I took a full panel STI test 2 weeks (14 days) after with a 4th gen HIV test. When I got my results back all negative, but my white blood cell count was high (11 H), Bilirubin was high (1.3 H) and my Neutrophils were high (8350). I also had a bad cough begin the next day, along with phlegm production which continued for 2 weeks with no fever or rash. I am anxious and will get tested with RNA and 4th gen test at about 40 days, but want to know if PrEP could delay a test result. Also would like to know my potential risks. 

Your main concern seems to be the visible feces. Almost certainly that did not elevate your risk of any infection from the exposure described. Every time you have insertive anal sex (topping), you can be sure there is feces contact, whether or not you actually observe feces on the condom. Brief contact of feces (or of anal fluids) with the unprotected head of the penis is not especially risky. It undoubtedly accounts for occasional urethral infections with fecal bacteria like E. coli and reglated "enteric" bacteria, and perhaps explains a few cases of gonorrhea or chlamydia. However, none of these risks is any higher than if visible feces was not observed. And this also did not materially elevate your risk of HIV, especially since you were taking PrEP. And the risk was very low anyway, since the condom use sounds successful overall.

I would not have recommended testing after this event, at least not from a medical or risk standpoint -- although I understand testing can have reassurance value even when the actual risk is low. Your minimally elevated white blood cell and neurtrophil counts say nothing and neitehr does your trivially elevateed bilirubin level. Why did you have those tests anyway? They are never advised to evaluate HIV/STI risks or help diagnose those infections. That said, the WBC result could have reflected the cough and phlem production, but these are not symptoms of HIV or any other STI; you caught a cold, nothing more. 

Your negative AgAb (4th gen) HIV test at 2 weeks is reassuring but not conclusive, especially if you were continuing the PrEP drug(s). For conclusive testing for HIV, you'll need to be off the anti-HIV drugs for 4-6 weeks, then test at that time. But all things considered, you can be very confident you did not acquire HIV and that any future testing will remain negative.

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

HHH, MD

I recently switched to a new doctor and they wanted routine bloodwork/test done and I had asked to include STI/std testing since things like Gonorrhea and Chlamydia show up within that 2 week time frame (and to see what my current health insurance is able to cover). Some research I did also said that a 4th generations test would be positive if I had symptoms and since elevated wbc counts would mean infection occurring I am more confident in the assumption that I am negative. I guess my main worry was my lack of full adherence to prep (I know it says to take it daily 7 days a week but some times i forget and either miss a dose or take it within 12 hours) and how that could increase my potential likelihood of contracting HIV. But most studies I have read have said that potentially 4 days of prep a week is almost as effective as 7 days and that 6 days is a very high level of protection. I have been taking my prep every day since the “hook-up” which would be 30 days as of today.

I guess I wont take another test and will wait until my normal 3 month test (which is coming up in 4 weeks) that I have to take to continue to be on PrEP and will keep telling myself that I am more than likely negative. Additionally since i tested negative on every other STI/STD that does alleviate some of my concern as I know Gonorrhea and Chlamydia have a much “easier” time spreading/infecting a person than HIV. I do still have a sore throat after the coughing and phlegm but it’s possible that that is just a bacterial infection, I will be getting a strep throat and mono nucleosis test to rule those out (I did make out with a different person 2 days after the hookup so maybe something happened there). 

I do also want to say thank you as the Ask the Experts website has been helpful for me in my initial search and in your responses, everyone of you who answers these questions are very well spoken and good at assuaging concerns. Thank you again. 

I agree with your own assessment that missing a single dose of PrEP in the preceding week is very unlikely to interfere with its effectiveness. 

Wise decision to not be tested again for HIV until your routine 3 month test. Stay mellow in the meantime; it will be negative.

I wouldn't advise going to the trouble and expense of testing for strep or mono, neither of which is likely to cause coughing. If you want to test further, more likely explanations are covid, influenza and RSV. But of course feel free to follow your doctor's advice if different.

Thanks for the thanks about our services. I'm glad we've been of help, both as a general resource and in response to this question. Best wishe and stay safe.