[Question #7983] Questions, clarifications about ITS

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50 months ago
Hello again dear doctors,
I am writing to you again to ask for some clarification. After I told you in the previous post, on June 9,  I had   protected sexual contact all time,   both orally and vaginally with a sex worker 4 times in the same evening.  I changed the condom every time with a new one. I don't know her ITS status even she pretend to be clear when i asked her. 
1.After 6 days I did a DNA test for Chlamydia and Gonorrhea and it came out negative. Is it 100% conclusive?
2. I  also took an rapid Trichomonas  urine test at 7 days and it came back negative . Is conclusive? It's specificity is 99% and sensitivity 100% (manufacturer's instructions) .
3.I plan to test for Syphilis at 14 days after exposure? (reagine and specific antibodies) How concludent would it be?  And again at 1 month after exposure. Should I take 14 days of  Doxycycline 2x100 per day just in case or should I wait ?
4. Given the fact that I had protected contact, how conclusive is a 4 th generation HIV test at 2 weeks and  after again at 1 month?  I know at 6 weeks is 100%.
5. I plan to take a DNA VHB ( for hepatitis B) test at 4 weeks ?  It's conclusive after 1 month? 
6. I also plan to test for HSV 1,2  , IGG and IGM at 2 weeks . It is ok or not?
7. Should I take a test for Mycoplasma and Ureaplasma at this time or it is meaningless?
Dr Hook estimated  in the previous thread, that 99% I did not contact any STI.
Thank you  for all the work you do and the advice you give. I will come back with the results if I will do the tests.


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50 months ago
One clarification: For Gonorrhea and Chlamydia I Took an Nucleic Acid Amplification (NAAT) Test -TMA&DKA not an DNA test. Still conclusive?
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Edward W. Hook M.D.
50 months ago
Welcome back to our forum although it saddens me that you felt the need. These questions are largely repetitive and the answers are not going to change. Condom protected sex is safe sex with very, very little risk of acquisition of most STI’s. Further, the tests for STI’s are highly reliable. All of this has been covered in our previous exchanges.  Straight to your questions:

1.  Yes, your results are entirely reliable. The nucleic acid amplification tests are amongst the most sensitive tests and all of medicine. Believe the results. There is no need for additional testing.
2.  Yes, this result is reliable as well.
3.  Your risk for Syphilis is low. Your 14 day test result is a bit early for reliable results. Results after four weeks/one month or four more reliable. Please remember however that Syphilis is a relatively rare disease. If you do not develop a lesion you should not worry about Syphilis and condoms are highly protective against Syphilis.
4.  Your four week HIV combination antigen/antibody test will be more than 99% conclusive. Following condom protected sex I anticipate your test will be negative and personally would not get additional testing.
5.  Yes the result will be conclusive but it’s also probably unnecessary. Your risk for hepatitis B like your risk for other STI’s is vanishingly low.
6.  We strongly recommend against blood tests for HSV of any sort. These tests are highly unreliable. Every professional organization recommends strongly against IgM testing and suggests that IgG testing is useful only in selected circumstances, none of which your exposure matches. You are more likely to be misled by your test results and to have an accurate answer.  False positive tests are very, very common with these tests.
7.  There is no need for these tests.
EWH 

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49 months ago
Hello again dear doctors,
I'm writing to you again because I did some tests on day 26 after exposure.
1. Anti HIV 1+2  ( ser/ ECLIA combi) - negative ( no fever, no rash, no swollen lymph nodes , just a whitish tongue....)
2. Treponema pallidum antibodies - index 0.06 (negative <1) I am still waiting for RPR results.
3. Red blood cell sedimentation rate (ESR) - 7 ( normal <15)
4. Blood count with leukocyte formula with Hb, Ht and indices ( including 22 blood tests , leukocytes, erythrocytes, hemoglobin, lymphocytes, basophil, monocyte, neutrophil, hematocrit, medium platelet volume and so on) - all normal

1.Please tell me how conclusive is the  26-day HIV test ,  given my exposure ( condom protect - vaginal and oral). Should I repeat this test at 6 weeks ( 42 days) ?Seroconversion may still occur ???
2.How conclusive is Syphilis test at 26 days? Should I repeat this test at 6 weeks? I did not  develop any lesion so far.(  I forgot to mention that I took 13 days of doxycycline 2 x100 per day) From  19 June to 1 July . Does it have any relevance in the test result?
3.What about Hepatitis? Especially Hepatitis B.  I followed your advice  and did not take a DNA VHB test. But for the peace of mind should I take some tests.? And what tests should I take ( AgHbs,  Anti HBC, Anti HBC-IgM?) and when? The girl I was with is 22 years old and according to our legislation she was vaccinated against hepatitis B at birth, but it's still 22 years since then....
4.I have not developed any genital herpes so far. Could I have contracted asymptomatic herpes and and I can transmit it on to my wife? I know you strongly recommend against blood tests for HSV of any sort. 
Please, please  give me the best advice to put aside this exposure and to be able to continue my family life. This will be my last mistake. I have already started psychological counseling for two weeks now.
Thnak you for your support and help !!!

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Edward W. Hook M.D.
49 months ago
These questions are, once again, repetitive.  There are not precise data on the day-by-day accuracy of tests and test results but we can make generalizations.  Brief answers will follow.  

1.Please tell me how conclusive is the  26-day HIV test ,  given my exposure ( condom protect - vaginal and oral). Should I repeat this test at 6 weeks ( 42 days) ?Seroconversion may still occur ???
As I told you previously, at 4 weeks (28 days) HIV tests of the sort you took are more than 999% accurate although further seroconversions do very rarely occur.  Your results are about 99% accurate and given your no risk exposure, you can be confident that you did not acquire HIV from the exposure you described.  

2.How conclusive is Syphilis test at 26 days? Should I repeat this test at 6 weeks? I did not  develop any lesion so far.(  I forgot to mention that I took 13 days of doxycycline 2 x100 per day) From  19 June to 1 July . Does it have any relevance in the test result?
Your risk for syphilis are also very, very low,  The fact that you took 13 days of doxycycline would have prevented/cured syphilis if you had been exposed.  There is no reason for additional testing for syphilis.

3.What about Hepatitis? Especially Hepatitis B.  I followed your advice  and did not take a DNA VHB test. But for the peace of mind should I take some tests.? And what tests should I take ( AgHbs,  Anti HBC, Anti HBC-IgM?) and when? The girl I was with is 22 years old and according to our legislation she was vaccinated against hepatitis B at birth, but it's still 22 years since then....
You are not at meaningful risk for hepatitis B.  I see no need for testing

4.I have not developed any genital herpes so far. Could I have contracted asymptomatic herpes and and I can transmit it on to my wife? I know you strongly recommend against blood tests for HSV of any sort.
Thank you for not seeking a herpes blood test.  I would not worry about having contracted herpes and would not worry about any risk for transmitting herpes to your wife through unprotected sex.  

Hope this helps.  EWH
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49 months ago
Hello dear Dr. Hook
Since our last conversation I have done the following tests:  
- 28 days after exposure
    - Anti HIV Ab+Ag p24 ( ser- CMIA) - negative
    - Ag HBs ( ser-CMIA, hepatitis B) - negative
-33 days after exposure:
     - Anti HIV 1+2  ( ser/ ECLIA combi) - negative
      -Ag HBs ( ser-ECLIA, hepatitis B) - negative
      -Liver enzymes : ALT- 10 U/L ( < 50 normal) -  and  AST - 16 U/L ( < 50 normal)
I know the results are 100% conclusive after 6 weeks but  can you share  your thoughts on these results please.How conclusive are  at this moment?
Until recently, I read in various posts on this forum that the result of the HIV test was conclusive at 4 weeks. Why was it changed at 6 weeks and what is the percentage of people who develop antibodies / antigens later according to your experience?
Have you seen or heard of a person who has a negative test at 33 days and then becomes positive at 42 days / 6 weeks?
Symptoms of ARS may still appear after 5 weeks or it is too late ? 
Finally I want to thank you for all the support and please let me know if you have any advice for me for the future!!!
P.S. at 6 weeks I will repeat these tests and with the will of the Lord I hope that everything will be fine and I will forget this ugly chapter of my life.
I wish you all the best in the world.

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Edward W. Hook M.D.
49 months ago
This will be the final response as part of this thread.  Furthermore, should you start a new thread related to these concerns it may be deleted without a response and with return of your posting fee.  These repetitive questions, like your earlier ones will not change our assessment or advice.  Repetitive, anxiety-driven questions are discouraged.  

Your tests remain negative.  The reason the recommended interval for conclusive test results was changed several years ago was because the VERY FEW persons were observed to convert tests in the time span between 4 and 6 weeks after exposure.  At 4 weeks tests are more than 99% conclusive.  Personally, I have never seen a person with a negative 4th generation test at 4 weeks go on to seroconvert in the interval between 4 and 6 weeks.

The symptoms of the ARS typically occur within 2-3 weeks of exposure. Five weeks is substantially longer than expected.    

End of thread. EWH
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