Worried about HIV and Syphilis

[klong1492]

Doctor,

9 weeks ago I had unprotected oral and vaginal sex with a woman of unknown status. I am circumsized. At 6 weeks post exposure I had a blood test for HIV which came back negative. At 7 (51 days) weeks I had a full panel of 8 STD tests which all came back negative.

My concern is a very small (less than 1/16") spot I found on the head of my penis just below the opening at 6 weeks post exposure. The blood test I had for syphilis was 8 days after I first noticed this spot. It doesnt look anything like the pictures of syphilis ive seen online. It kind of looks like a small scab and never was an "open" sore like Ive seen and read for syphilis.

Ive seen you tell people that a syphilis blood test will always be positive within a few days of appearance of a lesion but Ive also read on other sites that it can take up to 4 weeks after appearance for a blood test to be positive. Was my blood test (RPR) at 7 weeks post exposure and 8 days after appearance of the "sore" 100% reliable?

Also how reliable were my HIV tests at 44 and 51 days? They were the ELISA HIV antibody test. I am ready to put this all behind me and was wondering if these results were conclusive or would another test for syphilis and HIV now be conclusive (over 9 weeks since possible exposure)?

[Edward W Hook, MD]

1.  NAATs are the most sensitive tests for gonorrhea and chlamdyaial infection.  Further, urinary frequency in not a symptom of STI.  I recommend you believe your test results.

2.  Yes, trust your test results.  Sometimes urinary frequency is a sign of anxiety or simply increased attention to the possiblity of genital symptoms. EWH

[klong1492]

Sorry to bother you again doctor but I had a question. Here lately 10-12 weeks post exposure I have noticed an urgency to urinate during the day (this feeling is off and on) it also feels like I don't completely empty when I do go to the bathroom. I also notice some occasional discomfort in the tip of my penis after I urinate. It usually doesn't happen until I've pulled my pants up so maybe it is irratation from that? And it almost feels like there is urine leftover or something, it's hard to describe. I am 26 if that makes any difference.

My questions;
1. The chlamydia/gonorhea test I took was a NAAT urine sample. I hadn't urinated in about 2 hours. After reading online I think I may have given too much urine. I gave about 3/4 of the cup which was probably around 90-120ml. Would only waiting 2 hours or giving this much urine give my test a false negative for either of these?

2. If I am to trust my results what else could my symptoms be?

[Edward W Hook, MD]

Correct, you do not have syphilis or HIV.  EWH

[klong1492]

I had a negative blood test for syphilis and negative antibody blood test for HIV at 9 weeks post possible exposure. I take from your previous response that this is 100% accurate for both? Thanks for your help.

[Edward W Hook, MD]

Welcome to the Forum.  Thanks for reviewing earlier posts on this subject.  My comments below will, in part summarize and agree with what you have already learned from your review.

The timing of when a person with syphilis will develop a positive blood test can be measured in several ways.  One is following the appearance of a syphilis lesion.  In this instance blood tests are always positive just a few days after lesions of syphilis appear.  Thus your recent blood test is reliable evidence that the lesion you noticed is not due to syphilis.  In some textbooks a different time-frame is used, the time since exposure to an infected partner.  In this instance periods of anywhere from 30-60 days are used to provide the period in which blood tests can appear.  This time frame is relevant for persons who may not develop (or notice) lesions.  As I said above, in your case, you can be confident that the lesion you noticed is not syphilis (or other STI for that reason).

Similarly with currently approved tests for HIV antibodies, ALL tests will be positive within 8 weeks (56 days) of acquisition of infection. The fact is however than nearly all persons are now positive within 6 weeks and the 8 week figure is used by us to be absolutely sure that infection is not present.

Again, following your exposure, your risk for infection is extraordinarily low and if I were you, based on your 7+ week test results, you can be quite sure you were not infected with either syphilis or HIV.  I urge you to move forward and not worry any more.  EWH