Hiv convern . Please help me - ready to pay

Dear Doctors

I have read most of your posts and really respect your view. I have committed a big mistake and your opinion would really help me decide what to do next. I am married and i went to switzerland for work

I went to a strip club with colleagues who paid for a lap dance for me.  I ended up recieving a blowjob without condom for less than 30 seconds . I stopped her and walked out of there because of the guilt and fear. 27 hours later i saw a small cut on my penis probably caused by her nails or teeth. 

I went to the local emergency and started pep 27 hours post exposure even though the emergency doctor said im being foolish.

Its been less than 10 days but im now experiencing a huge panic wave. Im very worried and completely unable to sleep or even do simple things like walk or eat because of the worry. On day 8 i got myself tested for VDRL(blood), Chlymadia(urine) and gonorrhoea(urine). These came negative. 

Iv had the HSV 1 virus ( antibodies present) and had cold sores on my lips before but NOT at the time of the exposure. I didnt have any genital herpes or hsv 2( no antibodies) 

I want to know what are my risks for hiv ?

What is the likelyhood of aquiring Hsv 2 or HPV  or syphillus?

Can i stop my PEP - The side effects are terrible. 

Please help me. If there is any way i can donate money or pay for your opinion: I will gladly do that .

Please 

Warm regards

Pranav Saboo

I agree with the doctor you saw about PEP. The risk was too low and you should not have insisted on that treatment. There has never been a proved case of HIV being transmitted mouth to penis, so you were not at risk for HIV. Had you come to my clinic, we would have refused to treat you, no matter how strongly you insisted on it. You probably should stop taking it. However, we do not provide direct medical advice and you should discuss this with the doctor who treated you. Stop taking PEP only if s/he agrees you should do so.

As for other STDs, the risk also was low. Your negative tests for gonorrhea and chlamydia prove you did not catch either of them. The chance of syphilis is also near zero, because syphilis is very rare in heterosexual women in western Europe, including Switzerland. However, you'll need another syphilis blood test after 6 weeks to be 100% certain about it. HPV might sometimes be acquired by oral sex, but only rarely. Anyway, assuming you have had vaginal sex in the past, you can assume you have had HPV -- everybody gets it. Your risk is no higher on account of this particular event. Finally, HSV2 is not transmitted by oral sex, or only very rarely -- so  you are not at risk for that problem from this event.

It seems clear you are reacting emotionally to a sexual exposure and decision you regret. Deal with that aspect as you need to -- perhaps with professional counseling if your fears continue. But do not confuse your guilt and shame with infection risk from the event. They are not the same, and oral sex is safe sex.

Bottom lines:  1) Check back with the emergency doctor about stopping PEP; or if they referred you to another doctor for follow-up, check with that doctor. Probably OK for you to stop it, but don't do it only based on my advice. 2) Have another syphilis blood test and an HIV blood test in a few weeks. I recommend both not because I believe you were at any risk; I do not. I recommend them only for reassurance you will get from the negative results.

Thanks for your offer to donate. You have already done that with your posting fee. If you find this advice valuable and would like to make another contribution to ASHA's sexual health mission, that would be very welcome. If so, visit www.ashasexualhealth.org.

I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for your reply . 

A final question that i have i noticed inside my Meatus (inside - not outside the opening of the penis ) - is a small red circle which looks like a nerve. It could be a nerve or it could even be a wart. Since i am HSV 1 positive (hsv2 negative ) - is it possible that this is a genital wart . It has been there for over 6 months because i remember seeing it about 6-9 months ago as well. It may have been there for years but i only looked at my penis in detail about 9 months ago when i remember some pain which cleared up on its own . 

Thank you so much for taking out the time for my worries. i really appreciate it . 

Thanks for the thanks. I'm glad to have helped.

So i took your advise and went to the doctor and showed him the mark . Its just a blood vessel and nothing to worry about.

He said its up to you if you want to stop the PEP.

My only clarification is - i had a cut on my penis - a small cut that i found after the oral exposure. I had asked in my original question as well but i assume you didnt mention it because it doesnt matter ?

Does this cut ( it wasnt bleeding profusely but there was like a drop of blood when i squeezed it) increase my risk of hiv ? 

If it doesnt i will stop my pep. 

Also why does the cdc recommend testing 6 weeks after exposure in case of pep ? How accurate is this test - 80 percent ? 85 percent?

IF you had a FRESH, STILL BLEEDING "cut" on your penis, during the exposure, it MIGHT have SLIGHTLY raised the risk of catching HIV. But since oral sex carries almost no risk anyway, any elevation in that risk would be meaningless. I don't think this is a signficant consideration in whether or not you continue PEP.

CDC and other government agencies tend to take conservative stances on such things as time to conclusive HIV testing. With a 4th generation HIV test, 4 weeks is enough. However, taking PEP might delay the time to conclusive testing, and most experts would recommend that since you have taken it, you should wait until 3 months for a conclusive result. This is an important reason that PEP should be used with care. It prolongs the period of anxiety until conclusive testing can be done, to 3 months instead of 4 weeks. Don't misunderstand:  testing probably remains 100% valid 4 weeks after stopping PEP. However, we just don't know for sure, so a 3 month test also is recommended just to be safe.