Additional testing recommended?

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Hi, I'm a 32-yo male with auto-immune Addison's disease (primary adrenal insufficiency). I'm heterosexual, although I've experimented on a few occasions with men.

Following an encounter of receptive oral (no ejaculation) with a man of unknown serostatus on 1/6/06, I had a severe viral infection that, at the time, I thought might have been ARS. Based on the onset (4 days), recovery (by day 8/9), and inclusion of respiratory symptoms, ARS now seems unlikely (symptoms, including rash, resolved almost immediately following increase of cortisone dosage, which is normal procedure for Addison's patients with fever).

In any case, I had an Orasure Advanced Rapid HIV-1/2 test using oral fluid on 1/24/06, 18 days post exposure, at the Whitman Walker Clinic, ground zero of the HIV epidemic in DC. The test was negative. While not conclusive for the potential exposure on 1/6/06, it seems reassuring since 50 - 80% of HIV-infected people would have seroconverted by day 18.

In the 3 months prior, I had no exposures whatsoever. In the previous 6 months, I had 1 instance of unprotected insertive oral (and protected insertive vaginal) with a woman of unknown serostatus. In my life, I have had 3 unprotected, high-risk exposures: insertive vaginal with Thai prostitute in '97, receptive anal (no ejaculation) in '04 (2x). All of my other encounters have either been protected (condom use) and/or with persons of KNOWN HIV- serostatus (long-term girlfriends). I've abstained from all sex for the past 6 months.

I have not been tested for any other STIs, but so far have NOT had any symptoms indicative of HSV-1/2, HPV-6/11, HBV, etc. I had a normal CBC test in Apr06 for an unrelated issue.

Would my autoimmune disorder (or Addison's disease) impact the HIV test result?
Can I consider the test on 1/24/06 to be conclusive for all exposures prior to 2006?
Would you rate me as being at high risk? If so, do I need to get an additional, non-oral-fluid test (Orasure is rated as 97% accurate for those in high-risk groups)?
Would you recommend any additional HIV testing?
Would you recommend tests for other STIs?

Thank you for such a fantastic site. Being able to educate myself about HIV has helped me keep my sanity when I thought I might have been infected and reevaulate my sexual practices (no sexual thrill is the worry that stems from a potential HIV exposure, let alone actual infection).

[H. Hunter Handsfield, M.D.]

You're getting care at one of the most expert clinics in the country.  As a generalization, the Whitman Walker providers' knowledge about HIV diagnosis probably is much superior to mine.  To answer your specific questions:

1) Virtually no medical condition significantly alters the performance and interpretation of HIV test results.  There might be the rare exception for very advanced (near death) cancer or high-powered chemotherapy, but probably nothing else.

2) Standard antibody tests are highly reliable after ~4 weeks and, for practical purposes, 100% reliable after 3 months.

3) The exposures and sexual lifestyle implied don't seem especially high risk to me.  But much depends on details you don't describe, such as when and where you meet partners, what information you exchange about HIV status, and the like.  And on your resolve to avoid unprotected insertive or receptive vaginal or anal sex with high risk partners or in high risk settings.

4) If you have had a negative test at least 6 weeks after your last potential exposure, you do not need further testing until/unless exposed again.

5) It wouldn't be a bad idea to have a syphilis blood test and routine testing for gonorrhea, chlamydia, and HSV-2.  But the risks probably are low.  Discuss it with you WW provider(s).

Thanks for your kind comments about the forum.

Good luck--  HHH, MD

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3) The exposures and sexual lifestyle implied don't seem especially high risk to me. But much depends on details you don't describe, such as when and where you meet partners, what information you exchange about HIV status, and the like. And on your resolve to avoid unprotected insertive or receptive vaginal or anal sex with high risk partners or in high risk settings.

4) If you have had a negative test at least 6 weeks after your last potential exposure, you do not need further testing until/unless exposed again.

My female partners come from work or through friends (generally low risk). My 3 male partners have come from a local bathhouse, which is obviously much more risky. One of the anal partners claimed to be HIV-, tested frequently, and normally practiced safe sex (he was well-endowed and normally used large condoms; he could not maintain an erection with a normal condom).

Still, based on your responses, I'm assuming that I need an additional HIV test ONLY for the potential exposure via receptive oral on 1/6/06 since the test on 1/24/06 was at only 2.5 weeks. I'll get the syphillis, gonorrhea, chlamydia, and HSV-2 tests, as you recommend.

As far as 'resolve to avoid high risk partners', I don't intend to have any more encounters with men, at bathhouses or elsewhere. I'm more attracted to women, and my experimentation was related more to thrill-seeking than to actual attraction to men (strange, I know). But, as the song goes, "the thrill is gone". Worrying about HIV or other STIs has just been too stressful for me. Others might feel differently.

To other readers in the DC area: Whitman Walker Clinic is fantastic. After two weeks on panic in January, I drove there on 1/24/06 and received an anonymous HIV test on the spot; 20 minutes later, I had a negative result, as well as some kind support from the man who performed the test...and could tell I was on the verge of fainting or a heart attack. I'm not completely out of the woods due to the receptive oral encounter and other possible STIs, but HIV seems to be a much more remote possibility at this point.