Best tests/latency from exposure for complete STD panel

[rightplacewrongtime]

Greetings and thank you in advance. My bf has a long history of hidden unprotected chronic infidelities and sexual binge compulsivity. He has been in tx for sex addiction for only 2.5 months and his work just sent him to Bangkok for a week. Yes, it is like a bad horror/comedy. While I can allow/hope for people to change, I cannot risk my health once again. Therefore, we will be using condoms post trip until testing can be performed.

Within the past 6 months he tested negative for everything including HSV-II except for vaccine loaded HepB.

1) HIV Dual test. I have been unable to ascertain the cost of it in the DC area. Is it new enough to the US to be expensive and hard to find?

2) Since that will be tested at 4 weeks,  it safe to assume that all other antigen/antibody type tests such as syphilis, gonorrhea, and chlamydia, Hep series have gestated long enough to be accurately tested?  Which tests are most reliable?

3) Specific to HSV-2, if his last test was a clear neg then can even a low positive be measured as change in status? Which one is the best, with the lowest false negative and what period of time is optimal to wait to test? (I am less concerned for a false + than I am at being exposed)

4)I have organ involved lupus (steroid free for > 2 years). What is the risk to me with condom use or with oral sex. Is complete abstinence prior to testing a reasonable/educated stance or hysteria?  I cannot take antiviral medications without significant consequences. The one time I took Valtrex for an oral cold sore it spiked enough of a systemic reaction that my platelets dropped below 20K.

6) If he is tested neg for all STDs (incl HSV)at 4 weeks then can all be declared well and safe from that trip, or does additional testing need to take place?

Thank you very much for your time and the wonderful service your board is to anyone attempting to clarify the plethora of oftentimes erroneous information out there.

[Edward W Hook, MD]

Welcome to our Forum.  I'll work through your multiple questions:

1.  DUO (HIV antigen and antibody) tests can be difficult to find in North America.  If you are having difficulties you can achieve the same result with an HIV PCR test an a standard HIV antibody test at 4 weeks.  The only risk is that the HIV PCR test has a higher false positive rate than the HIV antigen test contained in the DUO tests.

2.  At 4 weeks standard tests for gonorrhea, chlamydia and syphilis will be reliable.

3.  No a low positive HSV antibody test could still be a false positive, even if your BF has ha a prior negative test.  Our advice is and continues to be not to use HSV antibody tests for the purpose you suggest.

4.  With consistent condom use for genital sex your should not be at risk for HIV. HIV is not spread through oral sex.

5.  If his tests are negative at 4 weeks your risk for getting an ST is virtually zero.

Hope this helps. EWH

[Edward W Hook, MD]

Oral HSV occurs very rarely although precisely why is difficult to explain an may related to fundamental biological differences between HSV-1 an HSV-2.  So rarely that there are not even estimates to the frequency with which it occurs.  

The reasons that you mention are a major part or why neither we nor the CDC recommend using HSV blood tests for diagnosis of HSV. The relatively high false positive rate means that in many settings the test would detect more false positives than true infections- this is not a good use of resources and fuels anxiety, insecurity an stigma.   Your circumstance may be an exception and  what we offer is advice which you may take or leave.  If you choose to have your BF screened, I would still use the HerpeSelect assay and, should a result be positive, then figure out next steps based on the situation and numerical values of the result.  While the increased values we suggest help a lot, they are not perfect, nor is the WB.  

All tests for HSV have false negatives.  The only available data are for WB in persons with PROVEN HSV, not in the situation you are suggesting.  In such instances as many as 7% of persons with known HSV-2 do not have positive tests.  

I realize you are concerned.  I hope these replies help.  EWH

[rightplacewrongtime]

Thank you very much for your time and thorough response.

While I understand that HIV risk with oral sex is almost non-existent, what is the risk for HSV2 transmission? It is not something I want to risk given my immune response to the medications used to control it.

Also, and as an aside, while I do understand the risk of false positives with the HSV 1/2 specific tests, since it is reported that a good number of people who are positive for HSV2 are asymptomatic and unaware, and the stats are underreported, why then advise to *not* test people who do not have (or do not admit) to possible exposure? Is it just due to emotional distress of false +? People who do not show symptoms can still shed and spread the virus, no? If one follows the cut off guidelines referenced on this site, rather than the ones used by the manufacturer, then doesn't that greatly decrease the risk of false positive?  What is the rate of false negatives? How many weeks post exposure is a negative on the test able to definitively rule out an infection? Is the Western Blot used at the University in Washington the only way to definitively do that?

Thanks for your assistance.