Further testing for HIV2

[aasustado]

Dear Drs. I have read some of the posts in the website and I congratulate you for your expertise/honest medical advice. My story does not appear to be any different that many others-unfortunately it involved heavy alcohol. 12 weeks ago in Vienna I had unprotected vaginal sex with an AA sex worker (not sure what part of Africa; unknown HIV status). 4-5 weeks after the episode I was tested for Chlamydia, gonorrhea (urine test) and HIV 1&2 Ab (EIA). I tested b/c I developed flu-like symptoms, face/hands felt swollen and red, skin in chest and back hot and tender. The place where I got tested also sent a HIV Quant RNA by PCR. I was happy when all tests came back negative. I continued fatigued and again like I had flu-like symptoms. My skin now feels itchy, specially my hands. They also flushed and red looking. I also developed some vague pain in the R upper part of my abdomen. I read that the HIV testing I had is pretty accurate at 4-5 weeks, however was told that the viral load only is HIV-1 specific. As such last week (11 weeks after the episode) I went back for testing and had another HIV 1&2 Ab (EIA) and this time they included a hepatitis B and C testing (surface antigen/antibody and HCV AB IA) and liver tests. I just got the results- All negative.
1. Do I need to get a specific HIV-2 testing? Especially as the woman I was with was from Africa
2. Do I have to test again for syphilis? I read that a rash in the hands could be related to syphilis
3. Is my hepatitis testing enough to detect acute viral hepatitis? I heard that hep C testing could miss an acute infection
4. US guidelines state that you have to have HIV testing at 3 and 6 months again. My HIV 1&2 Ab (EIA) was done less than 3months (81 days to be exact). Do I need to repeat testing again?  Especially if there is a possibility for an atypical variant that can not be detected this early
5. At what point can I resume sexual activities with my current partner?
Thank you

[Edward W Hook, MD]

My final advice is to put your concerns behind you and move forward without concern.  The concerns you mention do not suggest the need for HTLV testing.  

This will end this thread.  EWH

[aasustado]

Thank you Dr. Hook. My final question would be about HTLV viruses. Is it worth to test for it? (based on my exposure) when I read about it, it could lead to some of the symptoms I have (dry skin in palms with redish/white spots), itchiness throughout my body and tingling sensation in upper and lower extremities. If worth to test for, what would be the correct test to obtain?  Or based on your expertise, do you thini this would also be a waste of money and resorces?

[Edward W Hook, MD]

I'm perplexed- I wrote "At this point you have ruled out the possiblity of STDs, no further testing is needed." and you come back with a number of additional questions about testing.  did you read my earlier reply?

In answer to your questions:
1.  No further testing is needed or useful.  If you'd been exposed to syphilis (most unlikely) the azithromycin has a good chance of having cured it but either way, your 11 week results are definitive.  

2. See above.

3.  thanks. further testing would be a waste of time and money.

4.  See above.  

5.  In answering your question I considered your exposure history as well as all of your earlier tests.  

Thanks again for your kind words.  I will presume that this thread is now over. EWH

[aasustado]

Thank you again for your comments and expert opinion Dr. Hook. Just have few final questions as I am trying to get an explanation for the persistance of my fatigue, muscle aches, joint pains and the reness/white spotes in the palms of my hands

1. Can the RPR test be affected by previous exposure to Azythromycin. In retrospect I had a z-pack for 3 days (500 daily x 3 days) couple of weeks after my exposure- this was done for URI like symptoms. I remind you that I tested negative for Syphilis IgG <0.2 (normal<0.9 AI) at 11 weeks.

2. As in 1, is there any other test for syphilis worth for me to do?

3. I have followed your advice and will not have additional testing for any of the viral hepatitis, specifically the PCR for Hep C.

4. In you expertise is HTLV, EBV, CMV or other HSV like herpes worth to test for?

5. I was curious to see that your partner Dr. Handsfield just recomended someone with a negative test at 5 weeks to test at 4 months. I understand that every case is different. Is your recomendation against further HIV 1 and 2 testing in my situation based on the HIV PCR 5 weeks after exposure? or just simply the HIV 1&2 Ab (EIA) negative I had at day 81 post-exposure?

Again, I think that you provide a frank and clear message to the readers, especially to those whom for whatever reasons look to the two of you for medical expertise. I assume we all are afraid or ashamed of seeing our local doctors. Thank you again for a great service.

[Edward W Hook, MD]

thanks for the update.  Your syphilis tests are conclusive.  

At this point you have ruled out the possiblity of STDs, no further testing is needed.  My suggestion is not to worry further about the exposure you have described.  If your symptoms are troubling you, you should look for other, non-STD causes.  EWH

[aasustado]

Thank you kindly for your response and clarification.

This afternoon I had to go to a family doctor becase of the symptoms I described to you. I told the doctor I had written to you for advice. She did find my hands flushed with some white patches-like but said it did not look like syphilis. She could not explain the tingling sensation/itchiness in my hands and thought that the redness at touch of my skin in chest and shoulder region could be related to my current stress about this situation.

To answer your question, I did in fact had a Syphilis IgG testing that was negative at 11 weeks when I had the HIV 1&2 and Hep testing. The doctor today also suggested to have a HepC viral load as she could not explain may abdominal discomfort in that area + she said that some people dont make HCV antibodies before 3 months. She also said that she traditionally follo the CDC guidelines for HIV testing and suggested to repeat the HIV test now and at 6 months. Did not know too much about HIV 2. As you can see I am somewhat lost. Are these recomendations something I need to follow or do you think I need to see a local HIV/STD specialist like yourself to define the present issues.
Thank you again

[Edward W Hook, MD]

Welcome to our Forum and thanks for your kind words.  I'll be pleased to comment.  At this time there is no need for further testing related to your encounter more than 12 weeks ago.  If you had acquired HIV through that experience your HIV 1/2 antibody test would certainly have been positive by now and your 11 week result provides conclusive evidence that you did not acquire HIV 1 or 2 from the exposure you have described.

As for your specific questions:
1. Do I need to get a specific HIV-2 testing? Especially as the woman I was with was from Africa.
See above, no further testing is needed.

2. Do I have to test again for syphilis? I read that a rash in the hands could be related to syphilis.  If you had acquired syphilis you would have been expected to develop a penile lesion within 3-4 weeks of your exposure.  Since you did not, syphilis is unlikely.  I did not see any mention of a syphilis blood test above however, have you had one?

3. Is my hepatitis testing enough to detect acute viral hepatitis? I heard that hep C testing could miss an acute infection.
Hepatitis C is not a heterosexually transmitted STD.  Even if it were, your recent tests would have detected infection.  You did not let hepatitis form the exposure you describe.

4. US guidelines state that you have to have HIV testing at 3 and 6 months again. My HIV 1&2 Ab (EIA) was done less than 3months (81 days to be exact). Do I need to repeat testing again?  Especially if there is a possibility for an atypical variant that can not be detected this early.
No, there is no need for further testing.

5. At what point can I resume sexual activities with my current partner?
You have proven you did not acquire any STD, including HIV from the exposure you described. You do not need to hesitate about having unprotected sex with your regular partner related to this experience at this time.  EWH