potential risk?

[xeyeray]

Hi,

I'm a heterosexual (circumcised - not sure if this info matters) male in my mid-20s

Over 2.5 weeks ago I went out to a bar with friends whom I was visiting. I blacked out after drinking too much and I'm not quite sure what happened but I woke up hungover at my hotel room with all my clothes on the next morning. I was immediately concerned that I may have done something stupid (eg. had unprotected sex with a stranger). I was told by friends that I was with them most of the night except for about 10 mins when I went outside (not a nice neighborhood), presumably to smoke a cigarette. I recall sharing a cigarette earlier that night with a stranger as well. Also, they ended up sending me back to the hotel in a cab as I was too drunk. A sober and trusted friend of mine was at the hotel room and opened the door and made sure I got into bed. (I vaguely remember some of this). At no point do I recall coming into sexual contact with anyone, however since my memory isn't too reliable, I am still worried I may have done something either while I was outside or after I left the bar alone.

Today, I developed a very minor sore throat and headache and went to the doctor fearing the onset of ARS. I was checked for strep (negative), my lymph nodes around my neck are normal, I haven't noticed any rashes as of yet, and I didn't have a fever. My doctor suspects it's just a minor sore throat but also sent me to be tested for HIV, HSV, gonorrhea, and chlamydia just as a precaution. I get my results back tomorrow, but I'm very anxious about the outcome. I have never previously had unprotected sex, but for some reason I think I may have done something the night I blacked out.

If I had unprotected sex, what are the chances that I may have contracted HIV? Are my symptoms consisted with acute HIV infection symptoms? I think I'm being very paranoid, but I'd like a professional opinion.  

Thanks!

[xeyeray]

Thank you very much for your prompt response! I have no more questions :)

[H. Hunter Handsfield, M.D.]

"Titer" makes no sense; I think the clinic person you spoke with doesn't know exactly what test was done. But the numerical value suggests it was the HerpeSelect test, manufactured by Focus Technologies (which in turn is owned by Quest Laboratory, which might have done the test).  Your HSV-2 value is indeed very low; over 90% of persons with such results are not infected with HSV-2.  My advice is to have another test now, without waiting a few weeks.  My guess is a repeat value will be clearly negative, i.e. below 0.90, in which case you can stop worrying about it.  If it is again weakly positive, the next step is to request an HSV Western blot test, the ultimate gold standard in HSV blood tests.

It is impossible you caught HSV-2 during the night in question and that it already started to show up at 2.5 weeks.  In the unlikely event a repeat standard test is still positive, I would still predict a negative Western blot.  If the WB is positive, it will mean you have HSV-2 -- but not from the night in question.  It would mean you have been infected for some time, probably for at least a few months.

[xeyeray]

Hi Doctor,

My clinic tells me the that the test that was used was the Titer test. I am negative for HSV-1 and my HSV-2 value is 1.14. I believe the cutoff for a positive reading is 0.90. What is the likelihood that I have HSV-2 given I don't have HSV-1? Assuming I am positive, how likely is it that this was contracted about 3 weeks ago (in the episode described above)?

Thank you once again.

[H. Hunter Handsfield, M.D.]

As for the HIV tests, 2.5 weeks is also too soon for an HSV blood test to become positive.  If your result turns out to be true, it will mean you have been infected with HSV-2 for at least several weeks, perhaps years.  We can better judge this possibility -- including the likelihood that you have asymptomatic genital herpes -- if you can report more detail about the test.  Your doctor's office should be able to provide it -- specifically the name of the test and the numerical value of the HSV-2 result.  Also the HSV-1 result, if done.  (HSV blood tests usually check routinely for both HSV-1 and 2.)

FYI, it sounds like your doctor is up to speed on HSV testing.  Many are unaware about low positive results often being false.

I never thought you needed any testing, for HIV, HSV, or anything else, based on the events as you describe them.  But since you have started down that path and are likely to need another HSV test anyway, you may as well have a follow-up HIV test as well, at least 6 weeks after the night in question.  (This doesn't mean I really believe there was any risk.  Any further testing is strictly for reassurance, and you certainly don't need testing for any other reason.)

[xeyeray]

Hi Doctor,

Thanks for calming my nerves yesterday. All of my tests came back negative. However, my doctor told me the HSV-2 test was slightly elevated and is most likely a false positive but would need to be repeated in 2-3 months.

I have been sexually active with the same female partner for the last 2 months and I've always used protection (except when receiving or performing oral) and never noticed any sores in her genital area. However, I know I can still contract HSV-2 via skin to skin contact. How likely is it that I have HSV-2 given my results were slightly elevated and that I haven't experienced any symptoms?

Also, I know 2.5 weeks is much too early for a conclusive HIV test but I believe my doctor wanted a baseline before repeating the test in 2-3 months. At this point, I think my fears were probably irrational and that I probably don't require any further testing HIV testing. What do you think?

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.

Of course you (and maybe your friends) are in the best position to know whether you had sex during the brief 10 minute interval you describe, but it seems very unilkely.  But even if you did, the risk of HIV after any single episode of unprotected sex is very low, with the single exception of unprotected anal sex with another male.

My judgment of your symptoms is exactly the same as your doctor's. They are typical for a minor viral infection but not for ARS; all by itself, the absence of fever is good evidence against ARS.  And all symptoms of ARS are very nonspecific -- that is, the identical symptoms occur in innumerable other medical conditions, most of which are minor and harmless.  For that reason, even when symptoms are typical for ARS, almost always they are caused by other things, even in people at high risk for a new HIV infection.

So I predict your HIV test will be negative.  However, you were tested a bit soon to be certain.  If you remain nervous about it, and if your doctor agrees, you might have another test in a few weeks.  But frankly, if I were in your situation I would not be tested at all, and I would not recommend HIV testing for my own patients of for my son, brother, friend, etc.  

I hope this helps. Best wishes--  HHH, MD