HIV Testing/Resumption of Marital Sexual Activity

[dmarshall]

Dear Doctor:

The public service you provide is simply outstanding.  Thank you very much.  

I have reviewed the archives and can anticipate your reply; however, as you have repeatedly stated, sometimes a direct reply eliminates concern and provides clarity.

My story is similar to many others which you have received.  I am a 52 year old man.  I had a massage in Seoul, Korea, which ultimately led to protected vaginal and unprotected oral sex.  The oral sex was fairly prolonged.  The massage parlor subsequently confirmed that they test the workers on a monthly basis...for whatever that is worth.

I have had an otherwise totally manogamous 28 year marriage.  I frequently receive massage in Asia, although never before with any sexual contact.  I told my wife that I was concerned about Hepatitis from the massage parlor and have used condoms since the episode.

I had negative results on the usual STD tests at 8 days; negative results on Hep B/C, Syphilis, HIV antibodies at 15 days; and negative HIV antibodies at 36 days.  I am waiting for results on a 50 day HIV antibody test.  All testing has been done by Planned Parenthood.

I have had genital herpes for 30 years with mild symptoms several times per year.

I am obviously only concerned about HIV, although the test at five weeks has made me increasingly comfortable.  I understand the overall risks based on reviewing many, many other postings.  Specifically, when do you believe I can resume unprotected sex with my wife.  Is the 36 day result sufficient?  Should I wait for the 50 day result or need I wait for a test at 12 weeks?

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  But you won't be surprised at my reply.  Both from the low risk of the exposure itself and your negative test results so far, the odds you acquired HIV from the exposure you describe, even if your massage worker was HIV positive, are lower than the risk of dying on your commercial flight home, or in the next week from some accident or sudden illness.  You have been overtested already.  There is no reason not to have sex now with your wife.  But if you're still nervous and will feel better having additional negative results, feel free.

Good luck---  HHH, MD

[fearfire]

Testing negative at 36 days should nearly detect all HIV cases. Do get another test at 6-8 weeks to be sure. Testing HBV and HCV at 15 days sounds too early but they are not easy to transmit anyway (especially for HCV which can only be transmitted by blood).

As you have already got some encouraging test results, you might want to wait until the 3 month mark that many experts suggest? All tests (HIV, HBV, HCV etc.) will be definitely valid by then and you can put all your anxiety at rest in one go...

FF

[H. Hunter Handsfield, M.D.]

I didn't focus on your hepatitis testing until I saw fearfire's comment.  Neither hepatitis B nor C is transmitted by the kind of exposures you had.  (Hepatitis C probably isn't sexually transmitted at all.)  You don't need repeat testing for them or any other STD, except for HIV if your nervousness requires the reassurance of another negative result.

HHH, MD

[dmarshall]

Thank you very much, Doctor, for your thoughtful reply.

It will not surprise you to learn that my 50 day HIV test results were negative.  I plan to resume normal sexual relations with my wife.  

Forgive me:  Could you please confirm that, during your clinical experience, you have not seen a positive HIV test result following a negative result at 7 weeks.

Again, thank you so much.  I agree with another individual who suggests that there should be a forum focusing on the worried well.  That said, the level of worry, rethinking and regret is difficult to imagine unless you personally experience it.  The ability to review the thoughts of a highly regarded medical professional is invaluable.