[Question #10851] Hiv risk
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19 months ago
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Dear All,
I met an escort in Baku, Azerbaycan and had unprotected oral ( i was insertive) and protected vaginal intercourse. However, right after I entered, she told me that condom has slipped ( she somehow felt this) and I pulled out immediately and changed the condom. Unprotected part was max 5-10 seconds.She immediately said that she was clean. The day after I called her and she told me that she is a transwomen with penile inversion vagina and the risk is almost none for me. As a result of my insistence , 20 days after the exposure she sent me her results (?) all negative for hiv,hbs,hcv, anti lues and RPR. (I paid for it) (the test was Biotek IFA, first time I heart this). I really dont trust her, she may be lying and just changed her name on someone else’s tests. She also said that she has cosmetic surgeries regularly. And doctors are testing her before the surgery. ( could it be true)
I started PEP with Genvoya (1 pills per day) at 55th hours and completed 30 days course. My 4th generation test came back negative after finishing Pep. ( 32 days after exposure) . I know it doesn’t mean anything as I was on Pep. I also get Androflor test 20 days after exposure, all came undetected.
My questions:
1- what is the risk of transmission for penile inversion neovagina ? Is it riskier than anal sex ? Couldn’t find any study about it ?
2- how do you calculate my overall risk ?
3- can I resume unprotected sex with my wife ?
4- Would Hiv pcr test be conclusive 2 weeks after the last dose of Pep ?
5- should I take another androflor test for conclusive results for other STI’s ?
Any recommendations?
Many thanks in advance.
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19 months ago
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I also forgot to mentioned that I’m circumcised and never had any STIs in my life.
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19 months ago
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Correction: condom wasnt slipped but it was broken. There was a small tear closed to the top part. I don’t remember even the head of my penis was out or not .
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Edward W. Hook M.D.
19 months ago
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Welcome to the Forum. Thanks for your questions. This was a virtually no risk encounter. Since you did not know your partner's HIV status immediately after you had sex, PEP may have been reasonable but her negative tests (why would she lie?) indicate that you were not exposed. Your own negative tests 30 days after completion of PEP provide further evidence to prove that you were not infected. I would not be worried in the least. In reply to your specific questions:
1- what is the risk of transmission for penile inversion neovagina ? Is it riskier than anal sex ? Couldn’t find any study about it ?
I know of no good data to answer this question. The skin of a penile inversion vagina however is likely to be thicker and less vulnerable to STIs or HIV and less likely to be a source of transmission because of the different in the nature of the skin.
2- how do you calculate my overall risk ?
See my comment above. This was a low risk encounter to start with. That assessment is strengthened by her test results and subsequently, your ow negative tests.
3- can I resume unprotected sex with my wife ?
I would certainly net hesitate.
4- Would Hiv pcr test be conclusive 2 weeks after the last dose of Pep ?
It would be strong evidence that infection had not occurred. PEP failures are rare so the best way to detect them is not clear. Most experts would consider a negative PCR any time more than 11-12 days after completion of PEP or a negative 4th generation, combination HIV antigen/antibody test 30 days after completion of PEP proof that infection had not occurred.
5- should I take another androflor test for conclusive results for other STI’s
The Androflor test is not available in North America and I have no experience with it. If performed at a reputable laboratory, I would believe the results in your situation.
Any recommendations?
Only as noted above. Overall this was a low or perhaps no risk encounter despite the failure of your condom. I would move forward without continuing concern. EWH
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19 months ago
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Dear Doctor Hook,
Thank you for your reply.
I just want to correct that I’ve tested at 32 days after exposure only 2 days after the last dose of PEP. (Immediately after Pep) Im at 38th day of exposure now.Im still very anxious while waiting for my next test at 28 day after the last dose of PEP. I try to calculate my risk.
Would you be so kind to help me with this ?
- In case she has hiv and untreated, where do you see my risk?
Can I consider the risk for ,Unprotected neovaginal intercourse (circumsized) as 1/2000 and 50% Pep efficacy ( as I started after 50 h) = 1/4000 considering the brief exposure can I say 1/7-8000 and expect 99.95% negative results? If she has hiv with high viral load ?
Would your comments regarding resuming unprotected sex with my wife change ? As I dont have conclusive test results.
Thank you once again. Sorry if I’m asking stupid questions due to my high anxiety!
Many thanks
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Edward W. Hook M.D.
19 months ago
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IF she had untreated HIV (you have evidence she does not!) your risk for infection would be no greater than 1 chance on 1000 and probably low. In other words, chances are more than 99.9% that you would NOT be infected. PEP would make that even less likely. This includes if she had a high viral load.
My recommendation related to unprotected sex with your wife are unchanged
Please don't worry- you have virtually nothing to worry about. EWH
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18 months ago
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Dear Dr.Hook,
I hope you are doing well.
I have waited to receive my test results to send my last follow up msg.
1. 30 days post pep (9 weeks post exposure) HIV RNA and 4 th gen lab test results came back negative. Is it enough to rule out HIV or should I get tested again at 3 months mark ? British guideline recommends to get tested with a 4th gen test at 45 days for conclusive results and USA one at 3 months after exposure. Can I at least breathe a sigh of relief with the above results ?
2. TPHA and VDRL-RPR, HAV IGg, HbsAg, HbsAb, HCV tests at 9 weeks after exposure came back negative. Do you think these results are conclusive for hepatits and syphilis ? (No symptoms so far at 9th week of exposure)
3. In addition to androflor swap test ( STD 10 screening swap test ) at 3 weeks after exposure, my urinary test at 7 weeks came back negative for Gon, Mycoplasma and Chlamydia.
4. Does HPV and HSV swab test results came back negative at 3 weeks after exposure mean anything ? Or it just shows that I haven’t had anything before the exposure ?
Is there anything else I need to be careful about or get tested for ?
Many thanks once again for your time and services . Really appreciated!
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Edward W. Hook M.D.
18 months ago
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As you know, we provide up to three responses to each client’s questions. Thus this will be my final response:
1. As I have already told you your chances of acquiring HIV from the encounter, you describe is close to zero. The combination of an HIV RNA PCR, and a fourth generation HIV test 30 days after completion of PEP, proves that you did not acquire HIV. You can be confident of this. There is no reason for further testing.
2. Your encounter was also virtually no risk for these infections as well and your results are likewise conclusive. There is no reason for additional testing for these infections either.
3. As for the other STIs you have inquired about, your risk for these infections is virtually zero and your tests. Prove that you were not infected. No further testing is needed or recommend.
4. We typically recommend against these tests however, the fact that your tests were negative is both good luck, and indicative of the fact that you were not infected.
This completes this thread. You really have nothing to worry about at this point. No further testing is indicated. I urge you to put Emmy and all concerns that you might have a side and move forward from here. EWH.
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