[Question #7336] Risk and testing

6 months ago
Hello. 
Situation is I saw a TS Escort in the UK 19 days ago.  The exposure was oral both ways which was fully condom covered.  I topped which was fully condom covered  I rimmed for maybe 1/2 minutes. I was then topped for maybe 45 secs to 1 minute  (probably less time) at which I asked to stop due to it being uncomfortable.  Condom was used and as far as I know it didn’t break but I’ve had a number of anxiety issues regarding condom breakage since which has prompted testing.  She then fingered me with a condom on and masturbated me. 

I’ve since had (the following day) some GI issues for 10 days which you’ve answered previously and now seems to have settled down.  I did testing for Gonorrhoea and Chlamydia  at 6 days for throat, rectum and urine. All negative. I also did 3rd or 4th gen  HIV test at 6 days which was negative. Syphilis  also came back negative.    I’ve also done a home Finger prick HIV test at 18 days. Although from having researched this may only be a 2nd gen testing kit. 

I’ve had no specific ARS HIV symptoms other than feeling stressed and I feel like my lymph nodes could be slightly swollen in my neck. Although again this diagnosis could be anxiety driven assessments as I don’t really know what I’m looking for . I’ve had strange aches on my body which come and go for example in my arms, feet and armpits. I definitely would not describe these aches as the muscle and joint pain you describe with ARS - although now I’m not sure. 

My questions are how reliable are my tests for Gonorrhoea  and Chlamydia at 6 days?  How reliable are finger pick tests at 18 days - particularly if I was showing ARS symptoms?   Are any of my symptoms something you’d associate with newly infected HIV people?  

Thanks for your advice in advance. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Welcome back, but a bit surprised you found it necessary after the reassuring advice you had from Dr. Hook a couple of weeks ago. I'm taking this question, but I reviewed your discussion with Dr. Hook. I agree with all he said. To your current questions:

"how reliable are my tests for Gonorrhoea  and Chlamydia at 6 days?" 100% reliable. And as discussed with Dr. Hook, you weren't at risk for either of these infections, and your symtpoms also did not suggest them.

"How reliable are finger pick tests at 18 days - particularly if I was showing ARS symptoms?" For detecting a new  HIV infection, an antibody test (3rd generation) is probably ~60% reliable at that time an an AgAb test around 75%. However, both results are 100% conclusive that your symptoms are not due to ARS. The symtpoms of ARS are caused by the immune response to HIV, not to the virus itself. After 4-5 days of ARS symptoms, these tests always are positive.

Are any of my symptoms something you’d associate with newly infected HIV people? These symptoms are not at all typical or suggestive of ARS. I'll also point out that when someone suspects his or her own symptoms are due to anxiety or other emotional reaction, almost always that is exactly right.

You really didn't need STD or HIV testing based on the exposure describec. However, now that you have started down that path, it makes sense for you to have one more HIV blood test at a time that is 100% conclusive. For an AgAb test, that time is 6 weeks; for third generation antibody testing, 8 weeks. 

I hope these comments help you move on. Let me know if anything isn't clear.

HHH, MD


---
6 months ago
Thanks for your response. I do understand your responses and the previous response from your colleague.   However the main concern of exposure was potential of the condom breaking  when being topped even though it probably didn’t. I will continue with a lab based 4th gen test to get confirmation of results. Just out of interest the UK Biosure home finger prick test is I believe a 2nd generation test.  Do these types of test have any accuracy at this time since exposure which is now 21 days? Would they identify any antibody a this early since exposure?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Did the condom break? Of course I have no idea -- you were there and I wasn't! But it's hard to miss a condom rupture, and minor or micrscopic breaks are rare if they occur at all.

If your fingerstick test was 2nd and not 3rd or 4th generation, a negative result at 21 days is only slightly reassuring. I would estimate that around half of newly infected people would be positive at 21 days.
---
6 months ago
Many thanks for your kind responses. 

I take on board your comments that testing probably was not necessary In the first place. However I will continue to test confirmation and as good practices. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Thanks for the thanks. I'm happy to have helped.---