[Question #11282] Inquiry Regarding Recent Sexual Encounter and PEP

15 months ago

Dear Doctor,

I hope this message finds you well. I recently had a sexual encounter on April 8th while on vacation in Greece with a sex worker. The encounter involved insertive protected vaginal sex with no visible condom tears, and immediately after, I sought post-exposure prophylaxis (PEP) within 22 hours.

The PEP regimen I received consisted of tenofovir disoproxil accord on the first day, followed by a combination of Darunavir Mylan, tenofovir disoproxil accord, and Norvir (ritonavir) from the second day onward.

Around one week after the exposure I had a acne between my scrotum and my legs, which was very painful for two days but resolved on it's own, so I didn't give it much thought.

Around 14 days after the encounter, I began experiencing symptoms such as sore throat, fatigue, and a feverish feeling, albeit with a maximum temperature of 99°F. Concerned, I underwent testing for HIV antibodies and p24 antigen on the 20th day post-exposure in Dubai, which returned non-reactive (0.024). This brought some relief, but subsequently, on the 21st day and beyond, I've been experiencing various symptoms like runny nose, irritated bowel movements with burning sensation in upper abdomen, joint and muscle aches, and reddishness on my chest, which is challenging to differentiate between rashes and my pre-existing chest acne.

Given these developments, and my ongoing anxiety, I seek assurance regarding the possibility of seroconversion, especially considering the negative test results on the 20th day. Additionally, I wonder if there are documented cases of HIV transmission from a one-time exposure similar to mine.

H. Hunter Handsfield, MD

15 months ago

Welcome to the forum.

In my view, it was a mistake to seek or be prescribed PEP. Even if the sex worker has HIV, your risk was under one chance in 100,000 -- or even as low as one in a million -- of being infected with HIV. As a result of PEP, you won't be able to know whether you caught HIV until 3-4 months from now -- instead of 4-6 weeks without PEP.

It is impossible to have HIV symptoms while taking anti-HIV drugs. Probably you caught a cold, that's all. New HIV infection doesn't cause runny nose or "irritated bowel movements", nor does it cause anything like chest acne or aching joints. Most of your symptoms sound like anxiety magnifying trivial symptoms you otherwise would ignore or maybe not even notice.

At this point, you'll have to decide whether to continue PEP. If somehow I were in your situation, I would not have started PEP and would stop it now. You should discuss this with the clinic or doctor where it was prescribed. In the meantime, I am confident you did not acquire HIV and it is not the cause of your symptoms.

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

HHH, MD

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H. Hunter Handsfield, MD

15 months ago

You started a new thread with these questions. That thread will be deleted.

I started getting symptoms at the end of second week, and asked my first question at the time. It's been 30 now since exposure, and today was the last dose of PEP, however the symptoms have progressed to sharp joint pain, pain in palm and fingers, twitching muscle, pain in upper thigh, and uncomfortableness in lower abdomen. I also have what seem to be like rashes on my left arm, lower back and thigh. They are flat raised bumps, and look close to acne. I tested negative on the 27th day, but I just want to know if I have to prepared being diagnosed with HIV or is my exposure actually negligible.

Read online on forums about a few cases where people turned positive after protected sex with CSWs and until now had thought protected sex was safe.

These symptoms do not change my opinions and advice as above. These symptoms are not at all "classical" of a new HIV infection (acute retroviral syndrome, or ARS). The main ARS symptoms are fever, enlarged lymph nodes, sore throat; they can include skin rash, the rash you describe doesn't sound typical. You should return to the doctor or clinic where your PEP was prescribed. They might advise HIV testing at this time, but if so, you can expect negative test results. Almost certainly something other than HIV/ARS explains your symptoms. One possibility might be allergy to the PEP medications. And yes, condom protected sex is safe, i.e. very low risk of catching HIV.

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15 months ago

Unfortunately, since the PEP was prescribed in a foreign country I cannot return there. Thank you so much for your time here. I forgot to add that I have been having a sore throat since 3 weeks, that aggravate every few days, however, the test 4 days ago was negative. Just curious, if pep did fail, does it usually happen so soon? I am a bit concerned because of the co incidence of this possibly other infection. I feel feverish, but temperature remains to be below 99 degree Fahrenheit can I discount it to be not ARS related. When is the earliest I can get a conclusive test after PEP? Thank you for your time, I apologise if repeated any of my questions. I was able to login back to this account, thank you.

H. Hunter Handsfield, MD

15 months ago

Understood you can't return to the prescription source, but you certainly can find an experienced provider wherever you are: an STI or HIV/AIDS clinic per se, or a specialist in infectious diseases. You definitely should do it, for its expected reassurance value, and perhaps a specific diagnosis for your symptoms. Follow their advice about the timing of follow-up tests -- but usually the schedule is about a week after the last dose of PEP, then one or two additional tests around 2 weeks (for an RNA/PCR test) and finally 6 weeks for an AgAb (4th generation) blood test.

As discussed above, HIV/ARS symptoms cannot start while taking anti-HIV drugs. In addition, you truly were at close to zero risk from the exposure described. And your symptoms really do NOT fit with ARS! Finally, perhaps you would like to know that in the nearly 20 years of this and our preceding forum, with thousands of questions from persons concerned about catching HIV, not one has yet told us they eventually tested positive. You won't be the first! If that finally happens, surely it will be from a genuinely high risk exposure (think unprotected anal sex between men) and not a near-zero risk event like yours.

You really can be confident you don't have it. See again my opening comment above about the chance you had HIV (even before PEP) being under one chance in a hundred thousand. With PEP it's under one chance in many million. Please take my reassurance at face value and don't second guess it.

That completes the two follow-up questions and replies included with each original question, and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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