STD testing

[rich135]

I am a 37 year old male who had unprotected oral sex with a high end female escort three weeks ago. I have shown no symptoms since. At 2-1/2 weeks I had a full STD testing panel done (chl, gon, syp, hep a/b/c, herpes, hiv, etc.), and everything came back negative.

My question is whether I tested too soon and if I need to repeat testing even if I am not showing any symptoms.

Rich

[Edward W Hook, MD]

The time has come for this thread to end.

Fatigue and knee aches are neither a sign of herpes or of HIV,

This ends this thread. EWH

[rich135]

While the swelling and tenderness in my lymph nodes has gotten a bit better (but not 100% gone, yet), I now have fatigue and some knee aches. I assume this is just a result of my body fighting the oral herpes and it working through my system and not HIV?

[Edward W Hook, MD]

No, no reason for concern.  EWH

[rich135]

Sorry I had one more question. Two weeks ago I had a oral herpes attack which I have gotten every once in a while since I was a teenager especially when I'm stressed. It normally involves an inflammation in my nose and then swollen and tender lymph nodes and usually lasts about two weeks. I'm at the two week mark and the lymph nodes are still a bit tender. I assume it is just related to the oral herpes, especially given my test results. Anything to worry about?

[rich135]

Thank you. Your answers have been very prompt and helpful. You are really providing a wonderful resource for people. All the best to you.

[Edward W Hook, MD]

At 4.5 weeks a negative PCR is very storng evidence that you do not have HIV.  EWH

[rich135]

But at 4.5 weeks it wouldn't be optimistic, right?

[Edward W Hook, MD]

Their statement about just how early the HIV DNA test is postive may be a little bit optimistic but not much.   EWH

[rich135]

Thank you, and I assume what they said about the DNA test is correct?

[Edward W Hook, MD]

No, I would not recommend further testing.  The conbination of your test results (most importantly), her report and your exposure history rule out STDs and tell us that your lesions were not due to syphilis or HSV and that htere is no evidence of other STD.  No need for further testing.  EWH

[rich135]

So out of nervousness and generally noticing every sick feeling I repeated my tests at 4.5 weeks. I tested for syphilis, hepB, hepC and HIV 1 and 2 (both DNA and antibodies). All results came back negative. From what I understand the escort was given an all clear from her routine testing a week to 10 days after the encounter, though one never knows how accurate that info might be. At this point would you recommend further testing? Also per the lab provider the DNA HIV test is conclusive from 24-72 hours up until 3 months?

[Edward W Hook, MD]

Size is not a reliable predictor however, in general syphilis lesions would tend to be bigger.  EWH

[rich135]

Thank you, and I imagine a STD lesion would also be larger?

[Edward W Hook, MD]

The sorts of lesions which would be indicative of an STD are ulcerative lesions- that is open sores. They might or might not be painful.  What you describe is compatible with penile psoriasis or perhaps a fungal infection.  If the treatment for psoriasis makes your rash worse, I would be concerned that this might be a fungal infection (which is not an sTD).  EWH

[rich135]

Thank you again.
The only thing I can see is on the head of my penis is a small (0.3 cm) patch of red, raised, dry skin, which I think is simply from psoriasis I get from time to time. I imagine that is very different from a lesion? What would I be looking for?

[Edward W Hook, MD]

Syphilis lesions typically appear within 3 weeks of exposure and blood tests are positve 2-3 days after lesions appear.  syphilis is a VERY rare infection.  Your risk is low.  EWH

[rich135]

Thank you. Are the tests for syphilis conclusive once you show symptoms? So if I had any up to this point but didn't notice would the tests have shown it? In other words is it that it can take a while to develop symptoms and thus to show on tests?

[Edward W Hook, MD]

Welcome to the Forum.  Before I address your specific questions, let me provide some context.  Your risk of infection from this single exposure is low.  Most commercial sex workers, and particularly the high end ones do not have STDs. Further, if your partner did, only a minority of exposed persons become infected- most sexual exposures to infected partners do not lead to transmission of infection.  

As far as your situation is concerned, you can have confidence in your test results.  Testing at 2 weeks provides definitive evidence that you do not have the most common STDs-  gonorrhea and chlamydia.  Tests for some of the other STDs such as syphilis or HIV may take longer to diagnose 100% of infections but results of 2 week tests would likely detect over half of recently acquire infections. Furthermore syphilis, hepatitis and HIV are quite rare, Finally, STDs such as syphilis and herpes typically appear by this time with genital lesions which you have not experienced.  When all of this is put together, you can be confident that you did not become infected through the exposure you describe.  Personally, I would not worry further.  If you feel the need for your own peace of mind, results of an HIV test will be definitive at 8 weeks following exposure while tests for hepatitis and syphilis would be definitive at 12 weeks.,  I would not recommend further testing for HSV for you.

Hope this helps.  EWH