[Question #14008] HIV Risk

1 months ago

Hello Drs, on 5/3/26 around 2am I had unprotected oral sex (~2-6 min) and protected vaginal sex with a stripper/CSW (McAllen, Tx). I asked her if she was “clean” and she said yes that she gets tested. She refused that I use my own condom because the week before the condom broke with the person she was with and told me that we were going to use one of hers, idk if that’s some type of “I don’t trust your product, I’d feel safer if we use mine” type of thing, kind of gives me a sensation that she does care about her sexual health? Anyways Panicked, The next day Monday I went to the dr, he prescribed to me Emtricitabine and Tenofovir Disoproxil Fumarate tablets 200mg/300mg, I started overthinking and google stated that I should have been prescribed a third medication to go along with it, so I went to the ER that same day and the Physician Assistant stated that her up to date literature recommended the same medication for my episode, no additional medication was necessary. My questions are as follows.

1.) what is the risk I might have contracted hiv from this single encounter?

2.) based on your years of experience, should I stop taking the medication?

3.) when should I test in order to get a conclusive result? Should I even test? Or should I just move on (My dr offers 4th gen test)

4.) as I was reading on the questions you’ve answered from other people, Dr. Handsfield stated that HIV is hard to transmit, for education purposes can you please elaborate on this?

H. Hunter Handsfield, MD

1 months ago

Welcome back to the forum. Thank you for your continuing confidence in our services.

Glancing at your previous questions, it seems likely you over-estimate the chance of HIV from exposures that have little or no risk. In the US, female to male transmission of HIV is very rare, even with entirely unprotected vaginal sex. I would be very surprised to learn the risk is high in the part of the country where this event occurred. In addition, it is quite peculiar to recommend post exposure prophylaxis (PEP) following a condom protected exposure. I also disagree that a sex worker insisting on her own condom indicates reduced condom effectiveness: the vast majority of sex workers insist on effective and reliable condoms. That she may have trusted her own condom more than yours does not imply reduced safety; if anything, the opposite probably is true.

Did the doctor you say active recommend PEP or did you insist on it despite their advice? If so, I'm not necessarily criticizing you doctor: perhaps s/he has information about the frequency of new HIV in your situation. But you might discuss it again with them.

The newer 3-drug PEP regimens are only slightly better than the 2-drug treatments. I agree with the PA you saw at your second visit that there was no need or reason to add another drug to your regimen.

Those comments start to cover your specific questions, but to assure no misunderstanding:

1) Your overall risk of HIV probably was under one chance in several million.

2) We never advise forum questioners to alter the treatment(s) recommended by their own doctors. You should discuss this again with the doctor who prescribed it.

3) Testing is automatic following PEP. Given your very low risk, you probably could get away without testing -- but then you probably would continue to worry and wonder about it. So I advise you to follow your doctor's advice on this. Usually a single AgAb test (i.e. 4th generation) about 6 weeks after the last dose of PEP is advised.

4) Calculating the exact risk depends on lots of assumptions. In this case, I have no way to judge whether HIV might be especially common in female CSWs in your geographic area. But if we assume average risk, the chance she was infected probably was under 1 in a thousand. If a female partner has untreated HIV, her male partner probably has under 1 chance in 2,000 of catching it. And condoms can be considered 99% effective. These odds would translate into an overall risk of one chance in 200 million that you were infected.

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

HHH, MD

---

1 months ago

Thanks for the reply. My dr didn’t insist in it, he kinda just prescribed it as a precaution/ calm my worry I would say? He simply said Emtricitabine and Tenofovir Disoproxil Fumarate tablets 200mg/300mg is used for (Prep) but would work equally for (PEP) to take it for 28 days and after I should be okay, to test in 2 weeks.

Upon reading online some drs would say that being in said medication following my episode, would be the same as walking down the stairs with a football helmet on? Should I be even worried? What’s your take?

In your experience, what SHOULD I really test for following this episode?

When do symptoms of infection usually start? In my case it’s been one week since this episode

H. Hunter Handsfield, MD

1 months ago

Sorry, but I haven't a clue about the risk of serious injury falling down a stair while wearing a helmet! And we do not provide medical care or otherwise give explicit advice. Therefore once someone is on PEP or other prescription, our only advice is to continue to follow their doctor's advice about it, including post-treatment testing. I'll just add that if somehow I were in your situation, I would not have even been tested for HIV and certainly would not have sought medical advice or PEP.

Most people with new HIV have no symptoms at all. When present, symptoms like skin rash, lymph node enlargements, fever and feeling ill typically begin 1-2 weeks after exposure.

---

1 months ago

Would it change your mind if said individual had sores/bleeding gums? Some drs would say unprotected oral is a high risk because of bleeding gums or maybe because they are on the conservative side?

And finally, should I rest assured that this was a low risk exposure and that the anxiety far outweighs the current situation?

H. Hunter Handsfield, MD

1 months ago

Of course if your partner had obvious open sores or blisters you could see on her mouth, that would make a difference. Bleeding gums would not. But clearly these things weren't present -- so aside from trying to convince me you really were at risk, what's the point?

I've answered your closing question as best I can with my statement starting with "I'll just add...."

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Repeated questions of the same type are discouraged -- in this case, HIV worries from events that everyone knows carry little or no risk. Perhaps it also will help you to know that in the 22 years of this and our preceding forum (first question in April 2014), with thousands of questions from persons worried about HIV risk, nobody has yet reported they eventually tested positive. You won't be the first. If and when it finally happens, surely it will be an obviously high risk event (think unprotected anal or vaginal sex with a known infected partner) and not an event with little or no risk.

Best wishes and stay safe.

---