[Question #13140] HIV Exposure Risk

2 months ago

I performed protected fellatio, with a condom from beginning to end, for 2-3 minutes on a transgender CSW of unknown HIV status. She ejaculated into the condom after I stopped (via masturbation). I then received protected fellatio for 2-3 minutes, also with a condom from beginning to end. Since then, I have been concerned (perhaps unreasonably) that I may have been exposed to HIV. I have taken PEP x 4 days, but stopped today due to RUQ pain that I worried may be related to drug-induced hepatitis.

Question1 : in your opinion was this a risky exposure? 2: do you think it is reasonable to stop taking PEP at this time and test when reasonable?

Thank you so much for your consideration.

H. Hunter Handsfield, MD

2 months ago

Welcome to the forum. I think I can help.

Stopping for a preliminary reply after your brief first sentence:: Condom protected oral sex is zero risk for any and all STIs, for both the oral and penile partner. I'll keep reading, but unless a surprise is coming, I doubt you should be worried and probably do not need testing for anything.

Now moving on: "I have been concerned (perhaps unreasonably)": Yes, definitely unreasonably! I would have strongly advised against PEP in this situation. That said, there is little or no chance your abdominal pain is due to hepatitis, which usually is painless -- and unlikely to start so quickly.

1. "in your opinion was this a risky exposure?" Nope.

2. "reasonable to stop taking PEP?" Probably yes, but we do not provide direct medical are or recommendations. It would be best to see an HIV-experienced doctor or clinic for personal advice. But at a personal level, if somehow I were in your situation I would not have started PEP and certainly would be comfortable stopping it. I wouldn't even be tested for HIV or any other STI.

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

HHH, MD

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1 months ago

Hi Dr. Handsfield. I really appreciated your swift and informative reply to my query. I have a brief follow up for you.

I did discontinue PEP as exposure was extremely (as you say 0) risk of transmission. I then proceeded to develop every symptom of what I considered to be ARS—sore throat, headache, loose stools. I then had a negative HIV RNA test which I took 12 days after stopping PEP and 4 days after these symptoms developed. Am I correct in assuming:

1) If symptoms were due to HIV my test would have been positive?

2) 12 days should be sufficient for test to be reliable?

Thank you for the service and level headed advice you provide.

H. Hunter Handsfield, MD

1 months ago

1) The symptoms you list are very common in hundreds of medical conditions. Of those, ARS is far more rare than most. And actually, the combination of sore throat, headache and loose stools does NOT fit well with ARS. In any case, the answer to your question is yes: All HIV tests, of any type, always are positive in the presence of symptoms due to ARS. There are no exceptions to this rule.

2) Yes. The negative PCR proves not only that your symptoms are not ARS, but that you do not have HIV.

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