Good day Doctor, thank you for creating such forum.

I have read many of the questions on the website regarding hiv, testing, and can say fully understand better. Here are my questions.

Had protected sex with a CSW in Thailand for 3 minutes max, She may have touched her vagina when inserting lube, opening her labia and fingering. She then initiated for handjob and she began stroking my penis head and when finishing she wiped her finger to clear the sperm at my urethra. Realised what happened, seek PEP at a hospital where they provided Ricovir-EM and rilpivirine ate for 4 days and went to another clinic where they provided the rest Tenof-EM & Dolutegravir. Started within 12 hours, Finished PEP course on 2/12. 

Tested a day POST PEP - Determine Alere HIV1/2 Ag/Ab Combo - Negative

 

Thank you for reading other questions similar to your own. Having done so, you might have predicted my replies and advice; we have had hundreds if not thousands of questions about exposures like this. HIV is not transmitted by hand-genital contact, even when genital fluids are involved for lubrication. This was a zero risk exposure for HIV, even if your CSW partner is infected -- and statistically, probably she is not. I would not have advised PEP in this situation; had you come to my clinic, we would have refused to prescribe it. In fact, I would not have even recommended testing for HIV in this situation.

Those comments start to answer your numbered questions, but here goes:

1. "What are the risks handjob hand to genital...?" Zero, as discussed above. It doesn't matter if vaginal fluids were in contact with your penis. (Unprotected vaginal sex, with your penis in an infected woman's vagina for several minutes, the transmission risk would be around one chance in 2,500.

2. Although PEP was not needed, the regimen you took is nearly 100% effective.

3,4) There are not very good data on time to positive testing for HIV if PEP doesn't work. The problem is that even without PEP, at least 99% of exposed persons would not catch the virus; and with PEP being nearly 100% reliable, the proportion of treated persons who fail treatment is probably around one person for every ten thousand to a hundred thousand. Therefore, reliable statistics simply are not available. The experience of your PEP provider is typical; I also would assume that most people infected despite PEP would test positve within a week after the last dose. It is very likely that a negative HIV RNA PCR 11 days after the last dose is conclusive. However, given the absence of clear data, most experts and clinics recommend testing again after 4 weeks, with both another RNA PCR test and an AgAb (4th genration) blood test.

Howver, I stress you were at zero risk and could not possibly have HIV, even if you had not taken PEP. If somehow I were in your situaiton, I would not have any further HIV tests at all.

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

HHH, MD

Yes all the answers that you have given is somewhat what I would have guessed.

3/4. Your PEP provider might have administered PEP to a lot more patients than I have. Presumably he is truthfully describing his experience. However, I stand by my reply:  I agree a negative PCR 11 days after your last dose probably will be conclusive, but we simply cannot be 100% certain about it. But since you weren't at risk, I don't see that it matters very much.

That AgAb test is very accurate. 

How do we determine the specifications of lots of virus as mention previously some of the vaginal fluid was used for handjob on mucous membrane penis head and vaginal fluid was wiped multiple times when finishing on urethra. Could this not posed as a risk for infection as some of the fluids could have went into the urethra. I understand that there is no known cases just would like to determine as you have said this was certainly no risk and not even testing was required which shows extreme confidence that the above is impossible for infection ?

Lastly, I was having a sore throat after PEP course was finished however tested negative soon after would determine that the site throat was not due to infection correct ? 

Thank you Doctor

All in all, just ignore symptoms. They never are reliable in either making new HIV infection likely, nor in making it unlikely if symptoms are absent. Rely only on blood tests.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.