[Question #8484] Follow up on oral risk and testing

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43 months ago
Dear Drs. Had very brief (3-4 seconds) unprotected oral from a CSW massage place. The folks at MEDHELP and POZ only day to assume ZERO  risk and move along. No testing needed. Done.  However Dr HHH recently commented that CDC says it is a quantifiable risk and testing IS reasonable to do.  My concern is that I have experienced mild symptoms that are on the acute hiv symptoms list. Over 3 months post exposure and still horse voice and irritated throat. I learned here that tests overrule symptoms so … 4th gen blood drawn labs at 51, 88 and 95 days. A finger prick 4th gen  Alere Determine rapid at 105 days.  CDC implies that it could take 90 days or more to produce detectable antibodies with no date certain.  Some online chatter even says to test at 6 months. 
1. So looking past the anxiety, and assuming the CSW to be positive and not in treatment, did I test enough to get to a solid 100% conclusive state?
2.  If not, how long do I need to keep testing to get to a conclusive status and can I use rapid tests or only the blood drawn lab ones?  
I don’t want to hope or assume it’s ok. I want the science to assure me I’m ok. 
Thank you drs. for your assistance. 


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H. Hunter Handsfield, MD
43 months ago
Welcome back, but it is frustrating that you had your three previous threads deleted. We can give our best advice when we can integrate our replies with previous ones, especially when about the same exposure and related issues. I have to believe these questions already were answered, or that the answers are obvious from your discussions with Dr. Hook over the past 4 weeks.

You have over-interpreted something I wrote. But the risk at the time of exposure is irrelevant: no matter how high the risk at the time (in fact your risk was zero for all practical purposes), HIV test results done sufficiently long after the window period are always 100% relliable and overrule risk level and symptoms, no matter how high the risk at the time or how typical the symptoms might seem to be. You could have told us you had mainlined HIV infected blood and we would still have reassured you 100% that you did not acquire HIV. As for the 90 day advice you found about antibody production, that's true for some (but not all) antibody-only blood tests -- but it doesn't apply to the AgAb (4th generation) tests, which are conclusive after 6 weeks. It seems very likely Dr. Hook said much the same. (Deleting threads has the additional disadvantage that the user him/herself cannot re-read the replies, which often is very reassuring in itself.)

Question 1, yes. 2. Therefore question 2 is irrelevant; you should not have any more tests of any kind. And yes, all I have said is based entirely on well established science.

Let's plan on this discussion not being deleted, OK? In addition to the reasons cited above, one purpose of the forum is the education of users other than the questioner. Also, whether deleted or not, this will have to be your last question on this topic. Repeated anxiety-driven question are subject to deletion without reply, and without refund of the posting fee. Thank you for your understanding.

HHH, MD

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43 months ago
Dear Dr HHH


Thank you for the direct response on hiv. I got the message and -No deleting. Since that part has been answered I have a follow up inquiry as to other STIs if I may. 

I don’t know the risks for all other STIs from this exposure. As part of the screening, I was tested at 6 weeks for gonorreah , chlamydia , syphillis and hep b and c. Then again at 12 weeks for syphillis and hep b and c.   All negative. 

  1. For my exposure, were any or all of these appreciable risks?
  2. Are these test results conclusive and reliable to exclude these?
  3. Is there any re testing or different testing I should still do?
  4. Had a throat culture and they found yeast in post nasal drip mucous. Can that be a result of some infection from this exposure ?  And if so, what do I do to address it?
  5. Although the urine tests were negative, could something from this event still get to and infect the prostate ?

Thank you Dr. for your patience and understanding. 


Sent from my iPhone
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H. Hunter Handsfield, MD
43 months ago
1,2. Unprotected oral sex (in this case oral to penile) is low risk for all STIs. Of the ones you list, gonorrhea is most likely; syphilis next; and chlamydia and viral hepatitis extremely low risk, close to aero. In any case, your negative tests show conclusively you weren't infected.

3. I would not recommend any further tests and nothing that needs retesting.

4. Yeasts can reside normally in the throat and nasal drip. Just a positive result on culture does not in itself indicate an infection that requires treatment. Whether or not it needs treatment depends on symptoms, physician examination, etc. 

5. No infection acquired from oral sex is likely to cause a urinary tract infection or to infect the prostate.
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43 months ago
Dear Dr HHH

Thank you for the info. and for your compassion. I forgot to mention that I took Augmentin (for sinuses) prior to the STI urine testing for chlamidia and gonorreah and trichamonis so I may have caused a problem with that. I have not had any overt symptoms with urinating burning or urgency, or discharge or off color urine or groin pain.  

I guess I was pursuing more information because I had a lengthy throat irritation with a horse voice and occasional feelings of hot or chills with slight elevations in temp. It’s like I have some sneaky infection somewhere but no big symptoms to point at.  Or it’s in my head.  These symptoms are all improving but pretty slowly. It’s more than 4 months post exposure.  I did the home UTI test strips but negative on those. 

As this is my 3rd query,

  1. Did I ruin the STI urine testing accuracy 6 weeks post exposure with the previous penicillin antibiotics requiring re testing now?
  2. I didn’t get a NGU test. Should I get that?
  3. Could any STI that I could have been exposed to in my case be the cause of my upper respiratory issues or the hot and chills feelings?
  4. Based on the above, can I have an ongoing STI from this event without the classic symptoms that I need to test for and treat?
  5. I neglected to ask, are my several 4th gen tests sufficient to also exclude HIV2?                            Thank you very much. 


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H. Hunter Handsfield, MD
43 months ago
1. The Augmentin probably had no effect on test reliability. Absence of symptoms (often quite painful) is itself solid evidence you didn't have gonorrhea -- and if you did, the Augmentin would have cured it anyway. Either way, the negative test result is reliable. Trich and chlamydia testing would not be affected by it -- and both are extremely low risk (chlamydia) and zero risk (trichomonas) from oral sex. 
2. There is no standard test for NGU in absence of symptoms. Without discharge, you can be sure you don't have NGU. And NGU from oral sex is believed to be harmless anyway, nothing to worry about.
3. No STI causes such symptoms.
4. You can be confident you have no STI from the event described.
5. Yes, the HIV AgAb (4th generation) blood tests are reliable for HIV2 -- which in any case is exceedingly rare in the US and mostly occurs in immigrants from east Africa.

All is well -- do your best to move on without further worry!

That concludes this thread. Thanks for agreeing not to delete it. Also please note the forum rule against repeated questions. This being your fourth about the same exposure and testing, it should be your last. Excessive questions are subject to deletion without reply, and without refund of the posting fee. Thanks for your understanding. I hope the discussions have been helpful. Best wishes and stay safe.
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