How accurate is the HIV test after five weeks of exposure?

Question

Hi doctor,

For the last month and a half, I have been in crisis. I tried having sex six months back. That day I did not get erections, so she gave me oral. I did not perform vaginal sex because of non-erection, and whatever I tried was protected. But I had unprotected oral sex where she gave me a blow job. After two weeks, I have noticed a bump on my penis. I went to my doctor (skin specialist), and he gave me a few medicines for one week. Doxycycline (two times a day), Zifi (one time a day), Lycopene, and one cream.

He also first asked me to go for a VDRL (Venereal Disease Research Laboratory) test, but the next moment, he refused. Still, I tested for VDRL, which came back negative (the test happened after a one-week medicine course), although the bump on my penis is now fully healed (after 2 to 3 weeks). I have also tested for HIV (human immunodeficiency virus) RNA (ribonucleic acid) and HIV 1 and HIV-2 antibodies and p24 antigen; both came back negative after five weeks.

The HIV 1 and 2 fourth-generation antibody test was negative on the sixth week. My doctor advised me to take Doxycycline for the next month, but I have not been taking it for the past four months. So, my Doxycycline course goes like this: one week (two capsules a day), two weeks (one capsule a day). My question is how much I can rely on HIV testing after five weeks. RNA, antibody, and antigen test accuracy related to the window period after five weeks.

Should I continue with Doxycycline, as I got a new bump on my face? Is that syphilis, too? I got a new bump on my face (picture attached).

Which test do I have to go for again to detect syphilis or get an HIV status? I have been facing a fever-like feeling for two weeks after exposure, where the fever is not measurable (not more than 98 even), but there are extreme body aches. Two times I got loose motions too. Itchy body.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have noted your concern, and I have viewed the attachments (attachment removed to protect patient identity).

Insertive oral sex has a negligible risk of transmission of HIV (Human Immunodeficiency Virus). Moreover, your HIV screening test (p24 Ag and anti-HIV antibody test) is conclusive. This test has a short window period of 2 to 3 weeks and is considered conclusive after that.

The bump on your face seems like an acne lesion. Is it painful? I suggest you apply Clindoxyl (Clindamycin) gel once a day. No need for oral Doxycycline. Since it has been seven weeks since your unprotected oral, I suggest you take a screening test for HSV (Herpes Simplex Virus) and syphilis (VDRL, Venereal Disease Research Laboratory), and again at 12 weeks for a conclusive result. There is no need to retest for HIV.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

The window period of a test is the period, starting from a possible risk exposure to the time when the test can reliably detect infection. For example, the window period of RNA (ribonucleic acid) PCR (polymerase chain reaction) for HIV is 9 to 13 days. It means that this test is not reliable in the first week after infection. Similarly, a fourth-generation HIV screening test has a window period of 2 to 3 weeks, which means that this test is only to be considered reliable and conclusive after this period from possible exposure, that is, 3 to 4 weeks onwards. A negative VDRL at three weeks is fairly reliable, but since the incubation period of syphilis is 9 to 90 days, it should be repeated at three months.

I hope this helps.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

Your STD (sexually transmitted disease) screening tests are conclusive. There is no need to do a repeat test for HIV (human immunodeficiency virus). A fourth-generation HIV screening test is considered conclusive at six weeks. However, for herpes, you may consider a follow-up at 12 to 16 weeks using an HSV (Herpes simplex virus) type 1 and 2 ELISA (Enzyme-linked immunosorbent assay) and IgG (immunoglobulin G) tests for a conclusive result.

A syphilitic chancre is usually an ulcer rather than just a bump; that is, it is a raw lesion. It is painless and has a firm base. In all likelihood, you did not have a syphilitic infection because your VDRL is negative. A VDRL usually turns positive within three weeks of infection and one week after the appearance of a syphilitic sore. Perhaps the bump on your penis was just a skin and soft tissue infection or an ingrown hair.

I hope this helps.