[Question #12783] HIV

5 months ago

Hi Doctors,

I had a sexual encounter with another man where I performed oral sex on him (he ejaculated in my mouth) and we engaged in mutual masturbation. During the mutual masturbation when he gave me a hand job he used his semen as lubricant and there was a large amount that got into my urethra. Before this sexual encounter I took Prep on Demand using Truvada.

About 8 days after this event I came down with body aches, a fever of about 99.8F to 100F and a slight sore throat. I'm afraid that this is HIV ARS which I'm surprised about because I thought Prep on Demand would protect me. I took an HIV Oraquick Saliva Test about 25 days after the sexual encounter and it was negative.

Are my symptoms an indicator of HIV ARS? Should I be worried and go get tested? Thank you so much for your assistance Doctors!

Edward W. Hook M.D.

5 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment.

This was a virtually no risk encounter. If your partner had HIV (apparently you do not know and did not ask him) your risk of HIV from performing unprotected oral sex on him is less than 1 infection in 10,000 encounters, on average. Further, it is difficult to imagine how "a large amount" of his semen got into your urethra. Even if it did however, your risk of infection, again IF he had HIV, is less than 1 infection in 20000 encounters, on average. In addition to these estimates of risk, you virtually eliminated any risk of infection by taking PrEP on demand. Your Oraquick results further reinforce that this was not HIV- if it had been the Oraquick would have been positive.

Your symptoms are almost certainly due to something other than HIV. If you wish to prove this to yourself, you can seek an HIV RNA PCR test or a standard 4th generation laboratory test of HIV. When either of these tests are negative, that will provide additional proof that the flu-like illness you describe was due to something other than HIV. EWH

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5 months ago

Hi Dr. Hook,

Thank you so much for the fast response! Your response sounds great. So if I'm understanding you correctly, I don't need to be concerned for HIV and my symptoms were not HIV ARS? Therefore, is there any scientific reasoning for additional testing or can I move on with my life?

For the future, I plan to continue using PrEP on Demand but I'm bisexual so I was thinking it might not be a bad idea to use daily PrEP instead. For daily PrEP how many days do I need to take it before I have full protection as an insertive partner? And is PrEP on demand basically as effective as daily PrEP? Apologies for the additional question. Thank you again!

Edward W. Hook M.D.

5 months ago

The only reason for testing would be to address any anxiety you might have. I am confident that your symptoms were due to something other than HIV.

PrEP might be a good idea. Most experts suggest it be taken for 7 days before it is fully effective. Like many recommendations, this may be overly conservative but better safe than sorry.

Studies suggest that PrEP on demand is just about as effective as daily PrEP although some argue that is is slightly less effective. If there is a difference it is very, very small. EWH

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5 months ago

Thank you again for all of the helpful information! I took another Oraquick Oral swab test this past weekend which would be 32 days after the sexual encounter and it was negative. I've scheduled a 4th generation test for additional peace of mind but at this point I believe I can accept the test results that I already have. I'll continue to take PrEP on demand for future exposures. Thank you for everything that you do Dr. Hook. I hope you have a wonderful rest of your week.