[Question #10759] HIV concern
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19 months ago
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Hey doc
I had protective oral sex and protected penetrative vaginal sex with a (female) escort last Friday. Since than I have been losing my mind scared I’m going to contract hiv.
I Haven’t been able to sleep or eat. The condom was intact the whole time and the session lasted no more then 30 min
The escort had told me she was safe with everyone and did not engage in bare sex with any clients as it says in her ad as well. She says shes clean but she won’t show me a sti test as I asked for. Which makes me believe otherwise. She was very hesitant…
I went to the emergency hospital and got Pep at 39 hours post exposure.
My questions are
1. what’s my risk assessment off what I told you above?
2. Is it appropriate for me to be taking pep and should I continue taking pep.
3. How soon after finishing pep can i take a conclusive test.
4. What HIV test can i take that will give me an answer as soon as possible. I heard the pcr test was the soonest to detect and be conclusive.
Thank you very much doctor
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H. Hunter Handsfield, MD
19 months ago
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Merry Christmas and welcome to the forum. I'm glad to help.
You needn't worry at all. The chance you acquired HIV in this situation is nearly zero and I would have strongly recommended against PEP. Escorts (expensive female sex workers by appointment) are generally believed to have very low rates of HIV and other STDs. For the most part they know the score, use condoms, get tested frequently, and have low risk partners (men like you). And people rarely lie about HIV status when asked directly, so it is very unlikely your partner has HIV. Even if she does, you describe entirely safe sexual contacts, with no risk of HIV. With no condom, vaginal sex with an infected partner has one chance in 2500 of HIV being transmitted, and there has never been a proved case of HIV transmitted mouth to penis. With condoms your exposures were truly zero risk.
I'm rather amazed that in these circumstances you found a doctor willing to prescribe PEP. Had you been in my clinic, we would have refused. To your questions:
1. Discussed above.
2. We do not provide direct medical care; PEP decisions are strictly between you and your doctor. Perhaps s/he did not fully understand the situation as I described it above.
3. One of the downsides of PEP is that it prolongs the period of uncertainty to conclusive testing. Without it, conclusive testing is available 4-6 weeks after exposure. With PEP, it is delayed to at least 6 weeks after the last dose, and some experts advise 3 months. Conclusive testing could be as long as 4 months away, as opposed to a month without PEP. Also to discuss with the doctor who prescribed it.
4. An RNA PCR test at 2 weeks is considered conclusive by many experts, but most believe it should be followed by an antigen-antibody test (AgAb, 4th generation) 28 days after exposure.
Had you consulted with me or my clinic before starting PEP, we would have advised you don't even need HIV testing after such an event -- and certainly that PEP isn't necessary. You really should not be at all worried about HIV. There is no possibility you were infected.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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19 months ago
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Merry Christmas to you as well doctor
Just a couple more questions
1. I had a cut on my finger from an accident at work. (A nail from the wall partially went into my finger) and caused me to bleed. That was two days before I had visited the escort. When I did visit the escort I had fingered her with that same finger that was cut. Could that transmit the virus?
2. I understand that the risk is very low or maybe non existent since I was wearing a condom but i rather be safe then be sorry if anything does happen and who knows maybe the pep will be the saver. On the other hand i really can’t handle 4 months of worrying like this. It’s mentally exhausting worrying this much. So maybe i should discontinue taking pep im only on day 2.
3. Say if she did have the virus. Is my chance still 0 because I wore a condom and nothing was done bare?
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H. Hunter Handsfield, MD
19 months ago
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1) Nobody has ever been known or suspected to have acquired HIV by fingering, regardless of exposed cuts and nicks.
2) That decision is yours, or between you and your doctor. You have my perspectives.
3) If your partner was infected, of course it raises the risk. But still very close to zero.
By the way, my comment about nearly conclusive RNA testing at 2 weeks is for someone not taking PEP. With PEP, it's 2 weeks after the last dose.
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19 months ago
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Thanks for your output doctor
Lastly I would like to ask
1. If you were in my position what would you do? Would you even worry? Should I just continue life without worrying of hiv and would you even bother testing?
2.can I get off pep now and still test at 6-8 weeks from the day of exposure? (Only been on pep for 2 days)
3.would pep even be effective at 39hrs post exposure?
4. Given everything I told you above could you give me a risk evaluation of chances please and thank you.
Happy holidays doc. God bless
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H. Hunter Handsfield, MD
19 months ago
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1. If somehow I were in your situation, I would not even get tested for HIV, let alone take PEP.
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2. There are no data on the effect of brief courses of PEP on testing windows. I suspect, and believe most experts would agree, that taking PEP for only 2-3 days would have no effect; testing probably would be conclusive at the usual intervals.
3. Here too, there are no data on whether such a brief course of PEP might sometimes prevent HIV. Probably not, but there's no way to be certain.
4. This asks for the same responses I've already given, using different words. My judgment is that you are at zero risk of HIV.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe (as you have been!).
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