[Question #10668] Hiv Testing/PEP Help

21 months ago

I had condom vaginal sex with an escort yesterday. Would you recommend PEP? This is an American escort living in Massachussts, who I know was tested 4 months ago with 4th gen and viral load, which came back negative. Some things to note is that we had sex for roughly 30-40 minutes going between blowjobs, handjob and sexual intercourse with a condom in various positions. I have some pimples/ingrown hairs on my groin area that had open and had not healed fully that same night... will this cause an increase of HIV risk? I’ve seen this girl before and offered to pay for her sti/std exam for her, which she obliged.

21 months ago

Should be getting most of the results by tomorrow morning and the rna test in a couple days. If the 4th gen hiv test comes back negative i probably don’t need PEP? Because i used a condom and it would have still picked up if she was very recently infected with a high antigen count? How reassuring is it if she test negative with 4th gen 12 hours after I see her. If her viral load test comes back negative is that considered conclusive for me that I can't get HIV from her?

H. Hunter Handsfield, MD

21 months ago

Welcome to the forum. Thanks for your confidence in our services.

We do not provide direct medical care, and that means we cannot advise specific treatments. PEP decisions must be made by patients with their personal health care providers.

That said, I cannot imagine any knowledgeable HIV expert would advise PEP in this situation. You have a partner who could safely be assumed not to have HIV at the time of the exposure. Plus condom for vaginal sex, which is highly effective in preventing HIV transmission. She doesn't have HIV. And by the way, pimples, shaving nicks, or other open sores in the genital area does not increase the risk of HIV from sexual exposure. That's an urban myth, nothing more.

I don't understand your question about "very recently infected with a high antigen count". That isn't possible. If she has any antigen at all, her AgAb test (4th gen) will be positive. But I predict she'll test negative anyway.

Congratulations for using a condom. You'll be fine.

HHH, MD

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21 months ago

Hi Dr,

Looking for some clarity. Her 4th gen hiv test came back as negative yesterday(after 12 hours of me seeing her). We are still waiting for her HIV RNA test to come back. If her HIV RNA test come back negative does that mean I cant get hiv since she wouldnt have any viral load to infect me? Is it reassuring her 4th gen came back negative? Should I feel confident that I dont need PEP with knowing her 4th gen his negative?

H. Hunter Handsfield, MD

21 months ago

As suggested above, I saw no need for PEP at all or even for you (or your CSW partner) to be tested. And now, with her negative AgAb (4th generation) blood test, you know for sure she isn't infected; you don't need to wait for her RNA test. For sure you should not be pursuing PEP at this time.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. In the future, if you continue to have occasional sex with female sex workers, you be sure and use a condom; not worrying about either testing or PEP afterward; and just plan on periodic (e.g. once or twice a year) HIV testing.

Best wishes and stay safe.

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