Unsafe sex - Help needed

[bennybake]

Good evening,

I'm a 29 yo Male from Israel. after a night of drinking (heavily), I had unprotected sex with a stripper. stupid, I know.

Here is the full picture:
1. after 2 days from that incident I started having deep pains in my groin left lymph node, which lasted for about 2 weeks, sometimes my right lymph node hurt too. they disolve after 2 weeks.
2. after 2 weeks from that incident - An ulcer on my penis apear, kind of red, doesnt itch or hurt. at the same time I started a flu which included running nose and coughing, fever was very mild (37.1 C the highest),fatigue but no rash. after 5 days I was Ok.
3. Now I'm almost 6 weeks from the incident - the ulcer on my penis still here, although smaller. the pain im my groin came back a week ago - still hurts on both sides.

I did a HIV Ag/Ab Combo Assay test at 28 days and about 5 hours after the exposure - the result was negative.

I did a syphilis test (treponema SCR./TPHA) - came back negative, still waiting for other std test results.

Test clinics here in Israel say that the result is conclusive at 49 days after the expsure. I read on medhelp that 4 weeks considerd as conclusive. I read somewhere an Israeli MD says "7 weeks is just because of the test manufacturer warranty". I'm really freaking out - too much information on the Internet.

My questions:
1. Am I safe? Could I Have HIV? The symptoms are really really strange, especially the pain in my groin.
2. Have you ever met somone who was 28 day negative that turned positive later on?  
3. The place that held my test writes that the test is HIV Ag/Ab Combo Assay, Are there different Combo tests In different place?

Thank you!
Benny

[Edward W Hook, MD]

Your other specialist is being overly consevative and you have calculated your risk incorrectly.  The 99.89% figure is the case if you have HIV- the likelyhood of having HIV is calculated by multiplying the risk that your partner had HIV (certainly less than 10%) X the risk of infection from an unprotected encounter (less than 1 in 1000) X the likelyhood of a false negative test (also less than 1 in 1000) making your risk, CONSERVATIVELY, 1 in 10 million or effectively zero.  Put another way this is 1000 times less likily than your risk for being struck by lightening.  

You can believe whomever you choose.  I am confident that you did not get HIV from the encounter you describe.  EWH

[bennybake]

Hi Again Doc,

You wrote "Groups who suggest you need a longer period for results to be different are acting conservatively."

I asked an Israeli HIV Specialist (Online) an she told me that the 4 week Combo test is not 100% conclusive, said that's from the manufactor's warranty..And that I should take the Combo test again at 7 weeks after...

I read a lot of what you and Dr HHH wrote, I also undersatnd from Dr Cummings that the test is 99.89% Accurate, What If I'm in that 0.11%, thats 1 in 1,000, an imppressive odds, but not impossible...

I guess If I didn't had pain in my groin I would have been more relaxed, but It is all very very scary. I just want to add that I'm generally in good health, Should I be worried, even a bit, from the test result and all that I wrote here??

[Edward W Hook, MD]

1. What did you mean by saying "This is one of the few places where I do sometimes recommend herpes blood tests".

Just what I said.  From your post it is not clear what the ulcer you noted on your penis was.   While I typically feel that blood tess for herpes are not helpful in diagnosis of HSV, in your case, given the appearance of a new ulcer on your penis, a positive test for HSV-2 would suggest that this might have been the cause of the ulcer you noted.  

2. Is it common to have groin pains while having Genital Herpes?
No

3. Should I take another HIV test just in case? from your words I understand that the Combo test at 28 days is enough?
You do not need further testing for HIV.  Your 28 day combo test is conclusive.  

EWH

[bennybake]

Thank you so much for your respons!

I would like to ask this as well:

1. What did you mean by saying "This is one of the few places where I do sometimes recommend herpes blood tests".

2. Is it common to have groin pains while having Genital Herpes?

3. Should I take another HIV test just in case? from your words I understand that the Combo test at 28 days is enough?

Thanks again!

[Edward W Hook, MD]

Welcome to the Forum.  I'll be happy to comment.  The appearance of a penile ulcer raises several possibilities, including both syphilis and HIV.  If your ulcer were due to syphilis, the syphilis test done recently would have been positive as syphilis tests do become positive just a few days after the appearance of penile sores.  Alternatively however, this lesion could be herpes which, statistically speaking, is far more common than syphilis and can mimic syphilis closely.  At this point herpes testing of the sore might be difficult.  This is one of the few places where I do sometimes recommend herpes blood tests.  If a HSV blood test were positive, I would think it is likely that the sore you described was genital herpes.  

As far as HIV is concerned, your 28 day DUO test rules out it as a possibility from this exposure.  Groups who suggest you need a longer period for results to be different are acting conservatively.  

With respect to yoru specific questions:
1. Am I safe? Could I Have HIV? The symptoms are really really strange, especially the pain in my groin.
You have ruled out the possibility of HIV from your encounter six weeks ago.  If you had HIV, the DUO test would have been positive.

2. Have you ever met somone who was 28 day negative that turned positive later on?  
No.

3. The place that held my test writes that the test is HIV Ag/Ab Combo Assay, Are there different Combo tests In different places?
Yes, there are several different manufacturers of combo tests but they are all held to the same performance standard.  If you had HIV, the combo test would have been positive at 28 days or any time beyond that.

I hope these comments are helpful.  Be confident that you do not have HIV from the encounter that you describe.  EWH