[Question #7854] HIV, HCV, HBV-worries

51 months ago

Dear Dr. Handsfield or Dr. Hook,

I am in a worry cycle again and hope you can help me. 8 weeks ago, I had sexual contact to a woman from Kenya in Germany, so I suppose she is of somewhat higher risk for HIV, HCV and HBV. It was mutual masturbation. I have been tested for HIV, Chlamydia, Gonnorhea, Syphilis 39 days after the exposure, all negative. In March I tested negative for HCV. Over the years I had many exposures typically of the same sort, a few times I received blowjobs, but that's it.

My questions:

1.) How accurate is my 4th generation HIV-test at 39 days?

2.) For HCV only my last exposure, mutual masturbation could possibly be a risk. But what from I have read this risk approaches zero or is effectively zero, right?

3.) About my biggest worry is HBV for which I haven't been tested recently. I have been vaccinated (Twinrix) 13 years ago. My Anti-HBs-Titer was tested last October: 549 IE/l. So is it even possible that I was infected before or by this last exposure in spite of this level of protection? I have read about breakthrough infections. Is this really a concern? For this worry not only mutual masturbation is relevant as I haven't been tested for HBsAg and AntiHBc over the years, so some blowjobs I received are here also relevant. But this happened to a maximum of 5 times.

I would appreciate if you can give me estimated numbers for the respective probabilities, numbers always help me.

For years I haven't had sex with my wife and I hope we might resume sex somewhen soon. And of course I don't wanna be a risk to my wife. I guess that triggers my somewhat irrational fears. But I do hope with your answers I can put my worries to an end.

Kind regards

Karl

H. Hunter Handsfield, MD

51 months ago

Welcome back. I haven't re-read your several previous threads, but I'm pretty sure these are similar to most or all of them. You have occasional new sexual exposures that typically are highly safe, then are concerned about HIV or other rSTIs. The answers we have given and their reasons have been very consistent, I'm sure. It seems you likely could have seen the answers you need this time in the previous threads, either directly or by logical implication. For example, surely we have discussed that no STIs ever are transmitted by hand-genital contact or fingering -- regardless of how high risk your partner might have been or what transmissible infections s/he may have. The same is nearly true for receiving oral sex, with low risk for all infections (compared with vaginal or anal sex) and essentially zero risk for some, including HIV. I'm sure we have also discussed the timing (window period) to conclusive HIV test results. To your specific questions:

1) As you undoubtedly have seen before, the AgAb (4th generation) HIV blood tests are nearly conclusive by 4 weeks and 100% so by 6 weeks. At 34 days, the negative result is at least 99% reliable, and should be oonsidered conclusive since the exposure could not have transmitted HIV anyway.

2) HCV isn't really an STI except in one circumstance: potentially traumatic anal sexual practices among men having sex with men. Contrary to what you might assume and many websites will imply, it is not transmitted by vaginal sex. (One calculation by investigators in Denmark calculated a risk of once in 190,000 vaginal sex event, if one partner is infected.) For sure zero risk for hand-genital contact.

3) Pretty much the same for HBV -- and any case, HBV immunization is valid and protective for life. Certainly at 13 years, and with the strongly positive antibody response that was documented, you are protected now and into the indefinite future. Anyway, no known transmissions by hand-genital contact.

From all you say here and we have discussed previously, I'm sure there is no risk of any STI transmission to your wife if and when you resume unprotected sex with her. The only possible exception might be HPV, which in theory might be acquired by hand-genital contact or oral sex, but only rarely; and everybody gets or has genital HPV anyway, and assuming you had your have have had other partners in the past, you can safely assume you and she have been infected and could still be carrying one or more HPV types. Certainly the sexual events you have described would not materially increase the chance your wife would have HPV or develop anything significant from it, e.g. an abnormal Pap smear (by far the main HPV consequence in women).

I hope these comments are helpful. None of them should be surprising.

HHH, MD

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51 months ago

Dear Dr. Handsfield,

I've just had a bottle of fabulous Bordeaux with my wife (and a cigarette afterwards at the window of my home office in the attic). FYI I seldom drink alcohol and have a cigarette about every 2 years. That's just to "excuse" a tone I might chose now which is influenced by the state of mind in minimal intoxication I am in now.

So here it goes:

I love you guys!

It is indeed impressive to me, how compassionate, differentiated and thorough you are with your answers. You receive so many questions on a daily basis and still you are making a difference, how individual you answer them, scientifically based and thoroughly frank, kind of "tough love". I do appreciate it!!

So in a nutshell: No testing and no medical worries are any helpful here, right? Indeed my wife and me both have a background of about 10 sexual partners before we entered our marriage. That is 25 years ago. And she has had indeed a positive pap smear some years ago and I indeed also a "positive" HPV-diagnosis. But that's the past. We have both tested negative before and reassured ourselves sincerely that we both haven't had vaginal or anal intercourse with other partners since last being tested. And I do hope we will get to a satisfying sex life together. And even if not I may be going back to having my massage exposures, strictly limiting them to mutual masturbation. So we will be safe in any case.

So I was looking for reassurance and you provided that. Thank you!

I will go back to the living room now where my wife and 10 yo daughter are waiting for me. No contradiction to our (also sexual) history at all in my opinion.

I wish you well, take care! And thank you again for not only answering questions by replicating blueprints.

Cudos!

A relieved and happy

Karl,

from Germany

H. Hunter Handsfield, MD

51 months ago

Thanks for the thanks; I'm glad to have helped once again. ---

51 months ago

And just finally, the negative result was at 39 days, not 34, so testing must be in itself really very close to 100%, right? That will be my last follow-up and I wish you well!

Best

Karl

H. Hunter Handsfield, MD

51 months ago

Yes. I would consider it 100%.---