[Question #1980] Is further testing warranted ? Only insertive oral exposure

46 months ago

Dear Doctor

Thank you for this website. My wife and i have held on to this website as our guide through what has turned out to be the toughest time of our lives. Both of us are 29 years old and look towards you for guidance. Please forgive us if we ask too many questions . we are scared and we need some answers  

For your information - i have posted two questions before this which were very kindly answered - however i have a few clarifications.

 

My situation - I was in Switzerland for work for a company that I founded with my wife . I completed a very large deal and my colleagues took me to a strip club. It was my first and only time iv been to a strip club. Under peer pressure I was taken for a "lap dance " behind a curtain. I said no many times but ultimately I thought how bad can a lap dance get behind a curtain. I was slightly drunk and ended up with insertive oral exposure of about 30 seconds and deep kissing of 20 seconds. I stopped the lady (from slovakia) and immediately went to the emergency hospital in Switzerland. I saw a small cut on my penis. Doctor at hospital said no need for peps. But 27 hours later - out of fear , guilt and Lack of knowledge i started peps triple therapy. Today is day 21 and we are back in India. There is an obvious lack of HIV specialists here and we have access to no one.

 

My questions are –

1. Doctor Hunter mentioned i didnt have a real risk  from insertive oral and he felt it was okay to stop the peps.  It was about day 15 when I posted this question and when he mentioned that do another hiv test and a syphilis test in a couple of weeks and then I can put this behind me. Considering the very low risk of Insertive oral can I do a test 4 weeks post exposure and put this behind me ? My local doctor says I can do this test at day 28 and if it is negative I can forget this entire chapter but I would really appreciate your opinion as you have more experience with HIV than my doctor back in India . I dont have the courage anymore to go through another 28 days after the first 4 weeks. Its been like torture for meI know i should have been strong and said no to the lap dance and to the lady but it all happened quickly and before i stopped her - half a minute had gone by .My wife and i are racked with tension( i told her everything)  and want to go on with our lives . If i had known this I would never have started my pep. Do you think a test at 4 weeks post exposure and on the day of ending my PEP (considering only risk is insertive oral)  is enough for me to forget about this ?

2. Doctor Hunter also mentioned on the same post that I can take a syphilis test in a couple of weeks . Iv decided to do a test at 4 weeks post exposure – which one should it be – VDRL or TPHA ? These are the only two available here. Which one is better to take at week 3 ?  Why week 4?  Because I would like to be able to kiss my wife and once again have sex with my wife . It will help us move on

 

3. I have tested negative for Chlymadia and Gonorrhea on day 10

What would you advise a friend who has had insertive oral exposure and kissing as an exposure, and told his wife ? Can I now kiss and have unprotected sex with my wife  . Should I wait for the test at 4 weeks post exposure ?

How long before I can be normal with my wife?

Sorry to ask for questions again and again but your answers help me very much and I really respect you doctors . Please help me with your answers . Iv suffered so much mental anxiety, my wife is very stressed and helpless, my work has nose dived. Please. 

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
I'm sorry you felt the need to return to our site for additional advice related to the NO RISK for HIV/VERY LOW RISK for STI encounter that you experienced three weeks ago. 

1.  Both Dr. Handsfield and I have told you that there was no need for PEP and hence, it is logical that there was no need for testing either.  Whenever you test for HIV in relationship to the exposure you have repeatedly described, your test will be negative because there was no risk for infection to start with.  Had you been exposed the recommended time for testing following completion of PEP for a known exposure is at 4 weeks and again at 3 months following completion of PEP.  As I have said above, in your case this is irrelevant since there was no risk to start with.  I think you should have forgotten about the entire exposure and move on without concern some time ago.

2.  Likewise your risk for syphilis is very, very low.  At 4 weeks you should start with a VDRL test.  If that is positive (I doubt that it will be) you will then need a TPHA test for purposes of confirmation to make sure that the positive test result was not falsely positive. 

3.  Your tests for gonorrhea and chlamydia were definitive at time they were taken.

There is no reason for you to not normally kiss and have unprotected sex with your wife.  You did not get an STI from the exposure you described.  You need to put this behind you and move on.  EWH

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46 months ago
Thank you for this doctor.

My wife and i have decided to follow your advise.  No required testing for HiV as no risk. 

On day 28 - I will test for Vdrl. If negative - can i put this episode behind me ? 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
I think the decision you and your wife had made is a good one.  I endorse it.  You have made the right decision.

Yes, if your VDRL is negative at 28 days and you had not developed a lesion at a site of exposure (I am confident that you will not), then you should consider this proof that you did not acquire syphilis and move forward without concern.  Take care.  EWH
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46 months ago

Dear Doctor 

Today is day 28. The last 4 weeks have been a nightmare for my wife and myself. 

I tested negative in my VDRL test on day 28 . I dont have any lesions .  As mentioned by you i am considering this as proof and moving on from my syphilis fears.

As advised by you - i was at no risk for HIV . No need for peps either even though i had foolishly started it under great fear and anxiety. I stopped it as advised by you and Doctor Hunter. ( gathered enough courage after 27 days ) . With the VDRL test i also took a duo hiv test which was negative.

I know the above test after reading cdc guidelines is conclusive only when checked three months later but since you had mentioned that hiv testing wasnt even warranted for this single episode- iv decided to completely move on and forget about this incident. 

1. I hope that i have your blessing / approval on my decision. In the end ofcourse i understand it is my decision alone.

2. I want to move on from this incident but i also want to give back to society. This incident has also shown me that health is the greatest wealth. I am fortunate enough to be a CEO of a luxury company. I would like to donate to prevent / cure other people and bring them back to health. This incident has opened my eyes. Is there a way that I can donate to your company ? Who would be the right person to speak to. I want to join the fight to find a cure.












Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
1.  I do agree with your decision, time for you to move forward.  All is well and you have not suffered infectious consequences of the unexpected exposure you described. 
2.  If you wish to support the work that we and others do in the field of sexual health, I would suggest you contact The American Sexual Health Association (AHSA) and  the CEO, Ms. Lynn Barclay.  They can be reached through an internet search.

I'm pleased that you found the information provided helpful and than you for your thanks.  I wish you well.  It is now time for me to move on as well.  This thread will be closed later today.  Take care.  EWH
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