Hello doctors

My last sexual encounter was in november with an expensive Sex Worker in Europe (this was a one and last time event). All the encounter (oral and vaginal) was condom protected and I belive the condom did not break (the Sex Worker removed the condom with a tissue and not say anything about it. Also, I think I saw the tip of the condom filled with semen after I pulled out). Six weeks after this, I took the following tests:

Hep B: Surface antigen HBsAG (Negative). At 4 weeks I also took the same test and the surface antibody test (both negative)

Syphilis RPR and Antibody Test (Negative).

HIV: 4th gen test (Negative). I also took the test at 12 weeks (Negative).

Gonorrhoea: Negative

I was ok with those tests, until I started to read about their window period, and besides HIV, I could not find consistent information, so I'm quite confused now and not sure if they are conclusive. My questions are:

1) Do you consider those tests conclusive? Can I move on?
2) Regarding HIV, is the 12 week test conclusive for both types (I and II)? There is no much info for HIV-2 Window period.
3) Should I take other tests for herpes and HPV? I ask, because yesterday, some small red dots appeared on the back of the head of the penis (corona area). I'm not circumcised. The dots do not hurt, bother, or itch. My first impression is that it is just an irritation, but I better ask.

Thanks for the valuable help!

The main reason you can't find conclusive information on time to conclusive testing ("window period") for infection other than HIV is that little research has been done or published. Most of what is known or believed by experts in testing for viral hepatitis and syphilis is based on years of clinical experience plus biological principles, but few if any systematic research on how long it takes for conclusive results. However, excellent research and data are available for HIV.

Honestly, though, I think you're over-focused on the tests themselves. You had very safe exposures with virtually no chance of catching any of the infections described. Escorts (expensive female sex workers by appointment, as opposed to bar pickups, brothel workers, etc) generally are health aware, have low risk clients (men like you!), require condoms, and get tested frequently -- and thus most have very low rates of HIV, syphilis, hepatitis B, etc. Had you asked before now, I would have advised that no testing was needed; or maybe if such exposures occur from time to time, maybe get tested once a year (and then only for gonorrhea/chlamydia, HIV, and syphilis). Finally, absence of typical symptoms is substantially reassuring that you didn't catch syphilis, herpes or gonorrhea (or chlamydia). To your questions:

1) Your results are absolutely conclusive for HIV and gonorrhea. (For gonorrhea, the window is just 2-3 days.) I consider your syphilis test concluisve, although given the uncertainties discussed above, some experts advise 3 months. You may have been tested a bit early for hepatitis B, but there was zero chance of it anyway. (In addition to the comments, above, probably your partner has been vaccinated -- and perhaps you were as well; hep B should have been included in your routine childhood immunizations.)

2) Your HIV AgAb (4th generation) blood test was conclusive at 6 week for both HIV1 and 2. Some experts would advise 8-12 weeks for HIV2, but that virus is so rare in North America and Western Europe that it's really a non issue anyway. But anyway, you have met even the more conservative standard.

3) There is no reliable or recommended test for HPV after sexual exposure. And assuming you've had at least a few partners in your life, you already have had HPV and the exposure described above did not materially increase your risk.  For HSV, "red dots" do not suggest herpes, and for people without symptoms, the current blood tests simply are too inaccurate to recommed testing in this situation.

So all is well. I don't recommend any further testing.

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

HHH, MD

1) The sex worker was not an escort. She works in an expensive strip club (that works as a brothel) and the tariff for the sex service is high ($200 for 30 min). That is why I said she was an expensive sex worker. (I suppose that given the price, she takes care of herself by regular testing  -but, who knows- and the place provides the condoms).

2) I'm not vaccinated against Hepatitis B. I thought I was, but when this last encounter happened I went to the hospital, they ran some baseline tests, and then they told me I wasn't.

3) Besides the sex worker, I just have had 3 female partners, and all the encounters were condom protected, except the oral sex.

Saying all that, my follow-up questions are:

1) If I were your patient, and considering this new info, would you recommend me testing again for Hep B or even for Hep C? Or should I wait for my anual check up as usual? (I am in the 15th week since the last encounter)

2) Regarding the red dots (which are not red now), should I concern or talk to my doctor? I got an appointment with a urologist (because of these dots), but the only available space is until March 21st.

Anyway, thanks for your help and sorry if the questions are a bit repetitive (I tried not to...).

2) You're still at little or no risk of hepatitis B from any one sexual exposure. But why not play it smart and get vaccinated now?

3) All low risk, by this description.

Questions:

1) No, I definitely would not test you for either one. Hepatitis C isn't even sexually transmitted between males and females (another urban semi-myth!).

2) Red dots under the foreskin suggest minor balanitis, not an STD of any kind. If they continue to clear up, I see no need for further concern or medical evaluation.

Thanks for the thanks. I'm glad to be of help.