[Question #8056] Potential Exposure

49 months ago

Docs, I find my self in a logical dilemma. I’m a 35yrd male, and I had a random unprotected 1 night stand with a 42 yrd woman (not sex worker). 1st time I’ve had sex in 2 years after divorce. I was able to contact the person after 3 months, and she told me she’s was “clean”, but I can only take that with a grain of salt.

At 3 weeks I got a 3-4 small red bumps on my penis head only. In panicked and went online and got a script for Cefixime 2 capsules 400mg, Doxy 14 caps 100mg, metronidazole 4 caps 500mg.

- would this prescription clear common STI infections.?

Tested-

OraQik 3 weeks (I know to early)-Neagtive

Doc office 8 weeks Chly/Gon/Syp/hep A,B,C -neg

Vaccinated/immune to Hep B

Doc office 12 week 4th Gen Hiv, quest lab- Neg

Clinic 14 week 4th Gen hiv, lab Corp- Neg

Clinic 14 Week Chly/Gon/Syph RPR- Neg

Throughout this I have odd symptoms, loud constant stomach growling from about 3 until now, 8 weeks 2 mouth cankers that won’t completely go away. Right eye that feels like pressure with blurriness/redness that comes and goes. And sharp shooting abdominal pain that has just recently started (5 days now). The pains happen randomly throughout the day.

My question is did I wait to long for the test to pick up the antigens given my body was slow to create antibodies? I’ve read a few things on the possibility of a second window period and worry about that possibility. Would a lack/no antibodies allow the 4th gen to pick up the antigens even at 12 & 14 week tests?

I also watched a recent video https://youtu.be/xy5UMFNR-Rg that Syphilis, could throw an HIV test off, because of antibodies? (I ask this because of my current eye issues) .

I plan on taking a test next Tuesday (6 months post potential exposure) .

Can I conclude if the test is negative that I’m clear of HIV?

H. Hunter Handsfield, MD

49 months ago

Welcome to the forum. Thanks for your question.

I really don't see any dilemma here. First, you describe a low risk exposure: the stastical likelihood a woman like your partner has an active, transmissible STI is low, and the chance of HIV almost zero. Second and probably most important, your test results all are conclusive. For HIV in particular, the AgAb (4th generation) blood tests are among the most reliable diagnostic tests ever developed, and when done sufficiently long after the last possible exposure (6 weeks), the results are always conclusive and overrule all other factors: no matter how high the risk of HIV at the time of exposure, and no matter what symptoms are present, the test result remains accurate and reliable. There is simply no possibility you have HIV, assuming no new exposures since then. There is no such thing as someone with HIV not having detectable antigen and/or antibody, either of which would make the AgAb test positive.

I haven't looked at the you tube video, but I can assure you in 100% terms that having syphilis has no effects at all on HIV test results or their reliability. In fact, there are NO medical conditions known -- nor any drugs or medications -- that have such effectss on the AgAb HIV tests. And in any case, your syphilis blood test results also are reliable and conclusive (and the risk of syphilis from the exposure described was almost as low as for HIV).

No STI is a likely cause of "red spots" on the penis. If you are uncircumcised, I would surmise you might have had nonsepcific balanitis, i.e. the kind of inflammation that is common in uncirumcised men. Certainly that symptom was an insufficient basis for the antibiotics you had. In any case, had you in fact been exposed to (or infected with) gonorrhea, chlamydia, or syphilis, those antibiotics would have eradicated the infection. (I would have not prescribed the antibiotics, even if you had asked or insisted. But once you were treated, I would not have done any further testing for gonorrhea or chlamydia, and probably not for syphilis.)

So all is well. Indeed, given the circumstances, you have been overtested. Please stop -- and go forward with complete confidence you have no STI from the exposure you are concerned about.

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

HHH, MD

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49 months ago

Thanks for the reply, and yes I’m uncircumcised, and have had no other sexual encounters since this day(1/13/21).

I miss spoke with HIV/Syphilis testing. The video is a Physician explaining ocular syphilis and that HIV could effect a syphilis test.

Could you please explain in a little more detail how the antigen drops and antibodies increase? I guess my concern is that i could have found my self in a gap where both could still be at low levels as they transition from detectable antigen to detectable antibodies, because I didn’t test at 4-6 week (early antigen detection). Would a PCR test be worth the money for me?

I know you state test results overrule symptoms, but since this exposure, my body has had me for a loop. And this is where things are just not making logical sense for me, hence the logical/illogical dilemma. Thanks for your time and knowledge.

H. Hunter Handsfield, MD

49 months ago

Thanks for clarifying the video, but I also disagree with your summary of the speaker's comments. There are no reported or known effects of HIV infection on the reliability of syphilis blood tests.

Soon after HIV is acquired, the virus replicates in sufficient numbers that p24 antigen (a component of the virus) appears in the blood, in sufficient amounts for positive testing as soon as 2 weeks, sometimes longer. The body's immune response to the virus then produces antibody to p24 antigen. It is the antibody itself that clears p24 antigen from the blood. The AgAb tests (duo, combo, "4th generation") therefore are positive if either p24 antigen or antibody is in the blood; the test result does not distinguish which component is positive (for a brief period, it can be both). Some sources have claimed that antigen may disappear before antibody has developed, in theory creating a "second window" of transiently negative test results. This is now known to never occur, or so rarely it can be ignored: once antibody develops, the AgAb test is positive for life. In almost all cases (98-99%), the AgAb tests are positive by 4 weeks (up to 90% within 2-3 weeks), but on rare occasions it takes 6 weeks. Hence that is the standard window period cited and recommended by most experts is 6 weeks.

All symptoms from new HIV infection are the result of the immune system response; none are caused by the virus itself. Therefore, it is not possible to have HIV symptoms without detectable antibody. Also, the symptoms of new HIV infection are nonspecific, meaning the same symptoms occur with multiple medical conditions, and symptoms rarely point to one cause in preference to others. Even with the most typical symptoms of a new HIV infection, a negative test proves something else is the cause. There are no known exceptions to this rule. Finally, your symptoms are not at all typical for HIV anyway.

Bottom lines: It is impossible you have HIV and you do not need any more testing (at 6 months or any other time) to be certain about it. Something else is causing them. Most are typical for anxiety magnifying trivial symptoms or even normal body sensations that you would otherwise ignore or not notice.

Got it?

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48 months ago

Thanks for the response. I really tried to not take another test, but my anxiety got the best of me. The wacky symptoms (1 eye pressure/blurry/floaters constant stomach noises and the 2 roof of mouth sores) kept me from accepting my results.

I had another: 6 months post

RPR - negative

Clear view instant hiv- negative

Cly/Gon - negative

I guess my question is how is the reliability of the Clearview instant test at 6 months? And I should be well past any chances of delayed antibody detection? I would have preferred a 4th Gen. I have started seeing a therapist to help me get past this cycle I have found myself in. I feel silly feeling asking these questions, but the fear has been a little overwhelming.

Thanks for your time and answers.

H. Hunter Handsfield, MD

48 months ago

All your test results are conclusive. And your focus on any particular test result, including the clear view HIV test, is wacko: I've given several reasons why you were not at risk and could not have HIV. The latest test simply adds to the reasons, but is no more conclusive than the others!

That concludes this thread. Please no more questions about this exposure and your HIV/STI test results! But I am glad the discussion has been helpful -- thanks for the thanks!

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