Chlamydia Positive...HIV worries

[lannigan]

On Oct. 16th I stepped out of a monogamous relationship and had a one night stand with a stranger. I had vaginal sex with her 3 times, each time with a new condom and received unprotected oral sex. There was a brief moment when we were making genital contact with very brief, if any penetration (I stopped her from trying to insert my penis without a condom). After a few weeks I noticed some discomfort in my urethra and redness around the opening of my urethra. I visited a convenient care provider who ran tests for Gonorrhea and Chlamydia. Chlamydia came back positive Gonorrhea negative. I was treated for the Chlamydia with a single 1000mg dose of Azithromycin on Nov. 2nd. My long term girlfriend was treated the same way on Nov. 4th. We obstained from sex for 10 days from treatment for her and 12 for me. When we resumed sexual contact it was always with condoms and I have been particularly safe. My first question is, is it safe to assume that the Chlamydia infection is safely behind us? Is this form of treatment always effective?

My real concern though is that I can't stop wondering how likely it is that this person gave me HIV. On Nov. 4th I tested for HIV and Syphillis. The HIV test was the rapid blood test (finger prick). Both of those resulted in a negative finding. Nov. 4th was only 19 days after the possible exposure and I know the recommended time frame is to be tested at 3 months. I have been unbelievably stressed out about this (I am a long time hypochondriac) and I find myself worrying on a daily basis. I currently have a sore throat, stuffy nose and pink eye and I continue to worry that it is a result of HIV. Am I going to have to continue to worry this way until the 3 month mark? I've read about the PCR testing that can be done, but it is awfully expensive. Is it worth it to put my mind at ease? Is this form of testing reliable? The bottom line is I need to get some closure on this issue and put it behind me. It has been the worst mistake of my life.

[Edward W Hook, MD]

We get many questions about the meaning of HIV test results at different time points.  This is now confused by the availability of a variety of different types of tests.  The traditional and most widely used tests for HIV are tests for antibodies to HIV which are available both as so-called "rapid" or point of care tests which can be done in the clinic and laboratory based antibody tests. For all practical purposes both of these types of test perform comparably and provide accurate information on the presence or absence of HIV infection in virtually everyone at 8 weeks following exposure.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.  

I hope this comment is helpful.  You are fine.  EWH

[lannigan]

The results on my test yesterday were negative. The nurse kept saying I  should be tested 3 months from my exposure but I know you have said at 8 weeks out the results are conclusive. I am confident that I do not have HIV, but I am curious, is the three month rule an out of date rule of thumb? If it is 8 weeks why are so many people still saying to wait until 3 months and in some cases I have seen 6 months. Again, I am 100% confident with my results yesterday that I have nothing to worry about, but I can't help wondering what your thoughts are on the varying time frames that seem to be out there regarding the "window period." Thanks for all your help

[Edward W Hook, MD]

Yes, the results of an 8 week test for HIV should be considered conclusive.  The rapid tests are just as reliable as the standard, laboratory based tests.  EWH

[lannigan]

It has been 8 weeks and I am going in this afternoon for testing. Once I get these results I can rest assured that they are conclusive? Is the rapid test just as accurate as anything else? Thanks again for your help...wish me luck.

[Edward W Hook, MD]

I would think that your night sweat was coincidence, nothing more.  It is a non-specific finding with many other possible calls.

As far as your other question, both HIV and chlamydia are STDs, but, as I also noted, most people with chlamydia do not have chlamydia and even if they were, following a single exposure, the transmission of chlamydia is 50-1000 times more likely to occur than HIV.

You are worrying too much.  EWH

[lannigan]

Thank you for your response. I did have some follow up questions. Would the contact required for me to contract chlamydia also be contact that could transmit HIV? One other development. A while ago I awoke in the middle of the night to find that I was very sweaty. I took my temperature and it was normal. This is something that I have never experienced before and when I looked up causes of night sweats I discovered that one of the causes can be an HIV infection. I know your stance on looking symptoms up on the internet but is this something to worry about or is it just a coincidence? Thanks again for your help.

[Edward W Hook, MD]

Welcome to the Forum. Let's deal with the chlamydia test first.  a 1.0 gram dose of azithromycin given as a single dose is the therapy recommended for treatment of chlamydia by the CDC.  Studies have shown it to be 97% effective in curing the infection and this cure rate is so high that follow-up testing is not thought to be needed.  Thus you and your GF were properly treated and should be fine.

So, what about HIV.   Unlikely.  HIV is rare in heterosexual women while chlamydia is not.  Chlamydia is much more common than HIV and much more easily transmitted. This year there will be over a million new cases of chlamydia seen in the U.S. and about 55,000 new cases of HIV.  Furthermore, while chlamydia is transmitted about 20% of the time after a single exposure, the transmission of HIV is about 500 times less likely- O.01%.

Finally, to put you mind at ease, you may want to get testing but you need not wait for 3 months to be sure.  At any time beyond 8 weeks (December 11 by my calculations) your results on standard HIV antibody tests will be definitive.  We do not recommend PCR for HIV testing, both because of cost but, even more importantly because the PCR test has more false positive results than the antibody tests.

I hope these comments are helpful to  you.  EWH