HIV/STD RISK AND TEST

[sunnyk590]

Dr:
I will explain my situation and try to keep correspondence to the minimum I am a 48 years old heterosexual male otherwise in normal health  A few weeks ago I had encounter with a couple of massage girls in canada  It was vaginal penetration for about 4-5 minutes  It was protected but I did not try to see after the act if it was intact which makes me nervous.  No oral.This was my only exposure outside the marriage  

1. 28 days after the exposure i visited my GP as stress was overwhelming. He ordered test for Chlamydia,gonorreah,Hep A, B, C, Syphillis and HIV. All tests were negative.I was not sure what test for HIV he had ordered, The test was done at CDC lab(provincial). I called CDC and they told me 3rd generation EIA is the standard antibody test.

2. When I visited the doctor for test results i asked him if HIV test at 28 day was reliable  He said it is highly reliable In his opinion over 95% at 28 days and he has not seen anybody turning positive after negative result at 4 weeks He recommended though to have another at 6 m to be 100%

3. I have read on several sites and from your comments on other mails, that at 4 weeks it is close to 90%  I called CDC and they also told me over 90% (3-4 weeks) but conclusive after 3 months

4. Are my tests at 4 weeks reliable for HIV and Syphllis. What does a negative result mean at 28 days. Do you agree with my doctor that it is rare to have negative test turning positive after 4 weeks. If it is 90% at 4 weeks then who are those 10% people with delayed seroconversion. Also do I need another syphliis test

5.I also read that 3rd gen tests pick up both previous and recent infections(IgM and IgG) as compared to 1st and 2nd generation(IgG only).

6. I had sore throat recently.Can HIV symptoms occur after 6 weeks. Is age(48 years) factor in seroconversion time. Also i noticed a few tiny pimple type rash on the penis head. No itching or pain  Could it be sign of herpes at this stage( 7.5 weeks now)

Thanks

[H. Hunter Handsfield, M.D.]

All your test results are 100% reliable.  There are no medicines, vaccines, or health conditions (except advanced and terminal illnesses) that interfere with HIV test reliability.  The HBV vaccine has no effect.

[H. Hunter Handsfield, M.D.]

To my knowledge there are no data in the US, and probably none in Canada, that would suggest an increased risk of HIV in Chinese sex workers compared with other national origins.  So their origins or ethnicity do not change my opinion or advice.

You have already been told the answer to the question about HIV antibody test results at 4 weeks.  90-95% of newly infected people have positive results at that time.  That means a few newly infected people negative at 4 weeks would have positive results at a later time.  Still, considering that you were at extremely low risk to start (condom protected sex with someone who probably isn't infected), you can be very certain that you were not infected.  You can definitely expect any future tests to remain negative.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

A glance at a few threads at random would have told you that you are not at risk; you could have saved the posting fee.  Condom protected vaginal sex carries no risk of HIV even if the woman is infected, and it is pretty much impossible for a condom to fail and not notice.  Small or microscopic leaks that would show up only with close inspection are an urban myth, or at least too rare to worry about.  And the odds any particular sex worker in Canada has HIV is very low, probably on the order of one chance in 1,000.  So regardless of the details to follow in your numbered questions, you could not have been infected, do not need testing, can safely have sex with any regular partners, and any symptoms you may have cannot be due to HIV from the sexual exposures described.

OK, now I have read the details.  I nailed it.  Here are some specific responses:

1) I agree you did not need any of those tests.  An HIV test made sense for reassurance, despite zero risk, and it can't hurt to be tested from time to time for common infections like gonorrhea and chlamydia -- although you could not have caught either one, or viral hepatitis and almost certainly not syphilis.

2-4) Your doctor and CDC are right about test performance at 28 days.  A final test at 6 months and even 3 months is much too conservative; 6 or perhaps 8 weeks is plenty.  See http://www.medhelp.org/posts/HIV-Prevention/HIV-Testing-/show/764623 and http://www.medhelp.org/posts/HIV-Prevention/-A-Question-on-Testing/show/1347755

4) It takes 6 weeks for 100% reliability for syphilis testing.  But syphilis is too unlikely in this circumstance to be a worry.  There are only 2-3,000 new cases of syphilis each year in all of Canada, and most of those are in gay men.  And condoms are highly protective.

5) Yes, third generation HIV antibody tests become positive earlier than older tests.

6) HIV symptoms cannot start as late as 6 weeks, and sore throat alone, without other symptoms, doesn't suggest HIV anyway.  You caught a cold.  Your age has no effect on seroconversion time.  Herpes symptoms generally start within 2 weeks; 7+ weeks is definitely too long.

Bottom line:   You had safe sex.  Don't worry about HIV or any other STDs.  All is well.

Regards--  HHH, MD

[sunnyk590]

Dr:

I think you are right. CDC wants to cover all the cases because there may be some cases that are rare and take longer time.

[H. Hunter Handsfield, M.D.]

My initial reply included links to earlier threads that explain why CDC sticks with 3 months advice and is not likely to change in the near future.  Perhaps you should (re)read them.

That's all for this thread.  Take care.

[sunnyk590]

Dr. Handsfield :

Thank you for your advise. I wish CDC would change their guidelines soon because of all the testing and anxiety people have to go through. I asked CDC about test at 8 week mark and they did not give me any straight answer. Thay would keep saying 3 months.

Thanks again. I will consider my 8 week antibody test conclusive now as you mentioned.

Thank you.

[sunnyk590]

Hello Dr:

I had my results for HIV1/2 and Syphillis done at 8 week mark at public health clinic. It was ELISA antibody test, I believe 3rd generation that is standard in british columbia.They are both negative as you anticipated.

Can I consider these tests (both HIv and Syphllis) now conclusive at 8 weeks.Although public health clinic is still insisting on 3 months.

Also I had test for hepB and I am not immune. If I take shot for HepB, would it interfere with future HIV test or results.

Please reply. Your kind help and advise is much aooreciated.

Thanks

[sunnyk590]

Thank you very much.

[sunnyk590]

Thank you for your reponse and reassurance.

I just wanted your expert opinion on 28 day antibody test after exposure. I will just ask a couple questions and then would end this thread with thanks.

Does origin of sex worker have any impact on the risk like chinese girls working in canada who recently migrated or are working illegaly.
Also is it true that a negative test at 4 weeks rarely becomes positive.

Thank you very much for your time.