[Question #10218] Risk Evaluation
24 months ago
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Hello Doctor/s
Looking for some risk evaluation for the following sceanario. I met a Brazillian TS Escort here in the UK. We both took part in unprotected oral sex without protection which ended without ejaculation. We then had protected (Male Condom) penetrative sex were I was the receptive partner. This ended after around 3 mins without ejaculation for either party's. The condom remained intact and without slippage.
Escort stated negative HIV status Hopefully she was truthfull.
I have done the usual Googling ,including reading previously answered questions in this site.
Can you give me some figures for risk?
24 months ago
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As mentioned I have been doing a lot of research. Having come across this site https://hivphobia.com/en/
The risk stated for protected anal sex seems to be 0.22 per 1000 incidents. The cdc calculator is 0.39 per 1000
Some sites stated that condoms are only 70% effective at preventing HIV via anal sex.
I had before this incident occurred considered condom protected sex (without breakage or slipage) to be 100% safe. Am I wrong or are these sites being considerably Conservative?
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H. Hunter Handsfield, MD
24 months ago
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Welcome to the forum. Thanks for your confidence in our services.
I'm not clear whether your receptive experience means anal receptive. I assume that's what you mean.
Going first to your figure of 70% condom protection. That figure is based on very soft data. It comes from people's beliefs about the exposure that infected them, which often is wrong; and from finding only a 70% lower HIV frequency in people who say they always use condoms versus those who declare no condom use. This sort of figure is called "use effectiveness", and includes people who forgot, used a condom only for some of an exposure but not all of it, had a condom breakage, don't remember, and so on -- that is real world effectiveness over months or years. That's very different than biological effectiveness, i.e. a single episode of proper use without breakage with a known infected partner. That's believed to be at least 90% and probably more like 99% -- and this is probably appropriate for the exposure described.
As for risk from unprotected anal sex in different studies, such figures also are just best estimates. I would not view 0.22 vs 0.39 per 1,000 as significantly different from one another. Another published CDC estimate is higher still, 50 per 10,000 exposures (i.e. 0.5 per 1,000). All these figures are based on data before effective HIV treatment was available. If an infected person is on anti-HIV drugs, and has an undetectable viral level, he never infects anyone sexually and in fact some couple stop using condoms in that situation.
Anyway, I would view the exposure you describe as essentially risk free in regard to HIV and other STDs, and would not even recommend testing. Of course you are free to be tested anyway, if the negative results would raise your confidence over whatever reassurance you get from this reply. Or contact your partner and ask her to be tested, if not done recently. If negative, you'll know there was no risk, even if the condom had somehow failed without you noticing it.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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24 months ago
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Thanks for your swift reply Dr Handsfield.
Certainly puts me further at ease particularly your explanation of condom effectiveness.
As a mathematical calculation using the CDC figure of 50 per 10000 I assume this would be =
50 - (90 %) = 5 per 10000 , 0.5 per 1000 or 0.05 % out of 100?
or with 99% condom efficacy
50 - (99%) = 0.5 per 10000, 0.05 per 1000 or 0.005% out of 100?
I started PEP the following day after the event. The clinic in the UK was very hestiant in givng me it and I now understand why due to the very low risk. I expect this was more down to trying to reduce my anxiety more than anything else. .I did however stop treatment 4 days later due to terrible side effects insomia and sickness etc. So, My final question is when if at all would I be able to test? would be x number of days from my final dose of PEP or from the orignal interaction?
Kid regards
24 months ago
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Appologies, I see the error in my math and that the figures you quoted already take into consideration the condom efficacy.
Regarding the 0.5 per 10000 CDC estiamte do you know what conom efficacy figure is used in this calculation?
Also Could you however answer the testing question please.
Thanks
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H. Hunter Handsfield, MD
24 months ago
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I'm sure your math is as good as mine would be, maybe better. No matter how you slice it, the odds are strongly in your favor.
The testing guestion: In my opinion, it was a serious error to start PEP. You may not have considered a major downside. If PEP doesn't work, i.e. someone becomes HIV infected despite treatment, it can take at least 6 weeks after the last dose for conclusive testing. That means that the duration until you can be certain you don't have HIV will be at least 10 weeks after the exposure, and some experts recommend 3 months after the last dose of PEP. So instead of conclusive testing 4-6 weeks after the event, you're looking at 3-4 months before conclusive testing.
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24 months ago
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"it can take at least 6 weeks after the last dose for conclusive testing.
That means that the duration until you can be certain you don't have
HIV will be at least 10 weeks after the exposure, and some experts
recommend 3 months after the last dose of PEP. So instead of conclusive
testing 4-6 weeks after the event, you're looking at 3-4 months before
conclusive testing. "
Thats no good. I have indeed made an error to start PEP. So just to clarify and get this clear.
I was potentially exposed: 19/07
Started PEP: 20/07
Ended PEP early due to side effects: 23/07
Deos that mean the first available conclusive test would be 6 weeks from 23/07 (the last dosage)
Meaning my first test could be 03/09?
Regardless of my error with PEP im still very low risk though?
24 months ago
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Could an Early Detection HIV (PCR) still be used 10 days from last PEP dosage?
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H. Hunter Handsfield, MD
24 months ago
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There are no data on prolongation of the testing window after PEP taken for only a few days. Probably there is no effect.
PCR testing is not considered conclusive on its own. A negative result 10-14 days after the last PEP dose should be very reliable, but in addition you should have an AgAb (4th generation) blood test 4-6 weeks after the last dose. Anyway, stay mellow in the meantime. There is no realistic chance you caught HIV. As I said in my initial reply, I would not have recommended testing at all. At a personal level, I wouldn't be tested if somehow I were in your situation.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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