How Accurate, Tests at 23 days?

[pazyamor]

Hi Doctors. About 1 month ago I had an exposure with another man although probably low risk; Unprotected oral given to me and had brief anal for the first time given to me (me being bottom). That lasted a few minutes because the pressure of being penetrated for the first time hurt me (please excuse my explicity in detail), probably lasted for 4 minutes. Although he did used a condom; My mind went crazy afterwards thinking that the condom might have failed or slipped off his penis. I couldn't see the condom because I wasn't facing him during penetration and wouldn't know how it feels when a condom fails/breaks since it was my first anal experience. I did have some strange symptoms including muscle/joint pain which still persist, constant urination(still persist), strange pain above my penis and in between my legs, specially when I sit down.  It feels as if my testicles were blown out or imflammed which creates discomfort, specially when sitting down.

23 days post exposure I got tested:

STD Panel test for gonorrhea, syphlis, clamedya = All Negative
HIV - rapid test (blood drawn from finger, instant result) = Negative
HIV - P24 = NEGATIVE. I was told this test has a 7-20 day window.
HIV - NAAT (NAT) = Pending result.  I was told this test has a 7-20 day window

If you don't mind, i have some specific questions:

1) Regardless of the exposure risk, how accurate are my tests at 23 days, specially HIV? I was told they had a 7-20 day window period. Does it affect the accuracy since i took them at 23 days?

2) STD test came back negative at 23 days, how reassuring it is that i didn't catch any of them? Do i need to test again for Syphlis? if so, when?

4) Do i need to test again for HIV? I might follow up with another set of tests at 37 weeks, depending on your answer.

I have had unprotected intercourse with my house a couple times since that encounter. She has had a few symptoms shown. I hope to god i din't give her anything.

Thank you!

[H. Hunter Handsfield, M.D.]

Test results always overrule symptoms; your test results PROVE that your symptoms are not due to HIV or syphilis.  And no other STD caues such symptoms.  Re-read my October 21 comments.  I haven't changed my mind, and no other STD causes symptoms like yours.

That's definitely all for this thread.  Believe the tests and do your best to move on without worry.  

[pazyamor]

Hi doctor, just wanted to check to see if i could get your last feedback on my above. thx.

[pazyamor]

Hi Doctor,

Jus wanted to post my results:

At 37 weeks the following came back negative:

P24
NAT
Syphlis

I have a strange lower back pain... could this be any sign of hiv given it started after my tests at 37 weeks?

As for syphilis, i know you said test at 6 weeks to be conclusive, would you still recommend i test now and my 37 week not be conclusive just yet?  The reason i ask is because for the second time i have developed a small, irritated, redness around my penis which usually goes in a couple days.  Not sure if it could be a sign of an STD.

Thnx, doctor, I'll await your feedback and this will be my last posting to you.

[pazyamor]

Understood. Thank you, Doctor.

[H. Hunter Handsfield, M.D.]

The rapid HIV test confirms you aren't infected; you can expect the p24 test to also be negative.  I'm also confident your other pending tests will be negative.  You will not need any more testing for HIV or any other STD.

That definitely ends this thread.  THere is no need to post additonal negative test results -- feel free to do it, but I won't be saying anything further.

[pazyamor]

Hi Doctor, just updating you on one of my recent results. .. I went for testing again on 10/26 @ 37 days post exposure.  I took the following tests:

Rapid HIV - Negative
P24 - Waiting results
Nat - waiting results
Syphlis  - waiting results

I know you said at 6 weeks my syphilis would be conclusive but how accurate is it at 37 days? Would i need to retest at 6 weeks or would you suggest I dont since it's not a big difference in days?

For HIV, my negative rapid is pretty reassuring at 37 days, right? If all come back negative, it will be 100% conclusive and I won't need to test for HIV?

Sorry i'm following up on my results at this time, i probably will leave on a business trip and won't have time to follow up on these final tests once i receive results.

[H. Hunter Handsfield, M.D.]

It is rare for a 23 day negative to later convert to positive and I've not seen such a case. But in theory it could happen.  However, given the low risk nature of your exposure, the chance you have HIV is extremely low, as discussed above.

If you have the same test, it will be 100% reliable at 4 weeks.  You don't need to wait until 44 days.

That will end this thread. Mellow out while you wait for the next test. Almost certainly it will be negative.

[pazyamor]

Hi Doctor. Just wanted to ask one last question that i forgot.

How probable is it that my negatives at 23 days change to positive on my next tests at 6 weeks? Have you ever seen this happen? How likely is that?

Thanks.

[H. Hunter Handsfield, M.D.]

Blood test.

[pazyamor]

The syphilis test at that point should be the rectum swap or blood based, doctor?  Thanks again.

[pazyamor]

Thanks, Doctor.  Yes, I'm going to wait until 44 days which will be Nov. 2nd.  I will come back shortly after that to share my results if you don't mind.

[H. Hunter Handsfield, M.D.]

Thanks for the follow-up.  I'm glad you asked your partner about HIV status, however indirectly.  People rarely lie about HIV or STD status when asked directly, so it is unlikely he had HIV.

Your minor symptoms don't concern me at all in regard to syphilis or any other STD, and your wife's symptoms sounds like she caught a cold or other minor viral infection.

Another HIV test at 37 days will nail that one down with 100% certainty (don't spend the money on anything fancy -- a standard antibody test is all you need).  However, that's a bit early for 100% assurance about syphilis.  Why not tough it out for 5 more days and have both tests at 6 weeks?

[pazyamor]

Thank you, doctor for your fast reply.

I did have a rectum swap test which i believe it was for gonorrhea, that came back negative.

For syphilis, I didn't have a sore but i did have some type of reddish type thing at one side around the tip of my penis. it didn't hurt. It went away in a few days. I noticed it came one night I had a couple beers and when i peed, my urine was yellowish (i assume because of dehydration) and maybe too acid and it burn my penis, ? That happened about 2 weeks post exposure. I also got hemorroids for the first time around that time. i never had any and it seem very coincidental that i happened to get them after my first anal sex experience.

I did mispelled "spouse." She has had flu like symptoms with some caugh, not too severe, though. It worried me also that she told me she has had headaches and feeling "funny." Kind of lightheaded and the headaches were different than what she's ever experienced. She's also had muscle aches.

My partner of such exposure told me he was "clean."  When I asked him if I should be tested or concerned he said "no, nothing to worry about." He also said he didn't do IV drugs. He was a total stranger to me.
This has been my only male to male experience and my second encounter outside of marriage in 13 years.

I will probably have time to go test this Saturday, which will be 37 days post exposure, is that OK?

I hope i can expect another Negative result?

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Oral sex carries little or no risk for HIV, even without a condom; and although anal sex of course is inherently risky, condoms work.  It is unlikely the condom failed without your knowledge.  But regardless of the risk, your test results are nearly 100% assurance you were not infected.

1) The figures you cite are about right. A window period of 7-20 days means the test will become positive within that time; tests at 21, 50, or 500 days are equally accurate.  Taken together, your test results are almost 100% reliable.

2) If your "STD panel" included a urine test for gonorrhea and chlamydia, it was a waste of money, since your urethra was not exposed.  The site of risk, if the condom had broken, was your rectum -- so meaningul gon/chl testing requires an anal swab.  As for syphilis, if you have not had symptoms (an open sore on or near the anus), the chance of syphilis is very low.  But it isn't zero, and the blood test takes 6 weeks to be reliable.  You'll need another test at that time.

3) To make it 100% certain you didn't catch HIV, I would recommend a final HIV antibody test any time 4 weeks or more after exposure.  For convenience, just return to the clinic one more time for both syphilis and HIV testing at 6 weeks.

Presumably "house" is a typo for spouse.  For the reasons above, it is very unlikely you transmitted to her.  However, if you want to say more about the nature of her symptoms, I might be able to judge this better.  Most likely it is safe for you to continue sex with her, but still go ahead with the additional tests I have recommended.

Now a final lecture:   You don't say anything about your male partner's HIV status.  Did you ask?  No male ever have anal sex with another man without first discussing their mutual HIV status -- and avoiding anal sex, even with a condom, with partners who are positive (and not on treatment), don't know, or seem evasive about it.  After all, condoms do break sometimes.

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

[pazyamor]

I always read you tell people that a set of tests at 4 weeks are almost conclusive but i wanted to know how much accurate at 23 days. Thanks again.