Testing Strategy/Risk Evaluation

Male. Straight. Married 17yrs.
Jan 11-Feb1= 4 encounters with $350 and up female Escorts in USA.  Different one each time.  Same scenario each time. Condom oral/vaginal.  No rips/tears/breaks in condoms.  Light kissing except last instance which was deeper kissing with tongue a few times. Nipple play.  3rd escort told me she had recently had a baby.  During nipple play, I tasted sweet on my tongue.  Thout maybe it was milk, so i stopped.  i looked at nipple and saw no milk.  Should have asked then about lactation, but I didn't.  No noticeable warts, sores, or scars on any of them.  Each one was adamant about everything being protected, and so was I.
I have read so much on the Dr.'s forums and have a pretty good understanding of my risk for STD (minimal if any). Please confirm.
@ 4 days past last exposure tested for baseline for HIV, HSV1/2, Gon., Clam., Syph. at Anylabtestnow.  All negative.  I would like to ease some anxiety by having an HIV test now, and then again at 6-8 weeks (seeing HHH, MD's opinion on 6-8 week accuracy) during another full panel as done @4 days.

For the test now, which test should I take for the greatest accuracy considering those available in Houston, TX? For the test at 6-8 weeks, I will do the standard 3rd generation Antibody test.  

Is this a reasonable strategy?  Should I include hepatitis testing at some point?

I feel horrible about the incident and mark it off as the biggest mistake in my marriage.  If anything, it has proved that no temporary feeling is worth losing your family.  I am also well read on the fact that guilt leads to anxiety, which leads to symptoms (no sores, lesions, discharge, etc.). I can accept that and am just trying to make it through to the point where I can reasonably assure myself I'm no physical threat to my wife.  No sex since incident.

Therefore, testing, even if not 100% coupled with the low risk will be soothing.  Any other comments or advice other than the obvious of keep it in my pants?

[Edward W Hook, MD]

Welcome to the Forum. Your questions indicate the considerable guilt and anguish you are felling over the exposures you describe.  In my opinion, this burden (guilt/shame) is your major risk, not STDs of any sort.  Please remember that most commercial sex workers, particularly the higher priced ones do not have STDs, including HIV (very bad for business) and even when they do, even most unprotected exposures do not lead to infection.   In your own case, the use of the condom makes the exposures  you report truly no risk situations.  That you may (or may not) have ingested a partners' breast milk does not change this- there are no data to suggest that ingesting HIV leads to infection in adults - none at all.  


The testing you have already has serves to confirm that you did not get the most common STDs, chlamydia or gonorrhea and from a biological and medical perspective there is no reason for further testing for these organisms - these results are reliable.  As for HIV, as I understand it you are now 4 weeks out from your last exposure.  If so, at this time a 4th generation or "DUO" test which tests for both HIV antibody and HIV p24 antigen can provide you with reliable results to prove that you did not get HIV. Alternatively, the combination of a standard 3rd generation HIV antibody test and an HIV PCR test can accomplish the same goal and provide definitive test results at this time (4 weeks of beyond).  Syphilis testing would also be nearly definitive at this this time and since syphilis is very rare, even among CSWs, a negative test can be considered definitive at this time although if you feel the need, testing at 60-90 days would be incontrovertibly definitive.  Finally as for HSV, we would not recommend testing at this time unless you develop lesions. the tests are not reliable enough and to be honest you are more likely to get a false positive result from re-testing than to find out that you had acquired HSV (and please, by NO MEANS should you get an HSV IgM- still more unreliable)

You really do not need to worry about having something from these encounters that you could pass on to your wife at this time, even without further testing.  

I hope these comments and suggestions are helpful to you.  EWH

[ScarletLettter]

1st escort was early 20's from Croatia.

[ScarletLettter]

Thank you Dr. Hook.  Not for only answering with an honest opinion, but for answering the direct questions that I asked, which also serves to reduce anxiety.

For sure, there are 2 parts to this: physical and psychological.  They become intertwined on this side of the situation only because the stakes are so high(ie family). I am sure that if I were single, I would evaluate the risk differently, and rationalize differently as well.  If one could see the anguish (in advance) such decisions cause, then you'd likely have fewer posts on this board. ;-)

At any rate, I thank you for your expertise and devotion to your field.  Both your posts and those of HHH, MD are a valuable resource in a time of need.

I will look for the DUO Test here in Houston.  A web search yielded nothing but the DNA PCR.  If you have any suggestions for a place to get the DUO, it would be appreciated.  I will also take your advice on the HSV testing and not have it.  I surely don't need a false positive dynamic adding to this.  I will post the results of the HIV test, which as you all say "I fully expect to be negative".

Thank you.

[Edward W Hook, MD]

Unfortuantely DUO tests are not widely available here in the U.S. (although they have been in Europe for some time).  The most direct alternative is to just get the regaular HIV antibody test and the HIV DNA PCR- this combination is a bit more expensive that a DUO and has a very slightly higher risk fo a false positve result (on the PCR) but will serve your purpose. EWH

[ScarletLettter]

Thanks.  Will advise when results are returned.

[ScarletLettter]

Ok.  Simply put, DNA PCR is in the mid $200 range.  I don't think I can find that much money that will go unnoticed.

I will try, but may end up waiting for 6 weeks and do a rapid blood test (antibody).

Your comments have calmed me down somewhat so maybe I can wait.  :-)

Thank you again!

[Edward W Hook, MD]

Try to wait. The odds that you have HIV are very, very low.  EWH

[ScarletLettter]

I just read some dat about DNA PCR and false positive rates.  Bottom line, it's starting to click.  My risk for getting a false positive is probably higher than my risk for having HIV at all.

HIV Risk 1/10,000 or less?
False Possitive rate 3% or more?

I'll get a rapid test at 6 weeks.  Seems to be the better choice.

Thank you.  Now I have a strategy.  

[ScarletLettter]

I looked up a clinic right next to my work.  They offer FREE HIV testing. Considering it was FREE, I went by and in 15 minutes had a negative Clear View finger prick test result!  Officially, 4.5 weeks past my last exposure, but 5 < for all others.  The one I'm especially worried about is the 5 week one, so this is great news in my mind.  In fact, 2 of the 4 are marked off the list completely in my mind considering durations of 6.5, and 7.5 weeks.

I feel much better with your comments and these results.  The technician,of course, offered a suggestion to come back at 12 weeks, but explained why he "must" advise that.  He does not personally agree with it, as he agrees with a 6 week test.  

For sure, talking face to face helped.  It was nice to be knowledgable (educated here) for that discussion.

Lesson learned.  I'm not built for this kind of stuff.  The trip isn't worth the toll.  Now I know. ;-)

Thank you Dr.Hook!

[Edward W Hook, MD]

Glad to help. EWH

[ScarletLettter]

At dinner Sunday night, my daughter and son both said "I haven't been acting myself".  This obviously shows the mental toll of the situation.

With that nudge, I decided to go to the clinic next to my work and go ahead and test for the HIV rapid test @ 4.5 weeks since last exposure and greater than 5 for all others.  Clear View Blood Test was NEGATIVE.  I am relieved somewhat.

My wife is a business consultant and is on a project in Canada.  She phoned last night and wants the kids and I to come up in 3 weeks as her assignment was extended.

With these negative results, I feel reasonably safe regarding HIV.  

I have had no lesions but have had burning, stinging shooting pains in scrotum and groin area as well as on the thighs,  back and stomach for 2.5-3 weeks now.  Lymph nodes tender all over.  Stinging pain is concentrated around left testicle, but other places as well. Not constant, just comes and goes.  

I have been assuming this is anxiety.  I notice that after just waking up that everything seems "normal".  Then after worrying a bit, the symptoms progress.    Just how far can anxiety push physical symptoms?  Obviously, I'm thinking Herpes.  With no lesions, is it possible to have these symptoms from the virus?  

IF, I decided to go ahead with HSV2 IGG test, what would the accuracy rate be at 6 - 8 weeks?  Any data?

Thanks.

[Edward W Hook, MD]

Anxiety is a powerful force which you appear to be experiencing.  I'll repeat what I said before, there is no reason for you to be worrying about having HSV.  As I have indicated before, we do not recommend HSV blood tests- should you choose to do so, your risk of a false positve test is higher than finging out that you ahve acquired herpes from the encounters you described.  At 6 weeks about 60-70% of persons who are known to have acquired HSV will develop positive blood tests.

I suggest you seek counseling, not testing.

This will end this thread. EWH

[ScarletLettter]

Syphilis returned negative
Herpes IgG HSV1= 0.270 negative
Herpes IgG HSV2=0.083 negative

Still no lesions anywhere.  Generalized burning/stinging on scrotum, penis, rectum, thighs, and torso.  Back pain and lymph node tenderness.  Comes and goes.

Telling myself it's my mind.  I pray you are right.

Thank you for your encouraging words.

[Edward W Hook, MD]

I agree with you- your anxiety is getting to you.  Please don't worry. EWH

[ScarletLettter]

Hi Dr.  Supposing 6 week accuracy is 70% for HSV2 primary.  What happens to the accuracy line (graph) after 6 weeks?  Is it a very slow rise in accuracy until 16 weeks?  I guess what I'm saying is that if one were going to test, does it make little sense to test between 6 and 16 weeks?  Also, I read somewhere that by using 2 tests (ie Herpeselect and Biokit) that there's some kind of increase in accuracy early on?  Something like 77% vs 93% at 6 weeks? Is this possible?

[nameless_stranger]

Dear friend, the Doc has replied you quote thoroughly, so why won't you read everything one more time and then believe what he says. You are at no risk. Stop worrying about the matter, stop googling for more information, just let it go. Go out, forgive yourself and focus on living a better life in the future. When you do so, you will instantly feel better too.

I have had symptoms of stress taking over me myself, when an ex threated to sue me and call to my working place because I left her. I had blood pressure so sky high over that incident I almost felt like getting a heart attach. Terrible chest pain, loss of sleep, loss of appetite.

Time is the best cure and seriously, the best cure for you is seeing a comforting person to whom you can open up to.

[Edward W Hook, MD]

My efforts to help are apparently feeding your anxiety. This will be the last response to this thread.  I don't know where the "somewhere" that you've heard that doing two kits increases sensitivity substantially is but I am not aware of any data to support this idea. There is NO evidence that you acquired HSV from the encounters you describe and to keep testng will only increase the accuracy a small amount.

You need to get a grip n yourself.  

There will be no further answers.  EWH