Are my Tests Conclusive and Good Enough?

Hello Doctors,
I am a male.31 yrs old,Asian Chinese and uncircumcised.I have performed the following tests 12 weeks (84 Days exactly) from my last exposure:HIV (Antigen and Antibody),Syphilis (VDRL),HSV Type I IgG Antibodies,HSV Type II IgG Antibodies,Chlamydia PCR and Gonococcal PCR(Both urine tests).All results are Negative.
84 Days before the tests,I received unprotected oral sex and protected vaginal sex from a CSW.
88 Days before the tests,I received unprotected oral sex, nude massage and frottage (penis and vagina rubbing) from a massage lady. My penis was cut from this exposure too. No bleeding but reddish spot. The cut has healed long ago.
110 Days before the tests,I received nude massage and frottage.All exposures were with different person.
1.Do my tests 84 days after last exposure will cover for all the exposures including my sexual history (which I did not mention all of them here)? Did the penis cut from the second last exposure made any difference?
2.I did not notice condom failure in my last exposure. Assuming,my condom did fail,are my tests conclusive and good enough? I read in online resources that the higher the risk, the longer the window period is. Is this true?
3. The HIV Test that I did is called HIV I & II Antigen and Antibody Screening Test. Is this test, what you refer as the HIV Duo Test? I have read that this test is most accurate at 4 weeks post exposure. Is the accuracy still there at 12 weeks post last exposure?
4. Do you think all the tests that I did enough to rule me out of any HIV/STDs? Do you still recommend me to go for any other test? I'm immunized against Hepatitis B. What about Hepatitis C. Do you think a test for Hepatitis C is necessary? I never take injection for drugs nor practice homosexual. However, I did have multiple female partners (both CSWs and not CSWs). I have read in an online resource that Hepatitis C infection or co-infection with HIV will delay the HIV seroconversion. Is that true?
Thank you Doctors.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

You have posted a rather long question.  I haven't yet read it, since there's a good chance I can give you an accurate reply based only on the title of your question.  If you have had one or more of the standard HIV blood tests, and if the result was negative more than 4 weeks to 8 weeks after the exposure you are concerned about (depending on the specific test done), then you can be sure you don't have HIV.  It doesn't matter what symptoms you might have had, and it doesn't matter whether your exposure was high or low risk.  The test results overrule all other factors.

OK, now I have read the question.  Guess what?  You don't have HIV, and your other STD tests also are completely reliable.  And in any case, the sexual exposure you described carried no appreciable risk of HIV or any STD, because condom-protected vaginal sex is risk free and oral sex, even unprotected, is very low risk (zero risk for HIV).  To your specific questions:

1,3) Yes. this was the duo test, for both HIV antibody and p24 antigen.  The negative result about 12 weeks after exposure is 100% reliable.

2) The risk level doesn't matter.  No matter how high the risk of HIV, the test results rule.  (But this was a virtually zero risk event anyway.)

4) Based on the nature of the exposure, you were over-tested.  You oould not have caught some of the STDs mentioned (HSV-2, hepatitis B or C, or HSV-2, chlamydia) and the risk for others (e.g., syphilis, gonorrhea) was extremely low.  In any case, the test results for those STDs are reliable.  It is NOT true that acute hepatitis infection delays reliable HIV results.  That's an urban myth; to my knowledge, it has never happened.

So all is well; you can be sure you are not infected.  Had I been in your situation, I would not have felt it necessary to be tested for any STDs, and I would have continuned unprotected sex with my wife with no worry about infecting her.

I hope this has helped.  Best wishes--  HHH, MD

[TommySoo]

Hello Dr. Handsfield,

Indeed your reply helps. Not only put my confidence in my tests at the highest level but also clears off some of my confusions.
Especially, on the test on 12 weeks after exposure for HIV Test. Previously, I was confused about this statement, whether to test on 12 weeks after the last exposure or to test on 12 weeks after each exposures.
Based on your reply, I must say my understanding is test on 12 weeks after the last exposure and if the result is negative, the result overrule all factors including risks and symptoms.
However, I still have a question regarding Hepatitis C which I am still a bit confuse. Based on the nature of exposures that I have mentioned above, you mentioned that testing of Hepatitis C is not necessary. Well, I think that is because the low risk nature of the exposures (unprotected oral sex and protected vaginal sex). To understand more about Hepatitis C, let me briefly explain about my previous sexual history. I have had multiple sexual exposures (with CSW and not CSWs). I always made sure exposures with CSWs were condom protected. My question is: If some exposures that I have had previously were unprotected vaginal sex or condom failure vaginal sex, do you think testing for Hepatitis C is still necessary?
I'm confuse because some resources mentioned that Hepatitis C is a STD but some resources mentioned that Hepatitis C is not a STD, even if it is it only happen to traumatic anal sex (homosexual). There has been no proven case of Hepatitis C transmission through vaginal sex and oral sex.

Hopefully you can clear off this confusion for me. Thank you Dr, Handsfield.
I am very very surprise of the waiting time you attended to my question. And the way you replied to my questions is very understandable. No wonder the forum readers treat you and Dr. Hook like heroes.

Thanks again for your help.

[H. Hunter Handsfield, M.D.]

"... some resources mentioned that Hepatitis C is a STD":  Those sources are mistaken, based not on data but on unfounced assumptions, e.g. that because HCV is blood borne, its transmission must parallel that of hepatitis B virus and HIV.  But the research simply doesn't support it.

"...but some resources mentioned that Hepatitis C is not a STD, even if it is it only happen to traumatic anal sex (homosexual). There has been no proven case of Hepatitis C transmission through vaginal sex and oral sex."  Exactly right.  These are the scientific sources based on research and surveillance that shows no higher rate of HCV infection in heterosexual partners of infected persons than in the general population, when one takes into account blood exposure (e.g., when couples also are drug users who share injection equipment).

You should not waste your money on HCV testing in this situation -- and I wish online lab services would stop including HCV in "STD test" panels.

[TommySoo]

Hello Dr. Handsfield,

Again, thanks for your clear explanation. This will put my worry to permanent rest.
You and Dr. Hook are doing a great and wonderful job here. You guys are real heroes!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  I'm glad to have helped.

[TommySoo]

Hello Dr. Handsfield,

I'm aware that our discussion in this thread has actually ended. However, I have a question that I would like to ask regarding my Syphilis VDRL test. If I will need to pay to ask, I will pay.
I have been reading about the antibiotics effect on VDRL test and the 'prozone' effect, which I don't really understand them.
Straight to my case, just to recap, I did VDRL test and other STDs test at 12 weeks (84 days) after my exposure.
In the 1st week of the exposure, I have went to see my doctor and told him about my exposures.He has given me Inoflox (Ofloxacin) for 4 days. He reasoned that the antibiotics will help to prevent gonorrhea.
In the 8th week of the exposure, again I have to take antibiotics because of my sore throat. This time it was amoxycillin for 5 days. But, the antibiotics was not good enough.
So, in the 9th week, doctor prescribed me with Cefuroxime for 5 days to combat the sore throat.
The period from the last dose of Cefuroxime to my testing day is around 3 weeks.
So, the question that I would like to ask, is do you think my affairs with antibiotics did actually affect my Test result for VDRL or any test that I have did as mentioned above posts?
I have actually did a full body check up test at 14 weeks after exposure, which in this test, HIV antigen and antibody test and VDRL test were included. So, I have actually did 2 VDRL Test, one at 12 weeks and another at 14 weeks after the last exposure.
However, it is good to note also that before my full body check up test at 14 weeks, I had just completed 5 days doxycycline. This time was for the sebaceous cyst near my thigh area. The doxycline was given after the 12 weeks test, so I assume the 12 weeks result was not affected by the doxycycline? But, probably, the 14 weeks test was affected?
Not sure if the information provided about the 14 weeks test and doxycycline is helpful.
Truly need your advice on this and lastly, since exposure till now, have been 24 weeks, I do not have any symptoms suggestive of STDs. However, if you think I need to re-test again, I will follow your advice.
Thank you, Dr. Handsfield. And, please let me know if I need to pay to create a new thread to ask this question.

[H. Hunter Handsfield, M.D.]

I suggest you lay off the internet on this.  You're selectively being drawn to pretty much irrelevant information.  Prozone is very rare and there are no antibiotics or other factors that have any effect on it.  Your negative VDRL results are reliable.

This thread is definitely over.  Do not ask any further questions about these events in a new thread.  Move on with your life.

[TommySoo]

Hello Dr. Handsfield,
Thank you very much for your reply. I agree your reply should end this thread and I should move on.

From your reply, as I understands it. Antibiotics have no affect on Prozone. And the series antibiotics that I have taken also have no affect on my VDRL Test negative results at 12 weeks and 14 weeks after exposure. So, they are reliable.

I might understand your reply wrongly. As you said antibiotics have no affect on prozone. As for antibiotics affect the test, I assume there's no affect as well?

[H. Hunter Handsfield, M.D.]

Antibiotics affect syphilis tests only by curing syphilis, so a test will never be positive.

This thread is definitely over.  Any more comments will be deleted without reply.  Please re-read my replies above, believe them, and move on. Your compulsive obsession with STDs is irrational.  Let it go.