[Question #11555] Followup on PEP use and Risks
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13 months ago
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Hi Doctor, hope that my previous question is still accessible by you for reference.
Currently on day 29 of Biktarvy and finishing course tomorrow.
Till now, and over the course of Biktarvy, have only been having protected sex with wife and unprotected oral. Two days ago, on day 27 of Biktarvy, I had protected sex with my wife, but there was some fingering done to her prior to the intercourse. I had accidentally scalded my finger the afternoon of that day making some pasta, and paid no heed to it - however the morning after the intercourse realized that the blister on my finger (due to the scalding) had popped sometime the night before; whether or not this was during the fingering I do not know. Blister is small and 0.5cm in diameter.
concerned at the moment if, in the event that I had contracted HIV, that I would have passed it onto her during the pre-coital interaction, if the blister had indeed popped while fingering her. Appreciate if you could clarify what risk there would be to her in this event, or if there was any risk at all. Also some clarity on the effectiveness of suppressing HIV this late in the course (Day 27) of the PEP and if me being on PEP offers any protection to a negative partner during unprotected intercourse. Many thanks.
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Edward W. Hook M.D.
13 months ago
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Welcome back to the forum although I am sorry you felt the need. On this occasion, I will be responding. In preparing to do so I reviewed your early interaction with Dr. Handsfield and agreed with everything he said, including that you really did not need PEP to start with.
That said the risk from the encounter you describe is virtually zero. HIV is not spread through masturbation of a partner, even when the hand used for masturbation Has cuts, scrapes, or in your case of blister which broke. If PEP had failed and you were placing your partner at risk, your HIV test would need to be positive. If you wish to prove that you did not put your partner at risk you can test for HIV and you will find that your test is negative. (Technically this does not take the place of following up your pep at 4 to 6 weeks after completion with another HIV test to prove that you were not infected). EWH
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13 months ago
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Thank you for your response Doctor. Just to clarify, are you saying that I would be HIV negative while on the PEP? And was also hoping to understand, if one had contracted HIV and started PEP within 24 hrs of the potential exposure, would HIV cells have any chance to be pr3sent around the day 27 mark? Apologies just trying to understand this better. Thanks for your time.
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Edward W. Hook M.D.
13 months ago
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Yes, you would be HIV negative while on effective PEP. P is not HIV treatment, it is preventative. Persons on effective PEP are never HIV positive. There is, and never would be virus in their system. EWH
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13 months ago
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Thank you Doctor - clear on the PEP and no HIV Transmission. I tested prior to this incident and was negative, and have only one partner until the incident. My final question is in relation to a very bad sore throat and high fever that my wife has just developed today. We had unprotected oral sex on Sunday the 30 of June, this was day 27 of the Biktary PEP as mentioned earlier. Could this have anything to do with any STI? HIV or Gonorrhea? Apologies if I am asking a similar question and greatly appreciate your consultation on this. To give you an understanding of the previous medications and tests I took after the incident (which Doctor Handsfield addressed) - on day 2 of the exposure I was given PEP (Biktarvy for 30 days), 1000mg of zithromaxine (taken as a single dose), and Doxycycline (100mg, 2 times a day, for 7 days). On day 4 of the exposure, I proceeded to test for Gonorrhea and Chlamydia, with results negative. At the end of the first doxycycline course, paranoid me went back to the doctor and got a shot of Ceftriaxone, plus another weeks course of Doxy at the same dose as before. Driven largely by paranoia and not wanting to pass anything onto my wife. Our next sexual encounter was approximately 5 days after the Ceftriaxone shot, and it was protected intercourse with unprotected oral. The next sexual encounter was a week after that, and most recent was, as you know, day 27 of the Biktarvy. All sex thus far has been protected intercourse, fingering and unprotected oral.
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13 months ago
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Specific queries are as follows;
1- at Day 4 testing for Gonorrhea and the negative result, could I be confident that I didn't have it?
2- After taking the Ceftriaxone (Day 7/8 after incident), would that have eliminated any possibility of Gonorrhea? To date have not had any symptoms.
3- Could her current symptoms today be related to an STI that i passed onto her? Sudden onset of bad sore throat over last night and today and fever from this afternoon, going up to 38 Deg C.
Many thanks for your opinion and advice Doctor.
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Edward W. Hook M.D.
13 months ago
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Your characterization of yourself as being paranoid is right on target. There is simply no way tht your wife's sore throat could be due to an STI transmitted to her from you. Thus, briefly, and in reply to your specific questions:
1- at Day 4 testing for Gonorrhea and the negative result, could I be confident that I didn't have it?
Yes!
2- After taking the Ceftriaxone (Day 7/8 after incident), would that have eliminated any possibility of Gonorrhea? To date have not had any symptoms.
Yes!
3- Could her current symptoms today be related to an STI that i passed onto her? Sudden onset of bad sore throat over last night and today and fever from this afternoon, going up to 38 Deg C
Np!
These are not opinions, these are facts.
As you know, we provide up to 3 responses to each client's questions. This is my 3rd response. The thread will now be closed. There should be no need to return to the Forum about your tests or the encounter you have described. Should you return, your question may be closed without a response and without return of your posting fee. EWH
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