PCR RNA & ELISA HIV negative 9 weeks

[asustado]

Hello Doc,

I'm scared like many. I had a sexual intercouse with a female sex worker on 14th December 2007 (with condom - oral and vaginal). I had some symptoms like cutaneous eruption, one day of diarrhea, joint aches, blurred vision and was treated for possible chlamydia (negative for gonorrhea, chlamydia, mycoplasma and ureaplasma) because I had some penis discharge. I have a whitish tongue and experimented a taste change with cigarrettes.

These are my test results:

12 days Elisa Ag/Ab HIV1&2 - negative
20 days Elisa Ag/Ab HIV1&2 - negative
67 days 4th gen. Elisa Ag/Ab HIV1&2 - negative
67 days PCR RNA HIV-1 - negative

61 days HBsAg - negative
61 days anti-HBc - negative

I was calm with these results but yesterday I noticed an ulcer on my penis (on prepuce). I went to the urologist and he examined me and told me that the ulcer didn't look like chancre or syphilis but in order to discard he asked me to test for VRDL.

Well I scared because genital ulcers are common in ARS (early HIV infection) but the PCR RNA and 4th gen Elisa both negatives at 9 weeks + 4 days (67 days) should discard HIV infection. Well urologist told me that this ulcer was common in rude sex, but I've remained celibate since this exposure. He asked me if I had practiced masturbation and yes I did the day before the emergence of the ulcer.

Then my question is: my results at 9 weeks are conclusive about I have not infected with HIV or the ulcer indicates that I have to test again and live all that stress again?

The ulcer is linear and clean, and is 1 cm long and a few millimeters width. And today on the same direction of this line the prepuce is irritated (similar features of the ulcer but it's not an ulcer) and has three or four tiny grains in the same area.


Thanks Doc

[H. Hunter Handsfield, M.D.]

You cannot catch HBV by condom protected vaginal sex or by oral sex.  You have NOTHING you caught from the sex workker.

This is my last comment.  This thread is over.  Do not post any more comments.

[asustado]

Well,

I mean knowing the consecuences of being infected with herpes.
In the case of HBV, I tested within the window period (89 days average), but the WP can even be 160 days as I read in medical publications. So in order to be sure I should be tested again in 180 day mark. I'm worried about HBV since I have some symptoms that fits with this infection:

- Change in the taste of cigarrettes
- Loose stools (stools are abnormals since the one day of diarrhea that I described at the first post)
- Bilirubin was slighty high at 50 day mark. (lab limit=1.3 & result=1.6)
- I also had urticaria (I forgot that)

I know that these symptoms are non specific of any infection, but since many of these symptoms began after this unique risk behavior there is an alert in my head.

Thanks for your disposition (disposition? - sorry this is not my mother tongue)

[H. Hunter Handsfield, M.D.]

Everybody with genital herpes (due to either HSV-1 or -2) can have healthy kids.  There is a small risk of neonatal herpes,  i.e. transmission to the baby during delivery, but only if the mother is infected, and couples can take precautions to prevent that.  Even when a woman is infected, neonatal herpes is rare and easily preventable as long as the woman's obstetrician is aware of the potential.  Properly managed, herpes is never an impediment to healthy pregnancy and healthy children.

I don't understand the second question.  Since you aren't infected with HBV, there are no "consecuences of this mistake".

[asustado]

Thanks Doc for your answear.

I have just a doubt: if I got HSV-1 or 2, or both, can I have children? Is going to be in danger my future wife? Do the vertical transmission happen with HSV? Is there any treatment to avoid the transmission to my future wife?

Well, I know I still have to discard the hepatitis B but I want to know what could be consecuences of this mistake.

Thanks again.

[H. Hunter Handsfield, M.D.]

Herpes is the single most common cause of genital ulceration, so statistically that's the best bet as the cause.  Syphilis blood tests are automatic for every patient with a genital ulcer, so it sounds like your urologist is just doing thing the right way; it doesn't mean syphilis is the most likely diagnosis.  Your description isn't typical for herpes, but it's still more likely than anything else, and you should be tested for it.

Genital ulceration is not a symptom of ARS.  An exception might occur if someone acquired herpes and HIV at the same time, but your test results prove you don't have HIV, especially with overtesting you had (there was no need for PCR, but it further confirms you aren't infected). And you describe no other symptoms that particularly suggest HIV.  Every symptom caused by ARS is also caused by other things that are much more common.  You don't need further HIV testing.

It sounds like your urologist is knowledgeable about STDs. Continue to follow up with him and trust in his advice and management.

Good luck--   HHH, MD