[Question #10928] Worried after PEP

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18 months ago
Hi Doctors, On the 8th December I had unprotected sex. She was latino from South America. That I was initially denied PEP, then later given just Travuda (it's based on risk calculation here in Australia) at 38.5hrs. Took all my pep for 28 days. Symptoms have been 1. Pain in groin/hip area (started 24hrs after potential exposure with the sore throat which lasted 2 weeks).  2. 23 days after - sharp pains/burning/swelling starts in my armpits. I want to scratch then constantly, however there is no rash.  Still occurring infrequently. 3. Diarrhea - Pretty much everyday since I've stopped PEP.  6. Rash - Strange 2mm red dots filled with clear fluid on lower chest and thighs which occurred 12 days after PEP for around 10 days.  Tests as follows: 1. Completion of PEP 2. 7 days after PEP 3. 12 and 14.5 days after PEP - Neg DUO lab tests (different labs).
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18 months ago
I spoke to the GUM clinic and told them symptoms are continuing but they just stated to follow up with my GP, as it was "unlikely" to be cause due to the tests.

 The GUM doctor wasn’t aware of the rash as it was initially small and I didn’t notice in the first few days, however he stated at the time that the symptoms if related would show in the test.  He also was confident I could start sexual relations with my wife again, but I told him I would wait. I suppose I just wanted some expert opinion on what you think regarding symptoms and further testing since I am not getting much from the GUM clinic.

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Edward W. Hook M.D.
18 months ago
Welcome to the forum. Thanks for your questions. 

Like the healthcare providers who saw you initially, I would’ve tried to have discouraged you from taking PEP for the low risk exposure that you described above. The testing that you have done as far proves that the symptoms you were and are experiencing are not due to HIV. If HIV were causing the pain in your groin, the pain in your armpit, or the rash you describe, your test would be positive. Like the GUM doctor, I am confident that it would be safe for you to resume unprotected sexual contact with your regular partner. 

Regarding the symptoms that you were experiencing, we cannot, and I will not, try to make a diagnosis over the Internet. Rather, as recommended, you should be seen by your regular doctor, who can do a thorough physical examination and laboratory tests.  EWH
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18 months ago
Thanks Dr Hook.

I very much appreciate the response in these worring times.
The risk vs PEP part definitely a point of contention. I know she would have been of higher risk being from South America.

Anyway, as my symptoms above still persist, I went and got tested again at 31 days post PEP which was negative with the Abbott Alinty 4th Gen 2021 AB/AG Lab test.

I am now at 6 weeks so I have just went and gone for another test with the same lab. Hopefully all will be well. I believe that 6 weeks post PEP is the advice on this forum? It's 8 weeks in Australia so even if this comes back ok I will be required to test again either way.
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Edward W. Hook M.D.
18 months ago
Thanks for the follow up information. If your symptoms were due to HIV, your test would have been positive. The fact that you have already had negative tests in the presence of symptoms indicates that your symptoms are not due to HIV. On the other hand, persons can acquire HIV and not have symptoms. With negative tests at six weeks following completion of PEP however, you can be confident that you did not acquire HIV from the low risk exposure that you described. When you get your next negative test results, as I anticipate will be the case, you can be entirely confident that you were not infected. I see no medical or scientific reason for additional testing. Recommendations to test beyond that point  Are overly conservative. EWH. ---
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17 months ago
Hi Dr Hook.

Just an update to this as promised.

I tested again with the Abbott 4th generation AB/AG at the pathology center. This was 7 weeks which gave me that reassurance as it was past the 45 day mark, meeting PEP guidelines such as the BAASH / NHS UK and as you also mentioned. Thankfully it wss negative.

I decided to go ahead and get another test to "tick the box" for the Australia ASHM testing standards( similar to the UK) which is a 8 week recommendation. I would need to supply this to the clinic either way( if I didn't want to wait for an appointment). Thankfully 9 weeks just came back negative which I read is now conclusive.

I just wanted to say a big thank you to you personally and Dr Handsfield for the work you do on this forum. Please continue your valuable research into HIV/STD testing and guidance. Behind every question is a person who truly appreciates the accurate guidance you both give. All the best
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Edward W. Hook M.D.
17 months ago
Thanks for the follow up information. I am glad to hear, but not surprised, that you were additional tests were negative. I trust that now you will be able to move forward without concern.

I hope that you’re not a HIV symptoms have resolved as well. This completes this thread, which will be closed now. EWH.
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