STD Questions/Concerns

[mike5965]

Hello Dr.

I originally posted in the HIV international forum http://www.medhelp.org/posts/HIV---International/HIV-Concerns-from-Oral/show/1705997#post_7804876 but had follow up questions regarding other STD’s that did not get answered. Could you please review my original post and answer my questions below based on my exposure.

I did a full panel at 11 days post exposure.

PCR RNA HIV
Syphilis RPR
Hep B
Hep C
Gon/Chlam swab Culture and Urine sample
NGU urine culture
Herpes IGG

Everything came back negative

Questions:

1.Do you concur with Dr Gonzalez that the PCR RNA HIV test is 99% conclusive at 11 days or should I follow up with the HIV Duo at 28 days, keeping in mind that this girl should be considered very high risk based on her origin.
2.Syphilis RPR, the Dr that did the test claimed this was very accurate as most people would show positive at 72 hrs., with the absence of symptoms should I re-test at 6 weeks?
3.Hep B or C how much at risk and should I bother to re-test if so when
4.HSV, while I understand 11 days is pretty much useless for this test but in the absence of symptoms should I bother re-testing. I am over three weeks past exposure and while I have tingling from time to time I’m ruling that as genital anxiety. I have been checking multiple times daily and have not seen anything that resembles a rash, blisters, or anything else out of the ordinary, while I understand not everyone has an initial outbreak but if I was how long after exposure would you typically get an initial outbreak.
5.Do you think I am safe to have protected vaginal and unprotected oral sex with my wife.

Concern is that at about 10 days post exposure I started with a cold, sinus and chest congestion and now two weeks later I still have it with a dry cough however no fever or sore throat but I have been very fatigued and tired with loss of appetite and have had diarrhea a couple times. Not sure if these are symptoms of STD’s or Anxiety.

Thanks

[H. Hunter Handsfield, M.D.]

This information doesn't change my opinion or advice.  I'm not going to get into a long distance debate with your doctor, except to say that I'm willing to stand my STD expertise, and Dr. GG's, against that of almost all GPs.

Thanks for the thanks about the forum.

[mike5965]

Hello Dr.

Quick clarification, you mentioned that Syphilis takes 6 weeks to show up, but since you said you wouldn't have tested in the first place I assume you mean you don't think I should bother testing for this at 6 weeks or any other testing for that matter.

The reason I did all the testing was because the Dr. I went to told me I was at risk for everything I tested for, when I explained to him that from what I've read this should be a pretty low risk exposure, he disagreed and implied who's the Dr. here and actually scared me a little, he is an older GP. Knowing that you're an expert in this field I will heed your advice and put this behind me if thats your take.

Believe it or not I am a fairly well educated person with multiple degrees in Engineering but it's amazing how illogical we become when something so out of character happens to us. I've been faithfully with the same woman for 30 years so I am very ignorant to STD's as I've never had the reason to become informed (I've read so much about them over the last few weeks I feel I know even less about them now). The internet as you can imagine can do just as much harm as good in cases like this, as for every question or symptom, you can find answers on both ends of the spectrum (one says you have a cold the other says sypmtoms of ARS). Not to mention the online testing sites, I called one of them which is why I ended up going to the Dr in the first place, I explained excactly what happened to the so called counselor and not only did he tell me he knew of cases where someone contracted HIV from receiving oral sex he had me convinced that due to the girl I was with there was a very high probability I contracted something from her and I would require additional testing over the next 4 months to confirm, just all sounds so unethical to me.

Either way I think what you guys are doing here is great and thanks for the advice and listening and hopefully the guilt and anxiety symptoms dissipate soon

Thanks,

Mike

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

I reviewed your discussion with Dr. Gonzalez on the international forum and agree exactly with his opinions and advice about HIV. As for other STDs, your risk for some STDs was low, and zero for some of them.  Specifically, based on the nature of the exposure, you were at no risk at all for chlamydia (which is rarely carried in the mouth and thus not transmitted by oral sex) nor for HCV or HBV.  There were real but very small risks for syphilis, gonorrhea, and genital herpes due to HSV-1, but not HSV-2.

Further, to the extent you decided on testing for reassurance despite little or no risk, most of your tests were done too early to be meaningful except as negative baseline results against which to compare possible future testing.  There is no "urine culture" test for NGU, so I'm not sure what that means.  To your specific questions:

1) You were not at risk for HIV and all testing is a waste of money and effort, except for its reassurance value (as Dr. G-G said).  Following a real exposure, a negative PCR at 11 days is at least 90% reliable, perhaps approaching 99% as stated by Dr. G-G.  If you need additional reassurance beyond that, have an antibody or duo test (antibody plus p24 antigen) at 4-6 weeks.

2) You misunderstood your doctor about the RPR, or s/he was mistaken.  It takes about 6 weeks to turn positive.

3) See above:  zero risk, no need for testing.

4) Re herpes:  There was no measurable risk for HSV-2, so that can be disregarded.  Any risk was for genital HSV-1, but that is sufficiently low that most STD experts would not recommend testing unless there were other reasons to suspect you had been infected, such as symptoms that suggest genital herpes -- and your symptoms do not suggest herpes at all.  Symptoms of new genital herpes typically start 2-5 days after exposure, rarely 2 weeks, and never later than 3 weeks.

5) If I had been in your circumstance, with the exposure you describe, I would never have stopped having unprotected vaginal or oral sex with my wife, and I wouldn't have felt a need to be tested for anything.

Cold symptoms almost always are exactly that -- a cold.  There are no STDs that cause "sinus and chest congestion" or cough.  The other symptoms you mention indeed are consistent with anxiety or depression -- and whenever a person suggests his own symptoms have a psychological origin, usually he is correct.

Regards--   HHH, MD