[Question #12096] HIV and STDs Anxiety after encounter & Possibility of Ruling out Infection

10 months ago

Dear Doctor, I had an encounter with an escort 17 days ago involving quick oral and vaginal intercourse, both protected with a condom. immediately afterward, I removed the condom and washed myself with body wash. After the event, I became very anxious about the possibility of HIV and other STDs because she appeared petite compared to her images and mentioned that she smokes weed. I asked about her status, and she told me she did not have HIV or other STDs. Due to my anxiety, I visited a clinic and explained the situation; the medical staff informed me that I was at low risk and did not need PEP, but they mentioned that if starting PEP would alleviate my anxiety, I could do so. I began PEP 43 hours after the encounter and took it for two days. During those two days on PEP (Emtricitabine 200 mg - 300 mg and Tivicay 50 mg), I experienced side effects like a red rash on my thigh that appeared and disappeared within an hour, mild throat discomfort, and itching on various parts of my body. Believing I may have started PEP unnecessarily, I requested the escort to get tested, she took an OraQuick HIV test at home 4 days after the encounter, which was negative, so I stopped PEP on day 4. I then asked her to take another Sure Check test at a clinic on day 10, and it was also negative. I underwent an HIV RNA test through stdcheck.com 10 days after the encounter (including the day of the encounter), which came back negative, and took another HIV RNA test at 15 days post-encounter, currently awaiting the results. My questions are: 1. Considering I took PEP for only two days, how valid are my HIV RNA test results? Could the medication suppress the virus and affect the test outcome? 2. If my second HIV RNA test at 15 days post-encounter comes back negative, can it be considered conclusive? Is it safe for me to stop worrying and move on? 3. I am experiencing occasional random itching without any rash and have noticed new red bumps on my chest that develop into whiteheads.

H. Hunter Handsfield, MD

10 months ago

Welcome to the forum.

The main bottom line is that you can relax: you definitely do not have HIV. Secondary bottom lines are that you were at close to zero risk to begin with; proved it again by having your escort partner tested; and seriously overreacted by seeking PEP in the first place and I'm glad you came to your senses and stopped. (For goodness' sake, what does your partner being "petite" have to do with HIV/STD risk??)

Female escorts are generally believed to be at very low risk for HIV (assuming "escort" is as usually defined -- expensive sex workers by appointment. They tend to know the score, use condoms, get tested frequently, and tend to have low risk clients -- men like you. Because they know their status by frequent testing, you could have (and should have) trusted her reassurance without insisting she be re-tested (twice even!). And even if she had HIV, with a condom that didn't break, you had no significant risk of HIV. Your symptoms are meaningless -- they don't hint at HIV or any STD.

To your specific questions:

1. Two days PEP is not likely to have affected the reliability of your HIV RNA test at 10 days, and...

2. ...will not affect the result at 15 days. That test also will be negative.

3. Itching isn't a symptom of new HIV infection or any STD, and neither are pimples anywhere on the body.

So all is well. Move on without worry when you get the second negative RNA test.

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

HHH, MD

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10 months ago

Thanks for reply Doctor Hunter,
I got 16 day (including encounter day) Hiv RNA as Negative. So based on your previous response the 2 day PEP meds which i took on day 3 & 4 didnt effect this result. I am relived from the stress. And do you recommend going for full STD panel for other infections like gonorrhea, Chlamydia etc.. again at 21 days on coming Monday ? I already did the FUll panel on day 2 from clinic before starting the PEP they all are negative. And should i continue making love with my regular partner without condom ? Or should i wait for 28 days 4th gen test ?

H. Hunter Handsfield, MD

10 months ago

Thanks for the thanks; glad to your stress is relieved. I recommend not being tested again for HIV, or for any other STD; and that it is entirely safe to continue unprotected sex with your regular partner.---
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