[Question #10490] REPLY FAST PLS..HEP B AND HIV (PEP)

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22 months ago
Hello Doctor Hansfield and EWH.I have 2 breakup of question. First one is need of PeP for Hep B and HIV after todays encounter i.e Protected oral with little redness on penis and intentional biting by the female CSW for 30 seconds on my nipple. As the room was dark i didnt saw any blood at that time but after 30 mins i squeezed my nipple but saw no blood coming. Also I am noticing it after returning but unable to found any big cut. Cant say about any microscopic blood.  PLEASE REPLY ASAP AS IF MY EXPOSURE REQUIRES PEP I NEED TO TAKE ONE. I AM 4 Hours AFTER THE EVENT. WHICH I AM GOING TO TELL YOU AFTER MY LAST EXPOSURES DETAIL.

Second one is
Below I am mentioning few of my encounters happened in the last 2 Months. NO PENETERATIVE SEX HAPPENED ANYTIME.
1) Unprotected Handjob with some fungal infection and redness - 3 Times
2) Protected Handjob - 2 Times
3) Protected oral with some fungal infection and redness - 2 times.
4) Unprotected Outercourse- 2 Times for max 40 seconds each.
5) Dry Kissing, Sucking boobs everytime i.e 6 times.

Have tested exactly after 2 months for Hep b and i.e negative. Do i need to get tested again after 3 months for HIV and Hep B?

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H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. But unfortunately, you apparently misunderstand the services we offer. We do not provide direct medical care, and that means we will not advise for or against PEP for any particular exposure. In addition, we are not available on an urgent basis:  you cannot expect (or ask) for immediate replies; we are not a source for immediate or urgent advice.

However, I you describe no sexual event that has any possibility of transmitting HIV or hepatitis B. I will also add, as we have said innumerable times on this forum, that the chance any particular female CSW in the US has HIV is very low. But for medical advice on whether or not to take PEP for today's encounter you will need to seek direct medical care from a source other than this forum.

As for the events over the past 2 months, all the exposures you list were entirely risk free for both HIV and hepatitis B virus. You did not need testing. Even if you had been exposed,  a negative HBV test at 2 months is conclusive. Negative HIV tests also usually are conclusive by 2 months, but there are several kinds of HIV tests, and the reliability of the result at 2 months depends on exactly what test was done. Feel free to let me know and I might have additional comments.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago
Respected Sir
Thanks for your prompt reply. I am sorry for asking for a quick reply because of my anxiety.
My questions are:
1) Will you offer Pep after this exposure if j came to your clinic?
2) If I suppose that the girl has both HIV and Hep B than overt biting which leaves microscopic cuts are able to transit these viruses?
3) is it possible that during protected oral some saliva touch the FUNGAL infection and that becomes a reason for infection?

I HAVE NO CUT OR MARKS ON MY NIPPLE AREA WHICH CAN BE SEEN WITH NAKED EYE.
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H. Hunter Handsfield, MD
22 months ago
1) My clinic would refuse to prescribe PrEP in this situation no matter how strongly you insisted.

2) IF known infected (and not on HIV treatment) and IF the bite was very traumatic with lots of bleeding, we might reconsider.

3) Saliva rarely or never transmits HIV and fungal infection or other inflamed skin makes no significant difference.
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22 months ago
Thanks a Lot for your reply Sir. I Think you are angry at my HEADING of question.Your answers are just to the point unlike you used to do at medhelp and also on this forum. I am extremely sorry for that. I was anxious so I did this mistake.

I just want to state the acts I did to check that there is any cut or not. AFTER HALF AN HOUR I SQUEEZED MY NIPPLE VERY HARD BUT DIDNG SAW ANY BLOOD.
AFTER 1.5 HOUR I APPLIED LEMON JUICE ON BOTH THE NIPPLES BUT DIDNT OBSERVED ANY DIFFERENCE.
AFTER 2 HOUR I CLICKED A CLEAR PICTURE AND FOUND NO SIGN OF ANY TRAUMA.
I PUNCTURED MY OTHER NIPPLE WITH BLOOD SUGAR TESTING PIN AND AFTER 12 HOUR I APPLIED GREEN CHILLI ON BOTH BUT PIN PAIN FOUND ON THE ONE I PUNTURED.

1)SO IS THAT REASSURING THAT NO SEVERE TRAUMA HAPPENED?

ALONG WITH THIS I HAVE A FEW QUESTIONS:
1) AFTER HOW MANY DAYS OF GETTING HPV VIRUS ONE CAN INFECT HIS PARTNER.
2) WHAT SHOULD YOU DO IF YOU WERE AT MY PLACE IF YOUNHAVE A REGULAR PARTNER?
3)SHOULD I START VACCINATION OF HEP B LEAVING PEP THOUGHT ASIDE?
4)WHAT ARE THE CHANCES OF HEP B WITH CONDOM PROTECTED SEX?
5) ARE MICROSCOPIC TEARS VALID ROUTE FOR VIRUS TRANSMISSION?
6) DO I NEED TESTING?

LASTLY I AM EXTREMELY SORRY IF ANY OF MY ACT IS NOT AS PER THE NORMS. I DONT HAVE ANY INTENTION OF HURTING OR DISRESPECTING ANYONE. CANT EVEN THINK OF DOING THE SAME TO YOU. YOU IS THE FIRST PERSON IN 2010 WHO HELPED ME IN MY HIV FEARS WHEN I USED TO BE A JUST GROWN KID.

thanks and sorry
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22 months ago
Sir few more things to add
7) Does in these 10 years your opinion regarding PeP and HIV changed as i remember at that time you said that overt biting even with profusely bleeding gums and new wounds contact cant transmit HIV?
8) The side effects of PeP are long term or short term?
9) Does Hep B vaccine and Immunoglobin also have any serious side effects?
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H. Hunter Handsfield, MD
22 months ago
There is nothing to apologize about and I'm glad my responses have started to help you. I am not at all angry about the heading (title) of your question. I only wanted you to understand out policy. We are not available for direct medical advice on PEP, and we are not responsible to provide urgent medical advice. 

As I said above, the exposure events you describe all were zero risk for HIV. The increased detail in this follow-up question does not provide does not change that opinion or my advice.

1) HIV probably is transmissible beginning about a week after catching it. 2) If I were in your place with a negative partner, I would not be tested for HIV, HBV, or any other STI. 3) I would not recommend HBV immunization or immunoglobulin in this situation. 4) HBV is zero risk with a properly used condom. 5) "Microscopic tears" are not known to lead to HIV infection. 6) From a medical/risk standpoint, you do not need testing. However, you might "need" the negative result to help you stop worrying about it. This is your decision, not my advice.

7) Our advice over time can change as new data become available. However, I do not believe I ever before had a question about whether or not a bite had increased risk of HIV transmission with or without heavy bleeding. Indeed, I am unaware that biting has ever once been known to result in someone catching HIV. 8) PEP usually causes few side effects, either long or short term. 9) Hepatitis B vaccination is harmless, with no side effects. Same for immunoglobulin to prevent HBV.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes to you.
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22 months ago
THANKS A LOT SIR. I AM FEELING VERY RELAXED. MORE RELAXED BY FINDING THAT YOU AFE NOT AT ALL ANGRY AT ME..

ONE THING I WANT TO ADD SIR. 
MY 1) QUESTIO N WAS FOR HPV (PAPPILOMA VIRUS) I.E HOW LONG AFTER AN EXPOSURE ONE CAN INFECT OTHERS WITH HPV.

THANKS A TON SIR FOR YOUR KIND HELP.
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H. Hunter Handsfield, MD
22 months ago
Oops -- sorry! I misread HIV instead of HPV.

There has been no research on when newly acquired HPV is not transmissible to sex partners, but it is slow growing and clinical manifestations like warts or abnormal Pap smears don't start until at least 6-8 weeks. Probably transmission is similar.

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe.
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