4-week negative HIV result

[lukewarm002]

Hello Dr. --

I believe I had a risky exposure 4 weeks ago with another male after a night of drinking. I woke up to the other guy penetrating me -- I immediately panicked, but realized he had a condom on. He told me we were protected the entire time and took it off after we were finished. I really have no reason not to believe he isn't being truthful.

Unfortunately, after some rectal bleeding, I went to get a complete STD panel and it came back positive for rectal gonorrhea. Prior to this, I went to the doctor and they felt a boggy hemorrhoid after a rectal exam -- so I'm not sure if I had inadvertently discovered I had gonorrhea from a past incident after having hemorrhoid systems, or if this guy gave it to me. The last time I had sex with my ex without protection with is September ... so I know there is a chance that he accidently gave it to me then.

Assuming my risky encounter did give me the gonorrhea and that he is HIV+, how reliable is my negative test 4 weeks out that I am in the clear? I do understand the difference between indicative/conclusive ... so I know that I do have to get tested again 3 months out. I just want to understand the odds of become positive after 4 weeks. Also, how easy is it to transmit Gonorrhea? To get it rectally, do I need to be completely penetrated to be infected? There have been more than a few occasions in the past few months that a guy has had the tip of his penis touching my anus without penetration. Is there a possibility I was infected by just coming in contact with infected fluids?

Thanks!

[Edward W Hook, MD]

Welcome to the Forum.  There are several "ifs" here. I'll try to help.  

What is clear is that you did get gonorrhea from someone in the past.  Precisely whom is difficult to say.  By extension if you were expose to gonorrhea you could have also been exposed to HIV as well.  Gonorrhea is more easily transmitted than HIV- we estimate that a single rectal exposure to a partner with gonorrhea will lead to transmission in about 1 in five exposures.  In contrast, as the receptive partner participating in rectal intercourse with an HIV infected partner the likelihood of infection following a single exposure is about 1 in 100-200.  In your own case, your negative test at 4 weeks is strong evidence that you were not infected with HIV.  At 4 weeks standard blood tests for HV would detect over 90% of recently acquired infections.  At 8 weeks virtually all persons with recently acquired HIV will have positive tests, thus you can re-test at 8 weeks.  A negative result (which is the result I anticipate you will get), should give you confidence that you did not get HIV from this exposure.  

Whether or not rectal gonorrhea can be transmitted through contact with secretions but without penetration is unknown but if it occurs, this is rare.  Your rectal gonorrhea was most like the result of direct contact. EWH

[Edward W Hook, MD]

The DUO test provides conclusive results earlier than tests which test only for antibodies becasue if tests both for antibodies and the HIV p24 antigen which is present in the blood before antibodies are.  The results of DUO tests are conclusive at 28 days.  You need to believe (both of) your test results.  There is no need for further testing.  EWH

[Edward W Hook, MD]

Yes, it includes oral rapid tests.

Yes, just as I alreay wrote, Gonorrhea- 1 in 5 exposures lead to transmission, HIV - 1 infection in 100-200 acts of recptive rectal intercourse.

EWH.  

[lukewarm002]

Thanks, Doctor!

When you say that at least 90% will be positive by 4 weeks ... Does that include the oral rapid tests as well? And just for clarification, when you say 1 in 5 leads to transmission, you mean gonorrhea .... Not HIV in gonorrhea-infected people, correct?