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I got a call from the County Health Clinic and need advice...
Jun 23, 2011

Saludos Doctor Roberto! I have been using condoms consistently for intercourse and have actually refrained from it for about a year. I have however, been engaging in unprotected oral because, as I understand, is considered low risk activity. Well, on June 9th I received a disturbing call from the County Health Clinic. I was told someone I had sexual contact with tested positive for syphilis and HIV and I should come in to get tested. So the next day, I went to the STD clinic and was tested for HIV, syphilis, gonorrhea, and chlamydia. I tested negative for all and so I refused the penicillin shot that is usually given for exposures to syphilis. My last sexual contact was on April 25th, exactly 6 weeks from my STD tests. Assuming the guy I was with is the one who tested pos for HIV and syphilis, can I be reassured I was not infected? I am male and my risk with this other male was unprotected receptive oral sex where I swallowed his semen and rimmed him. Please advise. I look forward to hearing from you. Gracias por adelantado!

Response from Dr. Frascino

Hola.

HIV-antibody testing performed before the three-month mark is not considered definitive. Certainly your negative test at six weeks is very encouraging, but it is not yet conclusive. The vast majority of, but not all, HIVers will have detectable levels of specific anti-HIV antibodies in their blood within four to six weeks after primary infection. I would recommend you get a three-month follow-up test.

Syphilis can be tricky to diagnose. There are a variety of screening tests, both treponemal and nontreponemal. The treponemal antibody tests usually become positive two to five weeks after initial infection. The chancre characteristic of the first stage of syphilis may appear anytime between 10 and 90 days (average 21 days) after exposure to the bacterium. Syphilis can be quite readily transmitted via unprotected oral sex. Because you were exposed, tested negative via some type of screening at six weeks and refused treatment with penicillin, I would suggest you retest if symptoms (painless chancre) appear and even if you don't notice any symptoms you should repeat your syphilis test 90 days after the exposure.

Regarding gonorrhea and chlamydia your your negative tests at six-week test are definitive.

Dr. Bob



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