Docs, please need your advice on STD/HIV

[roo_boy]

Dear Dr Handsfield and/or Dr Hook,

I write to you in a very anxious state. On the 14th of October I participated in low risk activities with seemingly high risk partners – condom protected oral sex, mutual masturbation and kissing. I did not notice any cuts or bleeding but it was dark and I am not sure what else happened – I am also vision impaired which adds to my uncertainty (and thus, the your opinions are priceless).

Your opinion on the timing of symptoms would be most valuable. 18th October I developed general fatigue that lasted until the 2nd of November. Severe night sweats from the 24th to the 28th of October but did not notice any fever. 18th of October I was frequently urinating and had tender testicles. My urethra looks inflamed and red (inspected under a magnifier due to vision and professionally evaluated).

Testing has been extensive and is as follows:
-23rd Oct (9 days): HIV Viral Load Test (PCR RNA) which was undetectable at <40.
-10th of November (28 days): general blood test and liver function test at the infectious diseases unit of a major hospital, the doctor said the results were “perfect”. Urine test for STD’s which was all clear.
-27th of November (44 days after possible exposure): HIV Antibody Test which was non-reactive and negative. The GP also gave an LFT which was slightly elevated and she said this indicated viral infection. I do not drink at all. Although, the doctor at the hospital warned me that stress can elevate liver enzymes before he actually drew blood.  

Doctor, based on these tests:
1)How confident can I be where HIV is concerned?
2)Does an inflamed and red urethra indicate an STD? Would the urine test have picked it up?
3)Is the slightly raised liver function test an issue?
4) Does heavy smoking and stress delay the production of HIV antibodies?

Thank you!!

[roo_boy]

Thanks doctor. I was in error in my original post, the antibody test was actually 49 days, so, about 7 weeks.

How conclusive is a PCR at 10 days and an HIV test at 7 weeks? Just so I can put this all behind me.

Much appreciated.  

[Edward W Hook, MD]

I think the risk of you having most STDs is very low.  You can be confident that you do not have HIV, both on the basis of your tests and the fact that your exposures were safe.  I do have some slight concern that you may have nonchlamydial NGU and discuss that further below.

1.  You do not have HIV,  Do not worry about it.
2.  The urine tests you've had were for gonorrhea and chlamydia.  In addition however, there is an entity call "nonchlamydial NGU" which is easily treated and indicated by the detection of white blood cells which can be seen on a stained swab test from the urethra when viewed under the microscope.  If you have had a gram stained urethral swab and it was negative, I would not worry.  If you have not had a stained urethral swab specimen, I would recommend it.
3.  No.  Slightly increased LFTs accompany many community acquired, non-HIV/STD viral infections which is what it sounds as though you might have come down with shortly after your exposure.  
4.  No, these factors would not delay development of HIV antibodies.

I think your risk if low.  Once the issue of nonchlamydial NGU is sorted out, I would not worry further or seek further testing.  EWH