Dr. Sushil Kakkar
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
From the last one and a half months, I am 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 have tried that 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 in a day), Zifi (one time in a day), Lycopene, one cream. He also first asked me to go for VDRL (Venereal Disease Research Laboratory) test but next moment refused. Still, I tested for VDRL which comes negative (test happen after one-week medicine course), although the bump on my penis now fully healed (after 2 to 3 weeks). I have also tested for HIV (Human Immunodeficiency Virus) RNA (Ribonucleic acid) and HIV 1 and 2 antibody and p24 antigen, both came negative after five weeks. HIV 1 and 2 fourth generation antibody test negative on the sixth week. My doctor advised me Doxycycline for next one month but I am not taking it for past four months. So, my Doxycycline course goes like one week (two capsules in a day), two weeks (one capsule in a day). My question is how much I can rely on HIV testing after five weeks. RNA and antibody and antigen test accuracy related to the window period after five weeks. Should I again continue with Doxycycline as I got a new bump on my face? Is that syphilis too? Why I got a new bump on my face (picture attached). Which test I have to go for again to detect syphilis or get HIV status? I am facing fever like feeling since two weeks after exposure where fever is not measurable (not more than 98 even) but extreme body aches. Two times I got loose motions too. Itchy body.
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.
Patient's Query
Thank you doctor,
About face acne, it was painful earlier means I was feeling discomfort, as well as entire mouth area (like above lips or over mustache). Still, I am feeling a little bit burning type feeling, little discomfort. My concern regarding the RNA(Ribonucleic acid) test is that because it has a short window period of up to two weeks. So, will it give an accurate result even after five weeks? Same concern related to HIV 1 and 2 antibody and p24 antigen window period is maximum four weeks. So is it accurate? And I have also gone through VDRL test almost three weeks after exposure that was negative but I had taken one-week medicines course that time and surely will go for these test again and will inform you further.
Hi, Welcome back to icliniq.com.
Window period of a test is that 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 so it should be repeated at three months.
Patient's Query
Thank you doctor,
I am quite tensed after knowing that few symptoms related to herpes now. I am feeling burning like sensation around my mouth and I came to know that it is not curable. So, it may affect my wife and baby as well.
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 do a follow up at 12 to 16 weeks with an HSV (Herpes Simplex Virus) type1 and 2, ELISA (Enzyme Linked Immunosorbent Assay), IgG (Immunoglobulin G) 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 every 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 syphilitic sore. Perhaps the bump on your penis was just a skin and soft tissue infection or an ingrown hair.
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