Risk and Testing

Doctors,
Thursday night the 1st I had unprotected vaginal intercourse with stripper at a strip club. Only after the incident did I ask her about her past. Unfortunately I was not as direct as I wish I had been. She said she was definately "clean" and gets tested but I did not ask for what and how recently. She claims she only did what we just did once before (I don't know if it was protected or not) and that she has a boyfriend. She alluded to me being married as to why our encounter seemed ok for her.  She offered to give me her number and showed me her student ID. This happened in Pittsburgh, PA and she is caucasion. With all that said I wanted to know what different tests can be taken at what times? It seems there may be some tests that can be taken sooner than others and my anxiety hopes to get to the testing asap. I plan to test for the more standard STIs in 2 days but wanted some more info on HIV testing and my risk exposure.
Thank you

[Edward W Hook, MD]

Welcome back to the Forum.  It seems that this is a bit of a habit for you- exposure to a new partner, typically a CSW, followed by concerns about HIV and other STDs.   I wonder if this might warrant some reflection on your part.

The risk from this exposure is low- most strippers/CSWs do not have HIV and most exposures to infected partners do not result in transmission of infection. The transmission of HIV occurs only with about 1 in every 1000 sexual exposures to infected partners.  Testing however is reasonable- testing for typical bacterial infections can be done at 2 days as you plan. As for HIV, a combination HIV p24 antigen/HIV antibody test (sometimes these are called DUO tests) or the combination of an HIV PCR and HIV antibody test can provide definitive evidence as to whether or not you got HIV at 4 weeks.  The standard antibody only tests do not provide definitive answers until 8 weeks following exposure.

While you are waiting to test however, I would not worry- this was a rather low risk exposure. EWH

[NR6182]

Doctor,
Thanks for your response and yes reflection/help is certainly in order since the common thread is always alcohol. It is obvious I'm sure the anxiety I carry regarding HIV and the fact that I went unprotected is just boggling as to the lapse in judgement.

Regarding testing, the combo test most commonly found in my area seems to be the PCR. Any concerns I should have regarding rates of false positive/ negative results? I still plan to test at 28 days, however, the site I visited says 21 days is good. I'm not trying refute just curious as to the discrepancies.

I tested for STIs today and will have results in a week. I currently show no symptoms and was told I look ok. My greatest fear continues to be HIV and I hope that having performed the act without lesions or cuts, my location (Pittsburgh)  and the race of my partner helps my odds
Thanks for any comments.

[Edward W Hook, MD]

PCR does have a higher false postive rate ahn other tests- that is part of the reason it is not recommended for diagnosis.

As to when it comes postive, I use 21 days becasue we have good data that this is what works for the DUO test- there are few good data about PCR for this purpose since it is not officially recommended or appproved for this purpose.  Thus y recommendation may be conservative.  

No matter how you spin it however, your risk remians quite low. EWH

[NR6182]

Does the antigen test have less false positive? Would you recommend waiting and just doing the antibody test? I don't want to get carried away if it is unnecessary.

[Edward W Hook, MD]

If your anxiety is not too bad ( and it should not be) the easiest and most reliable result will be to just wait and do an antibody test at 8 weeks.  if you do  that, I am confident that your test result will be negative and that the results will be reliable. EWH

[NR6182]

Thank you Dr. Hook.

[NR6182]

My anxiety is such that I am considering the DNA PCR with antibody test between 3 and 4 weeks over the antibody at 8 weeks. The company I spoke to says that in the event there is a positive PCR they do the test a second time to confirm. Does this sound adequate to rule out false positives?

[Edward W Hook, MD]

No, some false positive tests are repeatable.  

Your anxiety is getting the best of you an my sense is that my continued responses simply fuel your efforts to seek more assurrance than you really need.  Rather than do this, this will end this thread.  One last time however, as explained earlier, you really should not be worried.  EWH.