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Avatar universal

Weird Test Results - Can you please help conclude/analyse the HIV status?

Dear, Dr.

A friend of mine had a single unprotected exposure with another lady friend/colleague. Both are in India. This lady friend is married, monogamous and belongs to a low risk group with no other sexual partners (other than this incident with my friend). This was my friend’s first sexual encounter. He asked this lady friend to take an HIV test post incident immediately to confirm her status.

She took an HIV test - the ELISA blood test, at a diagnostic lab.The result came out positive.She took a retest at the same lab and went to two other hospitals to get tested. One of the two hospitals conducted the ELISA on two separate kits, both these kits reported negative results. The other hospital too reported a negative result. The lab however did an oral ELISA alongside which also came negative, but the second ELISA blood test that they conducted came out positive as in the first test they administered.

The doctors at both the hospitals and the pathologists at each of the labs discussed concluded that this was a case of false positive as the ELISA kit in the lab tested for only antibodies and not specific HIV antigens.  However, a Western Blot was advised just to be sure. This was sent to an independent testing facility http://www.thyrocare.com which too came out negative for both HIV 1 and HIV 2 antigens.

Summary:
Two hospitals conducted a total of three ELISA tests – ALL which came out negative
The Lab conducted ELISA blood test twice that came came out positive and an ELISA oral test which came out negative. The Western Blot Confirmatory came out negative or non reactive for both HIV 1 and HIV 2

Can my friend safely conclude that both he and she are HIV negative? Can she still be in the window period as she has not had any other sexual relations the past three months?

Your advice much appreciated.

Thanks,
Hivedoff
16 Responses
300980 tn?1194929400
MEDICAL PROFESSIONAL
False positive results certainly occur with all ELISA tests for HIV which is the reason that it is recommended that any positive ELISA be confirmed with a Western blot assay. Different ELISA assays are configured in different ways which is the reason that an ELISA test which gives a false positive result in one test may not give a positive result in another.  In contrast, when a person has a positive ELISA due to true HIV infection, all ELISAs, as well as the Western blot tests will be positive.  Based on the results you report (some postive ELISAs and others negative, as well a negative Western blot) your friend's partner has the misfortune of having a false positive test for HIV but does not have HIV. Your friend was not at risk for HIV through this exposure.  EWH
Avatar universal
Dear, Dr.

Thank you Doctor. So, does it mean that my friend on the basis of what you have explained (and the fact that this his first sexual encounter) is HIV negative and he has not contracted the HIV virus through this incident?

Hivedoff
300980 tn?1194929400
MEDICAL PROFESSIONAL
Yes.  EWH
Avatar universal
Dear, Dr:

I am not sure if the same post qualifies for a follow up question related to possible STD exposure. If you can answer this I would appreciate it else please let me know and I will post the same in the STD forum.

This friend had this sexual encounter in Nov 22 2008. This was unprotected exposure with oral and vaginal sex (lasting less than a couple of minutes, with no full penetration). Post that he has had no symptoms or outbreak of any sort, except that in the past two days he has had small white sores/flecks on the corner of his lips and the same on his inner cheeks. He believes to have noticed the same on the outer foreskin and the inside of the foreskin of his penis and on the penis head. He is uncircumcised.

Because of the sores on the lips he consulted an ENT surgeon today who classified it as Stomatitis Cheilitis and has prescribed three antibiotics, twice a day for a week. He wants to know what are his chances having contracted an STD including Oral and/or Genital Herpes.

Is there a risk ? and Is this a possibility? How long does Herpes take to break out and are these symptoms related to Herpes? Is it possible that after a month and two weeks with no symptoms it is possible to acquire Herpes of any sort?

Thanks!
Hivedoff
300980 tn?1194929400
MEDICAL PROFESSIONAL
This is most unlikely to be herpes or, for that matter, any other STD.  The timiing and what you describe is atypical.  It is far more likely that you have a yeast/fungal infection.  I suspect one of the antibiotics is an antifungal and should help.  EWH
Avatar universal
Dear, Dr:

If this was wrongly posted please let me know as I am new here and I would appreciate if you could let me know if this warrants a new post.  However, the delay in me providing information is being caused the difference in time zones and the dependency on my friend to provide details.

Thanks once again in advance for being considerately answering my queries.

Hivedoff
300980 tn?1194929400
MEDICAL PROFESSIONAL
I suspect our messages crossed elctronically.  I answered the question.  EWH
Avatar universal
Dear, Dr:

Thank you so much, I did not realize that you were also posting at the same time.

Am I to understand that you think the diagnosis of this as Stomatitis Cheilitis is nothing related to any STD? Because, this is what has been clearly mentioned in the prescription and advice note (I saw it myself)

Also, could you please care to elaborate what you meant when you said that "the timing and what you describe is atypical". Does it mean that the time period is well past the typical period? What is the typical period for a Herpes type of outbreak after an incident?

When you mention "What I describe is atypical?" Does it mean the description of the sores/flecks? or was it something other than this?

I would like to clarify that I did go and see these sores/flecks myself just so that
when my friend tries to describe this to me it does not get lost in translation. This is what it is to look at - The so called sore/flecks are at the lip edges where it joins are tiny pinhead sized (even pinhead is an exaggeration, it is more of pin tip sized) set of rash/cluster. This is visible on both bilateral points or lip edges on the mouth. The same is visible on the inner cheek in the inside of the mouth. The same set of rashes/cluster though smaller in number is I believe to be on his penis (I did not see that !!!!!!  I will take his word for it)

I appreciate if you can clarify these for one last time.

I value your sage advice and the time you spent on my friend's issue.

Wish you a prosperous albeit belated new year!

Thanks,
Hivedoff

Avatar universal
Dear. Dr

Appreciate if you can please clarify on my last post.

Thanks!
Hivedoff
Avatar universal
Dear, Dr

I am still awaiting your reply to my post on Jan 05, 2009 12:02PM. Please let me know if this requires me to post again by paying for this, I will gladly do it. But, It is very important and a great reassurance if you would reply to this specific post that has more details.

Thanks,
Hivedoff
Avatar universal
Dear, Dr:

Based on other posts in the STD forum, and your specific replies to my post, I gather that the following.

- A typical presentation of Herpes are lesions or vesicles with water blisters. If these are absent the sores/lesions are most likely some other dermatitis condition or fungal infection. Herpes lesions are shiny, smooth and water filled.

- Herpes lesions occur only on one side of the body's mid line or on one side of the penis and will not be spread all around the edge and tip of the foreskin like a ring or in a circular fashion.

- Herpes outbreak at the very earliest is around 3 days and typically from 4 to 10  days.Hence the timing of 45 odd days that I mentioned in my post is atypical for a Herpes outbreak.

- Getting Herpes and assuming that one could develop antibodies for 45 days without an outbreak is unlikely. Although Herpes could have many manifestations and  it depends on each individual, by the description mentioned in my first post you rule out the possibility of Herpes and any other STD.

- Additionally, the diagnosis of the same lesions around the mouth or lips, as Stomalitis Cheilitus, is not an indication of Herpes and is a fungal infection or some yeast infection.

Are any of these drugs that have been prescribed - Azithromycin, Omeparazole Magnesium and Desloratidine tablets typical medication for Herpes? Which of these is an antifungal medication?


Appreciate if you can confirm if my summarization is fair and if you agree or disagree to any of the points above.

Thanks,
Hivedoff
300980 tn?1194929400
MEDICAL PROFESSIONAL
Stomatitis/chelitis is not related to HIV.

Typical herpes appears 4-10 days after exposure.

End of discussion.  EWH
Avatar universal
Thank you Dr

I appreciate your conclusion and advice given. I will convey this.
Apologies for being so persistent in continuing the conversation till now.

Wishes,
Hivedoff
Avatar universal
Dear, Dr EWH:

*** Please help out *****

I really appreciate your patience in clarifying.

I sincerely apologize for one more post, I have been trying to close this conversation EVERY TIME but the paranoia my friend is undergoing is unbearable to see. It is getting difficult to calm him.

Hence I humbly request an urgent clarification from you !!!

I conveyed to my friend your advice and conclusion that you gave in the previous post.

He said that today on examining his penis he found a change in its state and that it looks as below,

1. There is a pronounced area like a soft spot about 3/4th the size of a finger nail.
2. The accentuated shape is marked by small bumps that form a near circular shape
3. This spot is found on the right side of his penis shaft within the folds of his foreskin.
4. It is not visible on normal inspection of the penis or during urination or otherwise.
5. He has to pull the foreskin back a fair bit before it is visible.
6. As the foreskin slides back the spot now appears to be closer to the glans or penis head
7. It has a slightly dark or red color
8. On touching it the texture felt soft and smooth. It does not look shiny
9. There does not seem to be any water spot or any water filled vesicle as yet.
10.It does not have a pustule or white head and is just kind of nearly flat.
11. He does not have any other symptoms like head ache, fever,tingling in the legs and back

He is very concerned now and wanted an opinion from you. He checked with his lady friend and she conveyed to him that she has had no prior history or symptoms of any STD.

To make it easier, I was wondering ig you can answer a YES/NO to the questions below and give your kind opinion.

1. Is this still a Herpes symptom  - a late breakout after 46 days?
2. Could it really have a chance of happening so late now?
3. If not herpes, what could it be? Is this some other kind of STD? What could it be?
4. Do you still conclude based on the case that this is unlikely it is an STD?
5. Is it still some kind of fungal infection as you suggested?
6. Could it be that it is some sort of inflammation or dermatitis condition ?

Appreciate your patience, help and ABSOLUTELY APOLOGIZE for stretching this and taking this conversation for granted.

If I have crossed the limits, please let me know and I will post it in your STD Experts forum for your opinion.

Thanks,
Hivedoff
300980 tn?1194929400
MEDICAL PROFESSIONAL
I will not answer further questions as part of this post.  In addition, I presume that you are talking about your own situation and not that of your "friend".  I have no patience with this sort of mis-representation.  If you have questions, ask them.  If these are your friend's quesitons, he will need to ask them.  Further anxiety-related questins will be deleted without comment.  EWH
Avatar universal
Dear, Dr:

I am sorry. I was ashamed of the situation and hence the third party representation in my conversation. I assure you this is the LAST POST from my side if you can just reply this once.

I see that you are an extremely good psychologist apart from being the fantastic doctor you are! As you guessed I am an anxious person bordering on paranoia now.

Can you please look at my last post and tell me if your opinion still stands unchanged about it not being any type of STD despite the 10 descriptions I have provided ?

I apologize for faking the "friend" act and testing your patience to the limit.

I sincerely wish you well and may your noble tribe increase, in case I do not get a reply from you for this extra last post.

Wishes,
Hivedoff

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