[Question #7571] Testing questions guidance

1 months ago

Dear Doctors:  I have some questions for which I would like your guidance.

Exposure was with an unknown perhaps high-risk women of unknown status.  Exposure involved unprotected nude rubbing (I think you call it frottage of the genitals) without penetration, sex (penetrative) for 25 mts with condom (I believe the condom was on at all times but I do not recall totally well if breakage or slippage occurred), unprotected oral sex giving and receipt, fingering, sucking breasts, and lip to lip kissing.

Test 1: 41 days post exposure. All Non-Reactive for HIV (4th Gen), Syphilis, and Herpes.

Test 2: 70 days post exposure. All Non-Reactive for HIV (4th Gen), Syphilis, and Herpes.

The tests were performed in a reputed lab in the US.

For the second test (Test 2), on the day after the test day, I had set up a doctor with my Primary Care Physician to see what he heard from the labs. They had not yet received the results the morning of the appointment and so, I called them to call the lab and get the results from the lab.  By the time I got there for my appointment, they had received the results from the lab. However, the results copy said ‘Courtesy copy PARTIAL report’ at the top.  It indicated non-reactive for HIV (4th Gen) and Syphilis and indicated that the Herpes test was pending. Upon asking them (the office staff) to check with the lab, they told me that the lab indicated that the Herpes machine was not functioning and that they have requested a replacement machine.  I was happy that atleast I was non-reactive for HIV and Syphillis and walked out thankful that I may need to wait a day or two more for Herpes results. As expected, the next day the primary care doctor office staff called me and said the second half of the results were available and that I could come and pick up a copy of the results.  In the FINAL (it was written FINAL at the top) report, all three were Non-Reactive. HIV, Syphilis, and Herpes.  Also, I noticed that the HIV ad Herpes tests in the second test were performed in different labs of the lab company whereas in Test 1 these two were performed at the same lab of the lab company.

My mind is playing games with me and I appreciate your responses to my questions below alongside any additional commentary you may have.  I also appreciate any real reassurance you could provide.

1.       I know in Test 2, the Herpes test was pending and the machine was malfunctioning so they had to get a replacement.  Does this impact my 70 day HIV (4th Gen for 1 and 2 antibodies and HIV-1 antigen) test results in any way?

2.       In Test 2, in the Partial Courtesy Copy HIV and Syphiilis were indicated non-reactive and they were non-reactive in the Final copy too. Does the Herpes test happen in the same machine as the HIV test?

3.        Is there anything I need to be concerned about with respect to manual errors, human errors with respect to the HIV testing that was performed post Day 70?

4.        I am assuming the lab would not interchange tests results and one test would not impact the other.  Is this correct? Could the malfunctioning herpes machine cause the HIV machine to conclude tests incorrectly and too soon (abruptly) as False Non-Reactive/Negative?

5.       That the Herpes and HIV tests in Test 2 were performed in different labs. Is this a concern?

6.       Does one test (for eg HIV)  have a bearing on the other test (Herpes or Syphilis for instance) being performed or can they be viewed as occurring independently and not in the same assembly line?

7.       Bottom line: Can my HIV (4th Gen tests, day 70 test) from the lab be taken as completely reliable, accurate, and complete irrespective of other factors (whether it was impacted by other blood works being performed and machines being used, other blood tests, etc)?

I am sorry for anxiety driven questions and hope they make some sense.  I would greatly appreciate your guidance and clarity.  Thank you for your service.

1 months ago
Hello doctor: I got a note that you closed the tread. I did not ask a redundant question or ask from a different account.  I am not sure which other thread you are reffering to.  Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Welcome (perhaps back) to our forum. The reason your thread was transiently closed is because it is nearly identical in many ways to question number 7566 which was posted recently from an almost identical internet account using a very similar user name. Your current questions are different enough from your original questions that we will go on and answer them.  Please review question 7566 and you will see why we believe that you are the same author.  FYI, Dr. Handsfield and I have worked together for nearly 40 years add while I verbal styles differ from one another the factual content and our assessments are always in agreement. No exceptions. I have reviewed question 7566 and agreed with all the Dr. Handsfield said. The replies I am about to provide will consider that post as the starting point for my replies although these replies are Independent an address your specific questions.

The encounter you described was very close to zero risk.  Statistically it is unlikely that your partner had HIV and even if she did, nearly all ( more than 99%) of unprotected exposures to untreated, HIV infected persons do not lead to infection. Further, there is no risk For HIV from frottage without penetration, condom protected genital sex, masturbation, breast sucking, kissing, and receipt of oral sex. The risk of genital herpes from these exposures approaches zero as well.  

In answer to your specific questions:
1.  The laboratory tests for herpes and for HIV are entirely separate And provide entirely independent results.  Neither test impacts the results of the other test. The machines used for these tests are different.
2. As mentioned above, the instruments used for the herpes blood test are different than the instruments used for the HIV tests.
3.  There is no reason to anticipate manual or human errors made your test results unreliable. Laboratorians undergo extensive training and nearly continuous quality control evaluations to assure that the tests are accurate and entirely reproducible.
4.  Correct. Please see my reply is above.
5.  That the tests were performed a different laboratories is not a concern. The test kits are manufactured uniformly, the quality control practices are standardized, and the results would be the same if the same tests were performed in different laboratories.
6.  Please see Reply number one. These are independent tests which do not in anyway influence the outcome of the other test.
7.  You can have complete confidence in the reliability and accuracy of your tests. Your HIV tests are entirely conclusive. HSV blood tests have a limited amount of inherent unreliability in terms of less than 100% sensitivity and occasional false positive test results. Clearly you’re you do not have problems with false positive test results. Given the low risk nature of your exposures and your test results I would have complete confidence that you did not acquire either infection through the encounter you have described.

 I hope thisInformation is helpful to you. If any part of this reply is unclear please feel free to use your up to to follow up questions for clarification. EWH
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1 months ago

I thank you Dr. Hook for your answers.

So, I can fully trust the 70-day HIV 4th Gen non-reactive results that were reported in the partial courtesy copy (given Herpes test was pending) as being complete, accurate, fully conclusive, and distinct and performed independent of the other tests including the pending Herpes test. Do you agree with this and say this is correct?

Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Repetitive.  See above.  Your results are conclusive. EWH ---
1 months ago
Dr Hook: Thank you for the simple and clear explanations, Dr Hook, which are very reassuring.
I just need some clarifications:
a. In your answer to question 7, the first part of your sentence was "7.  You can have complete confidence in the reliability and accuracy of your tests."
I am assuming you meant that for my HIV 4th gen 70 day test as that is what my questions and concerns were about.  I wanted to get your clarification because you also spoke about Herpes in the same answer and so I wanted to disambiguate.
b. Also in the same response, at the end you had "Given the low risk nature of your exposures and your test results I would have complete confidence that you did not acquire either infection through the encounter you have described".  I should take this to also mean that I too should be completely confident that given the results with the 4th Gen day 70 test, that I am not infected with HIV.  Would this be correct?

Different questions:
c. Partial Courtesy Copy reports mean that some tests are still outstanding.  But they do not have any relationship to the results (for instance the two non-reactives for RPR and HIV in the report) already reported in the Partial Report. Is that correct?
d. Given the results, would you recommend I forget the incident, not question the testing process, and move on with life without worry for the episode?

Thank you again for taking the time.
1 months ago
Dr Hook:  I apologize for another clarification request.

e. In your response to "4.  Correct. Please see my reply is above."
     e1. the "Correct" was in response to my question 4 : "  I am assuming the lab would not interchange tests results and one test would not impact the other.  Is this correct? "
     e2.  and your response "Please see my reply is above." was to the second part of the same question "Could the malfunctioning herpes machine cause the HIV machine to conclude tests incorrectly and too soon (abruptly) as False Non-Reactive/Negative?"  Is that correct?  I should have posed these as different questions originally.

Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
I’m sorry that you are having trouble understanding my responses. The bottom line here is that your encounter was virtually no risk and my advice is to put your concerns aside, avoid overthinking my replies, and move forward without con and without further testing.  I will provide a final set of brief responses below after which the thread will be closed.  Further questions on the encounter described may not be answered as your questions have become repetitive and anxiety driven.  Should that happen, your posting fee will not be returned..  on to my responses to your latest requests for verification:

A. Your assumption is correct
B.  You are correct.
D.  You are correct.  My recommendation is for you to not question the testing process and move forward without concern 


E1.  You are correct.
E2. The problems with the machine used for herpes testing would have no impact on the HIV result.

This thread is now complete.  There will be no further responses.  I encourage you to now move forward without further concerns or testing. EWH 
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