[Question #1931] Risk and PEP (Part 2)
92 months ago
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Dear Dr. Handsfield,
I am following up on my earlier questions
due to some developments. Since my last
post, my discharge became worse and was clear, thin, and sticky, I visited a
urologist and he asked me to take a urine PCR test for gonorrhea and
chlamydia. After that he gave me 1.5
grams of zithro and 600 mg cefixime which I took last Monday night. I just got the results today and gonorrhea is
negative but they said they need to retest chlamydia and will not be able to
give me the results for a week (never heard of this test taking so long).
Now, from your earlier threads I understand
chlamydia is impossible to get from oral sex and NGU is also very unlikely from
oral sex, so I am assuming that the condom must have slipped off and I
continued to have unprotected vaginal sex for a few minutes as that would be
the only way for me to have chlamydia or NGU.
This makes me more anxious for HIV.
I managed to track down the first csw and
made her take an HIV duo and pcr and both were negative. So, my hope is that the unprotected sex
happened with her and not the second csw (who I am very worried about as she suggested
for me to use 2 condoms, and the person in charge of the brothel refused to let
me take her for a medical even though I offered him a lot more money than the
cost of the csw).
So given these new developments:
1.
Looks like the 2 gm zithro I
took a week before the incident may have been ineffective (is that even
possible? – i.e. perhaps there was not enough zithro left in system after 1
week ).
2.
I still have some symptoms (though
much less) about 6 days post medication.
Should I consider switching to doxy or take a test of cure first (and
when)?
3.
What are the statistical odds
of chlamydia transmission from female to male for vaginal sex?
4.
If the csw had chlamydia and
HIV, would the chlamydia make her more infectious for HIV (i.e. would it
increase my risk)? I have read that this
is the case.
5.
I am still continuing PEP as I
feel that already 2 weeks are over so I may as well do everything possible to
have a favourable outcome. Based on the
new developments, would you still feel PEP was not warranted?
6.
Based on the new developments,
what would you estimate my risk of acquiring HIV to be (with and without PEP)?
7.
Do you think doing a duo 2
weeks after PEP is over is worth it? I
know guidelines say to wait until 3 months post exposure, but do you really
think I can take a duo earlier than that with some confidence?
Thanks!
Edward W. Hook M.D.
92 months ago
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1. Looks like the 2 gm zithro I took a week before the incident may have been ineffective (is that even possible? – i.e. perhaps there was not enough zithro left in system after 1 week ).
See above. This may not be an STI. sometimes following an encounter that persons feel worried about there is an increased tendency to notice nomal genital secretions which can vary in amount. If this were an STI, I would anticipate the medication you took to improve this and the fact that it has not further suggests that this is not an STI.
2. I still have some symptoms (though much less) about 6 days post medication. Should I consider switching to doxy or take a test of cure first (and when)?
See above. Further evaluation should include a test (preferably a gram stain of secretions obtained with a swab) of the discharge looking for white blood cells. If there are no white blood cells this is unlikely to be an STI. If I were going to treat this further (based on test results) I would use moxifloxacin for a7-10 days.
3. What are the statistical odds of chlamydia transmission from female to male for vaginal sex?
There are no firm data however estimates suggest that a male exposed to in infected sex partner has about a 20% (1 in 5) chance of getting an STI from a single episode on unprotected penile-vaginal sex.
4. If the csw had chlamydia and HIV, would the chlamydia make her more infectious for HIV (i.e. would it increase my risk)? I have read that this is the case.
You are getting into "what if" questions- try not to. Estimates are that like other STIs, the presence of chlamydia in an HIV infected person would increase the risk for HIV transmission by 2-3 fold.
5. I am still continuing PEP as I feel that already 2 weeks are over so I may as well do everything possible to have a favourable outcome. Based on the new developments, would you still feel PEP was not warranted?
As Dr. Handsfield indicated, PEP is a personal choice. Having started it, I see little reason for stopping it unless you are having bad side effects.
6. Based on the new developments, what would you estimate my risk of acquiring HIV to be (with and without PEP)?
Another "what if" question. Like Dr. Handsfield, I would not be worried about your risk for HIV. The fact that you have now proven that at least one of your CSW partners did not have HIV makes me still more confident that you did not get HIV from the exposures you have described.
7. Do you think doing a duo 2 weeks after PEP is over is worth it? I know guidelines say to wait until 3 months post exposure, but do you really think I can take a duo earlier than that with some confidence?
I see no reason not to test 2 weeks after completion of PEP as I sense it might help your anxiety but I would not call your results strongly suggestive until testing 4 weeks after completion of PEP.
91 months ago
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Edward W. Hook M.D.
91 months ago
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91 months ago
|
Edward W. Hook M.D.
91 months ago
|