[Question #10409] Mistake - advice requested
23 months ago
|
Dr. I have a history of Anxiety. Especially concerns HIV. Roughly 30 hours ago I had sex with a 26 year old Senegalese girl in Dakar, Senegal. She was not a street walker. Met her at a dance club. It was unprotected (twice), also oral sex. she said she had gotten checked not long ago and is going to send me results. And said she will test again Monday. She was worried about HIV aswell, I showed her my last test results.
The clock is ticking, since this was in senegal, do you suggest I seek pep? I read that the female prevalence is 1/200.
I took 2 grams of Azithromycin this morning.
I can't believe I made this mistake again. I am going to quit drinking.
![]() |
H. Hunter Handsfield, MD
23 months ago
|
You know what response to expect -- on two or three occasions you have been advised about the policy on repeated anxiety driven questions. That said, at least you describe a significant exposure this time.
Decisions about PEP should be entirely in the hands of local experts who understand the epidemiology and risks in the local environment. It seems unlikely your partner has HIV, and you should know for sure in the next few days. But if the prevalence of HIV is as high as you state in partners like yours, an option is to start PEP (in order to begin within 72 hr of exposure) and stop treatment if you learn your partner tests negative.
I would have recommended agains the azithromycin.
See a local HIV expert for personal advice ASAP. Good luck.
HHH, MD
---
23 months ago
|
Dr. I am no longer in that country. I'm back in the states. Online I read that the female hiv prevalence is 1 out of every 200 women. So .5%. That is high?
![]() |
H. Hunter Handsfield, MD
23 months ago
|
It is pointless to try to judge risk for any one exposure based on national prevalence data; the true frequency undoubtedly is highly variable between regions, cities and neighborhoods. A lot of experts would advise PEP in this situation. OTOH, your info about your partner suggests she doesn't believe she has HIV. In any case, we do not advise for or against PEP; that's up to you and an in-person health care provider. Find an HIV knowledgeable doctor or clinic ASAP. Good luck.---
---
---
23 months ago
|
At hour 35-38ish i started PEP (doctor didn't know what is was at urgent care). 5 days after unprotected sex, girl tested for HIV in senegal. I am not sure what test, she said they drew blood with syringe. But the test report shows Alere HIV1/2 - SD Bioline 1/2 - Multisure. None are checked off. She had to come back in 24 hours for results. I do not have a doctor here who knows about HIV, so i am asking your opinion about continuing PEP, i know you do not give direct advice. Also like i said, i took 2g of azithromycin and i took 200mg of doxy on day 2, did realize it was 10 years old. On day 5 i took 2 year old doxy, 200mg. What would you suggest as a testing regiment to clear myself of all STD's, so i can put the all behind me someday. I have decided i like your website, but not enough to return again (that's a joke). Getting on PEP opened my eyes, and i never want to be in this situation again, hopefully i get through it. The girl tells me she has not had any risky exposures in the last month (not sure how much i believe her). I also know Senegal has HIV-2, which has opened up another anxiety of mine. Thanks Doctor. I Greatly appreciate the work ya'll do, and plan to donate.
![]() |
H. Hunter Handsfield, MD
23 months ago
|
What are you doing taking all those antibiotics?? Sheesh. Having done that, there is no point in testing for any bacterial STI: absence of symptoms (urethral discharge, painful urination) rules out gonorrhea, and the azithro-doxy combination means will have aborted syphilis or chlamydia without ever knowing one way or another whether you were exposed or infected. (You could do follow up tests later. The negative results will show you aren't infected, without ever knowing whether you never were infected at all or infected but had the infection aborted by the antibiotics.
Your message isn't clear on your Senegal partner's HIV test results. Negative? If so, it's fine to stop PEP and to not have any further HIV test. Don't worry about HIV2; all standard tests detect it just fine (despite false internet buzz to the contrary).
---
23 months ago
|
Yes doctor. Her test was negative. May Have only been antibody only though.
I asked about testing in case she is in some type of window period.
Just clarifying.
![]() |
H. Hunter Handsfield, MD
23 months ago
|
It's an antibody test. Still, the chance she is in a window period is vanishingly small. However, nobody can guarantee she isn't infected until and unless tested a few weeks after her last possible high risk exposure (other than you). It's your decision to stop or continue PEP; if I were in your shoes, I would stop it. If you continue, be aware that PEP delays the time to conclusive testing at least 6 weeks after the last dose, and some believe testing should be extended to 3 months. So taking 4 weeks of PEP as recommended means that you are now at least 2 months away and maybe as long as 3-4 months away from knowing for sure you don't have HIV.
Obviously the prolonged period of uncertainty and possibly anxiety is a small price to pay if the risk is high. But with only a single episode of sex (which even if she had HIV had only 1 chance in 2500 of infecting you) and your self-stated anxiety issues, you should think carefully about it.
That completes three follow-up exchanges -- threads normally are closed after two. So that ends this discussion. I hope you have found it helpful.
---