[Question #10013] Risk for HIV
26 months ago
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Hi - I apologize for all the detail in advance. On April 28th, a man inserted himself in me (unprotected) for one thrust (about one to two seconds) as I wasnt expecting it and immediately pulled away. I was taking PREP daily. On Thursday May 11th, I went for my Prep appointment. I tested negative for HIV but they never gave me the results for my anal swab. I would not of had any other risk as there was no other contact. On May 21st, I had a man finger my anus. I had received results on my liver function which were high and decided to stop taking PREP on May 26th (28 days after the one thrust unprotected anal sex). On May 24th, i started to feel a bit constipated but travelled to another country for vacation. By 27th, i had not passed a stool and was only pooping mucus. I went to the doctor. They did a stool test on my mucus and it came back positive for a bacterial infection as well as an amoeba parasite. They prescribed me azthromycin and cefixime for 6 days along with metronidazole for 5 days. I am now on day 3 of medication and at least starting to pass stools again. Now my questions:
1. I am assuming that I had no HIV risk for either incident. The first one was brief and I was protected by PREP for a full 28 days afterwards and had never missed a dose.
2. Do you think I got the std (maybe just a bacteria infection) from the incident on April 28th and it took over 3.5 weeks to present itself or from the man that fingered me. I read no one could pass HIV through fingering. I did take PREP for another 4-5 days after the incident.
3. Did I have a risk for HIV if I caught an std since I quit taking prep two days before i started taking antibiotics
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Edward W. Hook M.D.
26 months ago
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Welcome to the Forum. Thanks for your questions. No need to apologize for the detail- it helps me in my assessment. Congratulations on your commitment to safe sex; I'm sorry that you may be having challenges taking PrEP. While I understand that receipt of a singe insertion seems minimal (and it is), there are no data on how long sex need occur to lead to transmission of infection. It is conceivable that your bacterial infection (I presume this was not gonorrhea or chlamydia but some other GI tract organism) resulted from your encounter on April 28. Both amebic infections and bacterial infections such as campylobacter, salmonella and shigella can be transmitted through rectal intercourse. The good news is that your infections were detected and are being treated. In response to your specific questions:
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1. I am assuming that I had no HIV risk for either incident. The first one was brief and I was protected by PREP for a full 28 days afterwards and had never missed a dose.
Correct. Your PrEP would have protected you from HIV during the April exposure and receipt of digital masturbation on May 21 was a no risk event.
2. Do you think I got the std (maybe just a bacteria infection) from the incident on April 28th and it took over 3.5 weeks to present itself or from the man that fingered me. I read no one could pass HIV through fingering. I did take PREP for another 4-5 days after the incident.
The infections you seem to have gotten could have occurred as a result of your April encounter or through ingestion of contaminated food during your travels (might I ask, where did you go. These infections are somewhat more common in tropical locations than Western Europe). . The likelihood that you got it on May 21 is miniscule.
3. Did I have a risk for HIV if I caught an std since I quit taking prep two days before i started taking antibiotics
PrEP does not prevent acquisition of STIs. Between your PrEP and the nature of the exposures you describe, I would not consider you at risk for HIV.
I hope this information is helpful. EWH