STDs concerned Postive Results

[concernedmen2013]

Dear Docs.I'm a male (2 child , 1 baby of 2 month) healty never have any kind of STDs symptomes.13 weeks ago i ve unprotected Oral sex with a prostitute,i ejaculate on her mounth.8week after exposure i have done STDs screen including HIV (Duo), Hepatite B,C,Gonorea,Chlamydia, HPV,mycoplasmes urealyticum,mycoplasmes hominis and Syphilis: all results come back negatif.4 weeks ago i got protected vaginal intercourse with a prostitute condom didn't broke but i ve seen some blood on my condom when i tried to pull it from my penis.18 days after this 2nd exposure i ve repeate the seam SDTs + HSV 1+2 IGG and IGM (i know IGM are useless but the lab propose it).All result were negatifs excepte HSV (i have repeate HIV test at 4 week and become negatif (test GEN3) and i ve done 2 more HSV test to confirme (4 days after the first HSV 1+2 results  2 labs:

Test at J+18 :  serology Herpes Type 1 & 2 (IGG): HSV Type 2 (IGG) index < 25 : positif
HSV Type 1 (IGG) index < 25  : positif HSV Type 1 (IgM) Technique ELISA: negatif (seuil < 25) / HSV Type 2 (IgM) Technique ELISA: negatif (seuil < 25)

Test at J+23 - LAB1:
HSV type 1 (IgG) (technique ELISA) result: 15.6 / HSV type 2 (IgG) (technique ELISA) result: 6.3 Interpretation: 11.0 Postif

Test at J+23 -LAB2:
AC anti-HSV1 IgG: CLIA Diasorin: Postif 39 Seuil :1.4/ AC anti-HSV2 IgG: CLIA Diasorin: Negatif < 0.5  Seuil :1.3 / AC anti-HSV IgM EIA Biorad: Negatif < 0.8  Seuil :1.5

Q1) Should i retest for HIV anymore ?
Q2) What /when should i retest for others STDs?
Q3) I know i ve to wait for 3 month to retest everything how much my results are accurate?
Q4) Is there any chance of having false postif for my HSV 1 (i ve read that postif HSV can make HSV2 postif and i guess that my result confirme i do not have HSV2 , what chance for  HSV2
Q5) What about my baby/ wife , any precaution should i have to prevent transmitting HSV-1?
Q5) Why index are changing ? possible false + HSV1 ?
Thank you very much

[Edward W Hook, MD]

Welcome to our Forum.  I will try to help.  I have had a little trouble following your concerns but believe I understand your message.   The exposures you describe were low risk. Few STDs are acquired through receipt of oral sex and condom protected sex is safe sex.  You should believe your test results for common STDs like gonorrhea and chlamydia- they prove that you were not infected through the exposures you describe.  As for your blood tests for herpes, the results you report are not reported in a fashion that I am familiar with.  This makes it difficult for me to help you interpret the test results.  I will add however that since you do not mention any symptoms, if your antibody tests are positive, they are more likely to represent older infections which you acquired in the past and were unaware of that recent infections as the result of the exposures you describe above.  

In answer to your specific questions:
Q1) Should i retest for HIV anymore ?
Your risk for HIV is virtually zero.  HIV is not spread by receipt of oral sex or condom protected sex.  I see no reason for additional testing for HIV.

Q2) What /when should i retest for others STDs?
I would not test for other STDs either. These were low risk exposures and you have reliable negative tests (see comment about your herpes tests above)

Q3) I know i ve to wait for 3 month to retest everything how much my results are accurate?
See above.  I see no reason for further testing of any sort.

Q4) Is there any chance of having false postif for my HSV 1 (i ve read that postif HSV can make HSV2 postif and i guess that my result confirme i do not have HSV2 , what chance for  HSV2
Positive antibody tests can be falsely positive or positive due to infections which may have been present for some time.  If your test are positive, this does not mean that got HSV-1 (or -2) from the exposures you described.  I am not familiar with the tests you describe.

Q5) What about my baby/ wife , any precaution should i have to prevent transmitting HSV-1?
See above.  Your HSV-1 is likely to be an old infection.  There is no reason for you to worry or change your behavior.

Q5) Why index are changing ? possible false + HSV1 ?
The way antibody tests are performed, the index can fluctuate from day to day.  

I hope this helps.  Sorry I am not familiar with the tests for HSV you had.  EWH

[Edward W Hook, MD]

Your results suggest you have HSV-1.  Most people acquire HSV-1 in childhood.  As I already said, I am not familiar with the tests you have been tested with however, it is not unusual for index values to fluctuate whe repeated.

Q6.  I would not be surprised if most people in your county have HSV-1, that is the case worldwide.  Once a person has HSV-1 at one site (usually the mouth) they cannot become infected at another site.

Q7,  taking azithromycin will not change your HSV test results.  EWH

[concernedmen2013]

Thank you very much for your detailed answer.

The test was done on Tunisian Lab (North Africa) and one of them was sent to France so i guess the tests from US/UK are quite difference, the only technical word in the Lab Test Results are HSV Type 1 (ELISA Technic) and HSV Type 1 CLIA DIASORIN both postif with two different index range and both negatif for HSV2.
The 3th test (the first was) was both HSV 1&2 wich give positif result for both.

For answer Q4 what do you mean "infections wich may have been present for some time" is this related to HSV1?

Two others question please:
Q6) I have seen that prevalence of HSV 1 in north africa (Tunisia, Morocco, Algeria) reach 90% of overall population is that correct? can HSV1 be contracted from vaginale/anal sex? (i have never done oral sex (i ve recieve some))
Q7) I ve take Zithromax 4 days after 2nd exposure (as a prevention) (2 -3 weeks befores HSV test, can this accure false positif result ?

These were my lasts questions , sorry.
Thank you again.