[Question #11455] HIV

14 months ago

Hi Doctors,

I’m very sorry to return again to this forum.

I've recently started PrEP. I’ve been going to therapy to work on the HIV anxiety I experience after sexual encounters, but it still affects my ability to perform in my job/enjoy life. I had a sexual exposure BEFORE going on PrEP that I would like to get an HIV test for. So my final questions (I hope) for this forum are:

1. Does PrEP affect the window period and/or the reliability for a 4th generation antigen/antibody test?

2. What is the latest time ARS symptoms can occur? I’ve read through responses and I see Dr. Hook has said no later than 30 days and Dr. Handsfield has said no later than 3 weeks. I experienced a sore throat, fatigue, body aches, and a small rash 24 days after exposure.

3. Can viral load affect HIV risk for receiving fellatio or vaginal fingering? I received oral sex and fingered a woman who I later found out does not ever use condoms (for vaginal/anal sex), is in an open relationship with a bisexual partner, doesn’t get tested often and has had several (above 40) sexual partners (I apologize if this sounds judgmental.) I’ve read that receiving fellatio and vaginal fingering are no risk but I just want to make sure this is the case even with a high viral load.

I’m very sorry again. I'm struggling and I don’t really have anyone else to turn to (that I 100% trust) and I really appreciate your feedback. Thank you.

Edward W. Hook M.D.

14 months ago

Welcome back to the Forum. In response to your specific questions:

1. Does PrEP affect the window period and/or the reliability for a 4th generation antigen/antibody test?

Timing is important here. How long after your sexual exposure did you start PrEP. If it was more than a few days, it is unlikely that starting PrEP wpould effect the timingh or accuracy of your HIV tests.

ARS symptoms typically occur 10-21 days after an exposure and do not occur more than 30 days after exposure

Receipt of fellatio and masturbation and NO RISK exposures. This fact is agreed upon by the CDC, the WHO and experts in the field. Viral load is irrelevant, not matter whether or not your partner was infected.

I hope that this information is helpful. EWH

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14 months ago

Hi Dr. Hook,

Thank you for your quick response!

1. I started taking PrEP (Truvada) approximately 5 days after my sexual exposure.

2. Thank you for the information regarding the timeline of ARS symptoms. My symptoms began 24 days after exposure (so within the timeline for ARS symptoms.) I had a sore throat, fatigue, body aches, and 4 small rashes approximately 0.5 inches in diameter across my arms. Are these symtpoms of ARS?

3. I understand now regarding viral load and having oral sex performed on me/vaginal fingering. I am a male by the way. I was just confused because the CDC states low to no risk and their estimated risk out of 10,000 exposures just says low, which made no sense to me.

Is there any purpose for testing after this exposure or is there absolutely no way I contracted HIV?

Edward W. Hook M.D.

14 months ago

Thanks for the additional information. Answers to your specific questions:

1. I started taking PrEP (Truvada) approximately 5 days after my sexual exposure.

PrEP started 5 days after a sexual encounter is unlikely to impact risk for infection. In theory it might delay a test becoming positive in a person who had been infected 5 days earlier but there are no data on this.

These symptoms could certainly be due to the ARS but it is unlikely. You don't mention fever which is typical of the ARS. Further, in studies of at risk persons who seek care for evaluation of flu-like symptoms of the sort you describe, in 99% of cases the symptoms are due to something other than HIV such as influenza, COVID-19, or some other viral illness. If your symptoms were due to HIV, a 4th generation HIV test would be positive at this time- tests are ALWAYS positive in persons with the ARS.

The CDC is by nature conservative in their estimates. There are NO cases of HIV proven to have been acquired by receipt of oral sex. Vaginal masturbation is also a no risk activity.

EWH

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14 months ago

Thank you for the information, Dr. Hook. I’m going to get tested just for peace of mind. Even though, if I’m understanding you correctly, there is no reason to test for HIV, correct? And I can likely resume daily life without the chance of putting anyone else at risk for HIV from this exposure, even if I had some symptoms that may have resembled HIV ARS?

I engage in insertive oral sex and vaginal fingering fairly often. Since these are no-risk activities for HIV, there is zero chance I’ll ever contract the virus if I just stick to these two activities, correct? I was advised by Dr. Handsfield to avoid partners with obvious high risk, such as known-infected women, but this can be difficult at times due to the fact that there are people who sometimes don’t even know if they have HIV.

I always use a condom for vaginal intercourse, but I’ve never been advised to use one for oral sex and vaginal fingering. I take my sexual health very seriously, so I just want to make sure I’m not putting myself at ANY risk for HIV if I have unprotected oral sex and participate in vaginal fingering.

Edward W. Hook M.D.

14 months ago

As you know, we provide up to 3 responses to each client's questions. After this final response the thread will be closed. There should be no need for additional questions.

Testing will rule out the possibility that you acquired HIV before starting PrEP, verifying the no risk nature of your exposures. Further, persons with negative 4th generation tests do not transmit HIV. I hope you'll move forward following receipt of your negative test results.

You are correct- if you stick to receipt of oral sex and masturbation of partners, you will not be at risk for HIV and will not need testing. With regarding to avoiding partners known to be at high risk, the best thing you can do is ask if they have HIV and when they were last tested. Most people do tell the truth. Even if someone did turn out to have HIV, you would not be at risk from the activities you describe.

No need to use condoms or masturbation or receipt of oral sex.

I hope this will help you to move forward. EWH

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