[Question #1251] Follow up - stds

47 months ago
Hi Drs,

I know you asked me to not follow up with the same questions so I'm following up with new ones:

As an FYI, I uploaded a question the other day on pep due to a recent exposure. I took home the French girl that I met at the club and we engaged in unprotected oral, protected sex (for the most part), grinding, and fingering (her not me).

My questions are:
1. I'm on day three of pep and I think I'm going to stop it. I don't believe I caught hiv from this woman. If I did stop it at 3 days and God for bid I did catch hiv, would I have developed a resistance to truvada or isentress? Would my hiv mutate into a resistant strain after 3 days of meds? 
2. I took a chlamydia and Gono test this morning so 3-4 days post exposure (it was Friday night / sat morning at 4am). Would this test be reliable? Or do I have to repeat them in a week?
3. Is there any preventative shots or medicine I could take for any of the bacterial stds?
4. When will std symptoms start showing up if I have anything?
5. Since I took 3 days of pep, will that delay my testing for hiv? I was going plan to get an rna viral load test at 11-14 days post exposure. 

Please let me know, thanks.

Bob

Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome back to the Forum.  I happened to pick up your most recent questions so I will be answering this time rather than Dr. Handsfield.  I did review your earlier exchange and like Dr. Handsfield would not have recommended (or willingly prescribed PEP for you).  That however is "water over the dam" and now we will address your questions related to the corner than you have painted yourself into by starting PEP. 

1. I'm on day three of pep and I think I'm going to stop it. I don't believe I caught hiv from this woman. If I did stop it at 3 days and God for bid I did catch hiv, would I have developed a resistance to truvada or isentress? Would my hiv mutate into a resistant strain after 3 days of meds?
Pep for you is almost certainly a waste time and money.  I agree with your plans to discontinue it.  It is unlikely that three days of PEP would have induced resistance in HIV if you had it (which is most unlikely). 
 
2. I took a chlamydia and Gono test this morning so 3-4 days post exposure (it was Friday night / sat morning at 4am). Would this test be reliable? Or do I have to repeat them in a week?
Your tests for gonorrhea and chlamydia will provide reliable results at this time. I suspect they will be negative.  When they are, believe them and appreciate that there is no need to re-test related to the exposure you have described.

3. Is there any preventative shots or medicine I could take for any of the bacterial stds?
I hope you are kidding.  You took PEP you did not need and now are asking for antibiotics which are more likely to cause side effects than to prevent any STI given the very low risk nature of your exposure.  I suspect that somewhere you could find a health care provider who would give you antibiotics. I would not and recommend against seeking them.

4. When will std symptoms start showing up if I have anything?
If you acquired gonorrhea or NGU your symptoms would have most likely started some time between now and a week from your exposure.

5. Since I took 3 days of pep, will that delay my testing for hiv? I was going plan to get an rna viral load test at 11-14 days post exposure. 
The studies on this are few and far between and are not conclusive.  Having taken PEP would, at least theoretically, potentially dealy blood tests for HIV from becoming positive.  There are no explicit recommendations as to what to do in this situation.  My advice would be to retest with a 4th generation, combination HIV antigen/antibody test at 4 weeks following your last dose of PEP, which I hope will be today.  EWH
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47 months ago
Thanks, doc.  Appreciate it.

I officially stopped the pep and informed my infectious disease doctor this morning. Took my last pill last night. 

Waiting to hear back on my gono and chlymadia tests. Praying they come back negative.

One concern that I mentioned in my original post (that increases my anxiety on this whole thing) is the fact that I have a significant other. I've kissed her in the past couple of days but have not and don't plan to have sexual contact until I'm clear of this nightmare.

Question - if I did catch anything is it possible to pass it off to my siginificant other through kissing? Not hsv1 since I already have that, but she's complaining of a soar throat today and it has me worried.  Like if I caught hiv or some other std from my exposure 4 days ago, would I have passed it off through kissing her and would she be experience symptoms already? Or is this completely coincidence and I'm over reacting?  I did not perform cunilingus on this random girl so not sure how I could have caught something orally? 

Also, on your testing timing suggestion, I'm not sure I can wait that long due to my anxiety. That being said I want to get retested for hiv / syphillis on the 18th. So at 18 days post exposure and 2 weeks post pep. Would that be reliable at all? Or am I going to have to completely disregard that test?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Since you already have HSV-1 your SO is not at any risk for acquisition of ANY STI from kissing. Kissing does not transmit STIs.  Her current sore throat is either coincidental or an overreaction on your part.

Your risk for syphilis from the exposures you describe is virtually zero (in the U.S. today, more than 80% of syphilis is occurring among men who have sex with other men) and syphilis in women is very rare.  If you acquired syphilis, you would develop a lesion at the site of exposure.  On average, this occurs about three weeks after exposure.  Testing for HIV 2 weeks after completion of PEP, no matter what test you use will provide helpful but not definitive results.  As I said above, results at 4 weeks will be reliable.  EWH

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47 months ago
Ok thank you doctor.

Few more questions then I will try to move on with my life until testing. 5 days post exposure now, no signs of discharge, lesions or pain. I guess that's still a good sign but I know it's still very early.

If I were to acquire genital herpes, would a lesion show up within the first 10-14 days? I read this online but who knows what's true.

When your patients are going through the waiting period to test, what do you suggest they do to clear their anxiety? It's pretty much taken over my life to the point where I've asked to take a week off of work to avoid speaking to everyone and I cannot stay off google reading horror stories about hiv and other stds. 

If something happens, god forbid, I will follow up.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

As you know, we provide up to three answers to clients who ask questions on this site.  Hopefully my answers have provided you with some help but it does seem to me, reading between the lines here, that your anxiety is far , far out of proportion to your true risk and that you are not making good decisions (taking PEP for instance). 

It really is not all that early for signs of the most common STIs, gonorrhea, or NGU to show up and given the very low risk nature of your exposure, I would take it as strong evidence that you did not acquire and STI from the exposure you described. 

Yes, if you acquired genital herpes you would most likely develop lesions at the site of exposure within 14 days following exposure.  If you do not, I would not worry.  We recommend AGAINST blood tests for determining if a person was infected with HSV.

As I said above, your concerns are far out of proportion to your risk.  This suggests to me (from afar) that you are overly anxious and perhaps feeling shame or intense guilt over your exposure.  If this is the case, testing or medications will not change this and the best approach is to address your concerns through working with a trained counselor or mental health professional. 

This will conclude this thread which will be close later today.  I wish you the best.  EWH

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