HIV 4th Gen, and Syphilis RPR. Sore clears in about 7-8 days. I made a dumb mistake and placed undiluted tea tree oil all over my penis and foreskin whenever the sore appeared as I heard it was good for genital sores, and I am still dealing with the burns on my glans and foreskin to this day, Becausw of this some discharge began to come out from my foreskin area, as well as several cuts. I went to my doctor who said skin might have became infected and right now I am using anti inflammatory creams as well as antifungal, and he also prescribed me 1g oral azithromycin, just in case of a bacterial infection from the raw skin and cut skin. My penis started to peal and is still bright red, with a couple sore spots that would bleed. It is however healing properly.

On to my questions. 

1. Would the doxycycline I took last year affect the reliability of my results I had following 7 months after my first exposure I mentioned , Did I test to far out hence a false negative ? I heard Syphilis RPR tests are a little complicated.

2. For my second exposure, if i tested negative at 45 days, which was 2 weeks before the sore appeared, would that exclude Syphilis conclusively as the cause of the sore on my penis ? If not when should I test again.

3. Are my HIV tests conclusive at 45 days after exposure ? I heard 4th Gen only tests the antibodies in HIV 2, not the antigen so when should I test again to conclusively rule out HIV1 and 2 ? Whats the max time it takes for HIV 2 antibodies to be detected ?

4. When could I resume unprotected sex with my wife, without fear of transmitting something to her ?

P.S i took an HSV swab of the lesion which came out neg, but i waited about a week and a half after the lesion appeared from my second exposure to test, so I know the reliability drops.


5 months ago
Sorry doctor, for my second question I meant to put 2 weeks after.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome to the forum. Thanks for your confidence in our services.

First, you should assume you have genital herpes, caused by HSV1. Herpes is by far the most frequent cause of recurrent genital sores. Your HSV blood test being positive for HSV1 and negative for HSV2 goes along with this; and unlike HSV2, recurrences of genital HSV2 tend to be infrequent:  two episodes more than a year apart is common. If you get another similar sore, see your doctor ASAP (within a day or two) for a swab test to confirm the diagnosis. (Not counting the "several cuts", which probably is a separate issue, discussed below.)

Going to your main questions, it was a mistake to take doxycycline after the first strip club event you describe. There was no chance of any bacterial STD that doxy could have helped, and It sounds like it indeed resulted in the yeast balanitis you describe. The second exposure also was low risk because of correct condom use (good move!). As suggested above, the penile sore you developed a month (29 days) later almost certainly had nothing to do with that event -- just a random recurrence of your genital herpes.

I agree with your (and apparently your doctor's) judgment that the more diffuse penile imflammation (with "multiple cuts") was due to the tea tree oil. There are no STDs or other infections that are effectively treated with TTO. Don't do that again!

To your specific questions:

1) The doxycycline caused only the yeast infection. It had no effect on your lab tests several months later. 

2) For the reasons already discussed, it was exceedingly unlikely the penile sore after the second exposure was syphilis, and the negative syphilis blood test 6 weeks (45 days) later shows it wasn't syphilis. You don't need any more testing for it.

3) Your negative HIV AgAb test at 45 days was conclusive for both HIV1 and HIV2. In any case, HIV2 is rare in the US. With few exceptions, the only HIV2 cases in the US have been in immigrants from HIV2 endemic areas (i.e. east central Africa) or their sex partners. The negative antibody component of your blood test is conclusive for HIV2.

4) You have no STD from either of the exposures described, and therefore nothing to transmit to your wife. As for your probable genital herpes, after years of sex with you there's a good chance she already has HSV1. Even without those exposures, half of all adults have HSV1, and those people are immune to new infections with it. To be maximally safe, you could discuss all this with your wife and arrange for her to have an HSV blood test. I predict she would have a positive HSV1 result. In the meantime, to be maximally safe, you should avoid having sex with her if and when you have another outbreak.

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

HHH, MD
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5 months ago
Hello doctor , it is with great honor to talk to you. I have been following you guys since last year whenever I had my first exposure.

I do know my second exposure was of no risk as you have stated that protected oral carries little to no risk, and should not stress about testing, but I am a big hypochondriac. With what if's such as, what if I penetrated her while she was dancing on me, and unnoticeably my condom was ripped, but anybody wouldve have noticed either. Especially since I myself took off the condom. I was calm about the situation, but seeing a sore 1 month after the encounter was to big of a coincidence, and matched perfectly with the syphilis chancre timeline.

Follow up questions-

1. I feel like this one may be repetative, but can I for sure move on concerning syphilis ? Are my results really conclusive ? If in fact this was a syphilis chancre would it have showed up on my test results, which I took 14 days after the sore first popped up, and 45 days after my exposure ?

2. Lets say these smaller cuts were not caused by the tea tree oil, although my doctor and I assume it was by the way it looks, the smaller sores and cuts on my foreskin started to form 5 days before I tested at 45 days. Would the test had picked that up as well if it were caused by syphilis ?

3. If I decide to test again in 2 weeks, just for peace of mind, which would be 9 weeks after exposure, would have taken 1g of azithromycin 3 weeks before testing at 9 weeks affect the reliability of my test results ? It would be RPR by the way.

Last and final 4. Although

I understand HIV 2 is rare, there is always that one lucky person who beat the odds and wins the lottery. Does testing for HIV 2 antibodies only, give 100% conclusive results at just 45 days ? One doctor I went to said my tests were conclusive, another I paid a visit to said 90 days. Is testing again a waste of money ? I just dont wanna put my wife in danger for anything because of my stupidity, I have avioded any sexual contact with her since my second exposure.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Thanks for the thanks. I'm glad my words started to help. I hope these additional replies get you the rest of the way.

I'm sorry you're so obsessed with syphilis in particular. Do you have any idea how rare it is in most of the US, except in gay men? The chance either of the women described above had syphilis is extremely low. And the scientific evicence against you having syphilis is conclusive.

1) It is 100% certain you do not have syphilis. The blood test definitely would have been positive by the time you were tested.

2) No STD is a likely cause multiple small cut-like sores of the sort you describe. Certainly not syphilis -- and once again you have the negative blood test.

3) It would be pointless to test again. (The azithromycin probably would have cured syphilis if you had it -- but wouldn't make any difference in the blood test result.)

4) When it comes to HIV2, there is almost nobody in the US who "wins" (in this case, obviously, loses). The AgAb test picks up call cases by 6 weeks. But here too, the chance either partner had HIV of either type is extremely low, and you had condom protected sex. You didn't even need HIV testing at all. But feel free to test again if it will make you feel better. If somehow I were in your shoes, I would never have stopped having unprotected sex with my wife and certainly you can safely resume it now -- but of course only after you discuss your genital herpes with her!
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5 months ago
Hi doctor, thanks so much for the quick and throughout responses. You sure have made me feel that no more testing is required.

By "all" cases in question #4 you mean both HIV 1 and 2 right ? With no need to test at 8,9,10,11 or even 12 weeks. I can safely move on at this point with my 45 day test results, and any symptom I have today or later on in the future will be totally unrelated to syphilis and HIV 1 and 2 since I am 100% conclusively negative even if the 4th gen only tests for antibodies in HIV 2 ?

By answering this Dr, I am truly appreciative of you and Dr. Edward on the incredible work you guys do everyday. This past year and last year have taken a toll on my mental and physical wellbeing, and I think it is time to move on. Much love from Texas Dr, have a good rest of your weekend :)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Yes, that statement referred specifically to HIV2. No need to test beyond 6 weeks and you can "safely move on" with the result you have. Any and all symptoms for the rest of your life will not be due to either HIV or syphilis acquried during the events you have described.

That concludes this thread. Thanks again for the thanks. Best wishes.
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