[Question #10082] Question if testing contact and use of pep

26 months ago

Hello doctors thank you for giving people the opportunity to talk with you. I want to know my situation with your experience.

I'm a men and I did vaginal sex with a street sex worker in Mexico. Unfortunately the condom slipped of, so there was penetration for about 2 or 3 minutes before I realized and stop it I Also didn't ejaculate.

Day after the accident I was scared so went to the doctor and offer me PEP so I started it at 24 hours after the accident. (also the doctor gave me Doxycycline for other STI's). My question are the next ones:

1- So after 40 days of our sex encounter I was able to reach the women and ask her for tests. She did HIV 4th generation test and the HIV result was negative ( I was able to download her results so I am 100% sure the result are real) Does this situation means that 40 days ago when we have sex she didn't have HIV and it is conclusive I couldn't be infected?

2- I have seen answers on this forum that PEP delays window test to at least 4-6 weeks post PEP or even 3-6 months. Do I still need to test after this times for a conclusive result?

3- Talking to my doctor that is also an HIV specialist mention me that it is not 100% conclusive that PEP delays window, that if PEP works or not antibodies would be detected by 4th generation tests. I'm still confused about this timing so I would like to know your opinion

Edward W. Hook M.D.

26 months ago

Welcome to our Forum and thanks for your questions. I'll be glad to comment, While I do not blame you for starting PEP in this situation, I can now tell you that you are in the clear. If your partner has tested negative for HIV since your encounter, she could not have transmitted HIV to you. There is no medical or scientific need for additional testing related to the encounter you describe. Thus, in response to your specific questions:

Correct. See my comment above.

2- I have seen answers on this forum that PEP delays window test to at least 4-6 weeks post PEP or even 3-6 months. Do I still need to test after this times for a conclusive result?

No, since you now can be sure that you were not exposed, there is no need for additional HIV testing related to your condom mishap.

I suspect what your doctor was saying is that, on those occasions when PEP fails, tests may become positive sooner than 4-6 weeks post PEP and even during the traditional 6 week "window" period recommended for persons not taking PEP.. For this reason, some persons will test before 4-6 weeks following PEP for the reassurance that it provides. That said, most experts would stil say that for someone with a known exposure, to be confident that they did not acquire HIV testing at 4-6 weeks post-PEP is recommended.

I hope this information is helpful. EWH

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26 months ago

Thanks for the answers doctor. Just to understand and continue

1-If her test was 40 days (after the sex without condom), and not at least 42 days(6 weeks) Is it still 100% conclusive for me and don't require more testing?

2-So if no HIV test needed after Pep, Is there a test needed regarding other issues? Just to be sure I didn't get any long term effects from Pep?

Edward W. Hook M.D.

26 months ago

1, Correct. If her test was negative at 40 days, it was negative when you had your condom mishap and thus she could not have infected you. Her 40 day result is almost conclusive evidence that you did not infect her.

2. I see no need for additional testing post-PEP. If there were adverse effects of PEP, they would have been transitory. F/U testing of the sort you describe is not typically recommended.

Hope this helps. EWH

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26 months ago

Thank you doctor

1- By you saying now "Her 40 day result is almost conclusive evidence that you did not infect her" Does it mean it is not 100% conclusive yet? And I suppose you mean "that she did not infect you" ?

Sorry for the misunderstanding I just want to have things clear thank you

Edward W. Hook M.D.

26 months ago

You have misunderstood my reply. Let me try again:

40 days after your condom broke, your partner had a negative HIV test. This proves that you were not exposed. If she had a negative test at 40 days after the condom broke, she was negative when the condom broke, Persons with negative tests do not transmit HIV. You were not exposed. OTOH, her 40 day negative test is almost conclusive proof that if she had been exposed (from you), she did not get HIV (while test results following an exposure are considered completely conclusive at 6 weeks/42 days she has not reached that time pint yet.

We provide up to three responses to each client's question. This is my 3rd response. I hope the information I have provided is helpful. This thread will be closed shortly without further replies. EWH

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26 months ago

Hi doctor indeed I was confused with your last reply. I will try to be more clear

3 days after the accident I had negative 4th generation HIV test (in order to continue taking pep)

28 days after the accident I repeat test and had negative 4th generation HIV test( that according your answers is not conclusive because of pep but my doctor still recommend it)

Then 40 days after accident I was able to talk to the sex street worker female and she got a negative test 4th generation HIV test ( so 40 days after the no condom sex)

Sorry the misunderstanding I hope this can get more precise regarding if I am 100% clear now and not needing to wait post pep testing according to your experience. Thank you

Edward W. Hook M.D.

26 months ago

You are not reading the reply. The street worker had a negative test AFTER the condom broke. HER negative test proves that you were not exposed. In retrospect you did not need PEP as you were not exposed. You are in the clear

Read my multiple replies carefully. This thread is over. EWH

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