[Question #13973] HIV or any STD

1 months ago

I’m a 43 year old heterosexual female. I was with my ex for the last 2 1/2 years and I have never had anything come up positive except for an abnormal Pap smear last year, which was ASCUS and HPV was negative and I had genital warts twice in my life years ago. My ex left and due to high stress in my life I was not smart and slept with new partner and I don’t know his status and he wasn’t willing to tell after the fact. I panicked and got biktarvy and started it at 67 hours after the encounter. had std testing at 3 and 6 days after the encounter. Nothing positive so far. The walk in clinic provider told me that HIV would show up that soon. I think I was misinformed. My ex showed back up and we both performed oral sex on each other.

1) is my ex at risk for HIV or any STD from the oral sex incident with me not knowing for sure (if all testing was too soon) my std status or the new partners status?

2) would any std show up at 3 or 6 days after the encounter?

3) with me taking biktarvy when can I test and get an accurate result for hiv?

4) is it highly likely that me or my ex could end up with HIV from the one unprotected sex incident?

H. Hunter Handsfield, MD

1 months ago

Welcome back. As we discussed in the most recent of your several previous questions, you tend to overreact in fear or belief that STIs are likely. The situation you describe does not seem to warrant HIV post exposure prophylaxis (PEP) unless there was specific evidence your partner was HIV infected or at especially high risk (like being gay or bisexual). And I disagree with the advice as you understood it from the walk-in clinic: if you acquired HIV, positive testing results likely would be delayed until after you complete PEP, i.e. days or even a few weeks after completing Biktarvy. One of the downsides of PEP is the delay until knowing for sure that you were not infected -- a few weeks from now. You might discuss this with the doctor or clinic that prescribed the Biktarvy and consider stopping it unless your partner is known to be at particularly high risk for HIV. This strategy might include again asking your recent new partner to be tested for HIV -- perhaps you could offer for the two of you to be tested. Maybe you'd find he's as worried as you are. If both tested and negative, you'll both know there was no HIV risk.

1) Oral sex rarely transmits HIV even with active, untreated infection in one of the partners. While taking Biktarvy the risk was zero for all practical purposes even if you have recently acquired HIV -- which almost certainly you do not.

2) Gonorrhea and probably chlamydia can test positive 3-6 days after exposure, but no others, e.g. syphilis.

3) See above. At the earliest, about 2 weeks after the last dose; and to be completely certain, 6 weeks after the last dose. In other words, a couple months from now -- unless you stop the drug early (but only with the advice and agreement of the prescriber).

4) I can't comment further about your risk of HIV from the new partner of unknown HIV status. As discussed above, your ex is not at risk.

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

HHH, MD

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1 months ago

As far as me starting the Biktarvy 67 hours after the incident happened due to issues of me trying to get the medication. Are my chances still high for contracting it from this encounter and taking the Biktarvy? The person was not cooperative and refused testing so I’m finishing the medication at prescribed! When will my results after finishing the med be conclusive?

H. Hunter Handsfield, MD

1 months ago

Assuming "chances still high" means you understand there is a high probability you were NOT infected, I agree.

I answered above about time to concluding testing after PEP. The data are not precise, but most experts would agree that a negative AgAb (4th generation) HIV test is highly reliable 2 weeks after the last dose, but for 100% certainty I would advise testing 6 weeks after the last dose.

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