[Question #12229] Hepatitis C risk - unprotected anal
9 months ago
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I am a gay man who has been on PrEP since becoming sexually active. About 5 weeks ago I engaged in unprotected anal sex with someone. I was the top/insertive partner. He mentioned after the fact that he had a "blood disease" that is not transmissible, but he did not want to discuss it or name the disease. He was pretty evasive and basically just told me not to worry. I have been nervous about possibility of hepatitis exposure since. There was no obvious bleeding during sex, and it was not rough or vigorous.
1) I have read that HCV is not considered a STD, but assuming I was exposed as the insertive partner, how risky would you consider this exposure?
2) I have read a few different things regarding the testing window. I have a doctor's appointment this week, which will be just 6 weeks after the possible exposure. Would a hepatitis test at this point be considered conclusive?
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Edward W. Hook M.D.
9 months ago
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Welcome to our Forum. Thanks for your questions. Congratulations on your adoption of PrEP- it will do much to keep you safe. I can understand how your partner's evasiveness could be anxiety provoking.
) I have read that HCV is not considered a STD, but assuming I was exposed as the insertive partner, how risky would you consider this exposure?
As you point out, sexual transmission of hepatitis C is quite rare and when it does occur, it has been associated with being the receptive partner is rectal intercourse. I would consider your risk of hepatitis C related to the encounter you describe close to zero.
2) I have read a few different things regarding the testing window. I have a doctor's appointment this week, which will be just 6 weeks after the possible exposure. Would a hepatitis test at this point be considered conclusive?
Yes
I hope that this information is helpful. EWH
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9 months ago
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This is a relief to hear. Thank you for the quick response and everything you do!
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Edward W. Hook M.D.
9 months ago
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I'm please I could help. EWH---
9 months ago
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If allowed, I have two follow up questions that came to me after the original post.
1) In reading other threads on this site, it wasn't entirely clear to me whether or not taking PrEP might sometimes yield a false negative on 4th gen HIV tests at six weeks (I'm sure it's clarified in your answers somewhere, but I had trouble searching). Is that a concern, or would the HIV test also be considered conclusive at this point?
2) I started having sex, and PrEP, pretty recently and believe that I may have timed incorrectly at the beginning. It takes 7 days before PrEP is fully effective. Looking over the timeline, my first unprotected exposure (receptive) may have been after only 6 doses, but I continued taking it daily after. Would this increase the risk significantly enough to worry?
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Edward W. Hook M.D.
9 months ago
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Your follow up questions regarding the potential for HIV PrEP to fail are challenging because failures are so rare. PrEP reduces risk for acquisition of HIV by more than 99%. In person who are taking PrEP, the anti-HIV medication may somewhat delay tests becoming positive, but rarely if ever by more than two weeks. Thus, if you are concerned, testing at eight weeks, following your encounter, should certainly be virtually conclusive.
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Taking prep irregularly during the first six days would only slightly reduce its effectiveness.
EWH
9 months ago
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I appreciate the reassuring info. I thought I would report back, not out of surprise, but just for posterity.
Ag/ab HIV test 57 days (8 weeks +1 day) after unprotected receptive anal following 6 prep doses: non-reactive
Hepatitis C Ab test 45 days following unprotected insertive anal: non-reactive
Thank you again!
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Edward W. Hook M.D.
9 months ago
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Thanks for sharing your results. We will close the thread now. Take care. EWH.---