Test Again?

[amflg]

Dear Dr HHH / Hook.

First let me thank you for the fine service you provide.

~ 9 weeks ago I had an anonymous sexual encounter with another male (unknown status). The encounter mostly consisted of mutual masturbation (no risk) and brief fellatio without ejaculation - I was the oral partner (low risk). I don’t know if I was exposed to pre-ejaculate.

~ 2 weeks after the encounter I noticed what appeared to be a mild rash (really just a mottling of the skin which has persisted on and off since – I suspect this might even be pre-existing and I simply did not notice it until after this encounter. At ~ 4 weeks I had a mild sore throat.

To be overly cautious I decided to test for HIV and other STD’s.

- 4 weeks negative for HIV and common STD’s
- 6 weeks negative for HIV

My doctor stated that 6 weeks was the “all clear”. (I am in Australia and these were lab based tests – I understand that virtually all labs in Australia use the 4th generation combined P24ag/ab assays.)

Having read the archives on this site I know the chances that I have HIV are extremely remote.
However, what concerns me is that shortly after the encounter I took prednisone for joint inflammation (doses of about 15mg over 2/3 days).

I have since read that prednisone could delay antibody production thereby effecting the antibody component of the test.

Do you agree with this? If so, should I retest? And if so at what time?

Thanks

[amflg]

Thanks for the quick reply and the reassurance. I will move on from this now.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.  My initial response is to jump to the most common phrase I heard over and over again when I last visited Australia:  "No worries!"

You had very low risk exposures; HIV is rarely if ever transmitted by oral sex, and never by mutual masturbation.  But more to the point, your doctor is correct:  a combination HIV test (for antibody plus p24 antigen) is 100% reliable any time 4 weeks or more after the last exposure.  Your prednisone made no different.  The dose was too low to have any effect.  And even with very large doses of steroid or other immunosuppressive drugs, that's one of the beauties of the combo tests:  such treatment might in theory delay antibody priduction (it's really only a theory, with almost no actual known cases), that very delay would result in even higher viral loads, making the p24 antigen component more sensitive.  In other words, each component of the test backs up the other.  Accordingly, there is no need for any additional testing.

It sounds like your physician is knowledgeable about HIV.  But if you have any doubts or ever want a peak-quality consultaiton, collectively Australia's sexual health centres are probably the world's very best network of STD/HIV prevention clinics, and the Sydney and Melbourne SHCs are the best of the best.  Don't hesitate to seek the SHC's advice if and when the need arises -- which I hope it never will!

I hope this has helped--   HHH, MD