[Question #12464] Risky Encounter

7 months ago

Hello I am a 38 year old bi-sexual male. I am terrified that I ruined my life from an act when I was single. Back in March, when I was still single, I had a one-night stand, unprotected anal sex with a male that I met on an app. I got on PEP within 22 hours of the exposure. However, like an idiot, while I was on PEP I had unprotected sex with a girl that I am still great friends with. After I completed PEP I took all of the follow-up tests and am negative for all STD's. but now I think that I could have given her HIV or syphilis (my mind is stuck on those two things) when I had sex with her.

q1 , should she have gone and got on PEP herself after having unprotected sex with me?

q2, Could I have given her hiv when we had sex while I was on PEP?

q3, I asked a doctor forum on Reddit and one doctor said "it is possible that said partner could have contracted HIV because there are still some HIV cells in the body while you are taking PEP." How true is this?

q4, if a patient came to you and told you that they had unprotected sex with someone who is in the middle of their pep regime, would you also prescribe them PEP?

q5, should I have done tests to check my viral load while I was taking PEP?

Edward W. Hook M.D.

7 months ago

Welcome to our Forum. Thanks for your questions and for your implied confidence in our service. I'll be happy to comment including my sincere efforts to correct the mis-information that you have gotten on the internet, including Reddit. FYI, the internet is a poor place to seek health information. What you find there is sometimes correct but often incorrect, either because it is out of date, taken out of context or simply plain wrong. A substantial part of our time on this forum is dedicated to correcting internet mis-information.

The encounter you describe was low risk with a likely risk of acquiring HIV of less than 1 in 10,000. Had you asked if you needed PEP we would have our best to talk you out of it and would have declined to prescribe the medication as it was almost certainly not needed. You don't mention when your last test was but if it was more than 4-6 weeks after completing PEP, there is no way that it would have missed a newly acquired HIV infection.

In response to your specific questions:

q1 , should she have gone and got on PEP herself after having unprotected sex with me?

Absolutely not. Persons on PEP cannot transmit HIV unless the PEP has failed. There is no reason to think you even needed PEP, much less could have transmitted HIV while taking it.

q2, Could I have given her hiv when we had sex while I was on PEP?

Absolutely not. This is yet another internet myth.

See above. There is no HIV circulating in persons who are taking PEP unless they have failed PEP.

q4, if a patient came to you and told you that they had unprotected sex with someone who is in the middle of their pep regime, would you also prescribe them PEP?

Absolutely not. I would refuse to do so.

q5, should I have done tests to check my viral load while I was taking PEP?

I think you have been misled through your internet searches. Please don't worry. EWH

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7 months ago

Thank you so much for your reply. That gives me a lot of reassurance. One question, you said that my contact was low risk. However, I thought unprotected anal sex is the highest risk for hiv. My initial contact with the male was unprotected and I was not sure of his hiv status. Wouldn’t this warrant PEP? Also does this change your assessment in terms of my female partner’s exposure or does it not matter since I was taking PEP when I had vaginal sex with her ?

Edward W. Hook M.D.

7 months ago

The reasons I characterized your encounter as low risk include that his HIV status was unknown and less than 10% of men who have sex with other men have HIV. Further the risk of a single act of receptive rectal intercourse is less than 1 infection in 100 exposures and for insertive partners is less than 1 in 1000. Putting these 2 facts together there as at least a 99.9% chance you would not be infected. That is low risk. Your PEP adds a further more than 90% protective effect.

In the future it would be a good idea to ask casual partners about their status and when they were last tested. Most people tell the truth. EWH

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7 months ago

Ah I understand. Thank you doctor. A few final questions to for you

1. My last hiv tests was yesterday (4.5 months after completing PEP). Is this final?

2. I am still great friends with my female friend and I want to clear my conscious. There is no way that I could have given her HIV from our encounter while I was on Pep correct?

3. In general, do you think it’s medically necessary to tell her that I was on PEP when we had sex even though it happened more than 5 months ago?

Edward W. Hook M.D.

7 months ago

Final Responses

1. Your results are absolutely conclusive. No need for further testing.

2. There is no way you could have given her HIV

3. There is nothing to be gained by informing her you were taking PEP.

This is the 3rd and final response to this thread. Accordingly this thread will now be closed. Take care. EWH

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