[Question #2506] Risk of HIV

43 months ago
Day 0 - in a strip club engaged in 1. open mouth kiss 3 times, 2. sucked breasts and nipples
Day 2 - paniced and saw an ID doc. Doc put me on PEP at 60 hrs post exposure for 28 days. Doc assumed blood/semen in saliva of the stripper
Day 30 - completed PEP after 28 days (Truvada + Isentress)
Day 32 - did a 4th gen antigen and antibody test- result negative
Day 38 - today, still in shock and panic of getting HIV

Questiosn:
1. How likely is it to get HIV from kissing considering stripper was HIV+ and had blood/semen in her mouth?
2. I am worried that she might have a meth mouth and could have HIV in her saliva. Does this change the risk?
3. Does PEP work if taken at 60hrs?
4. Does the 4th gen test that I took after one day of completing PEP indicate something?
5. What should I do next to calm my nerves down?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to our Forum.  I will be happy to comment.  My suspicion is that your doctor does not a lot of experience in dealing with HIV risks.  If I had seen you following the encounter that you describe I would not have offered or willingly treated you with PEP.  The exposure you describe was safe sex.   HIV is not transmitted by saliva exposure, even if there is blood present in the saliva. 

My answers to your specific questions are below:
1. How likely is it to get HIV from kissing considering stripper was HIV+ and had blood/semen in her mouth?
See above, this is a no risk event.  No risk for HIV or hepatitis.

2. I am worried that she might have a meth mouth and could have HIV in her saliva. Does this change the risk?
No, this would not change my assessment or advice in any way.

3. Does PEP work if taken at 60hrs?
PEP is more effective the sooner after and exposure that it is taken and has little significant impact after 72 hours.  It is reasonable that PEP would be effective 60 hours after a high risk exposure.

4. Does the 4th gen test that I took after one day of completing PEP indicate something?
No, this is too early for a test to have much meaning.  I would suggest that you re-test in 4-6 weeks and consider results 6 weeks after completion of therapy as definitive.  Since the exposure you describe was no risk, I see no reason for concern but, since you have embarked on PEP and testing, I am confident that your future testing for this exposure will show that you did not get HIV.

5. What should I do next to calm my nerves down?
Relax.  You have nothing to worry about.  EWH
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43 months ago
Thank you Dr. Hook for the reply.

One of the reasons my doc put me on PEP was that she claimed that she has seen two cases of HIV due to kissing. I will in my next visit ask for references, unfortunately I don't have any at this time. Maybe it was her personal experience.

I know that you have way more experience in dealing with HIV than most docs, and I take your word. Having said that, my own analysis of HIV due to kissing is inconclusive, as the data is hard to come by. Because -

1. As kissing is not done in isolation, so in such a case a more riskier activity will be put as reason for HIV. 
2. And in isolated cases of kissing, people generally treat it as not a big deal, coupled with long testing times a lot can happen to attribute a HIV case to kissing. Also, a lot can happen during the long testing times.
3. Anecdotal and personal experiences are not counted as data points - so data might be lost. And CDC might not be inclined to investigate the case.
4. And I didn't find any scientific conclusive evidence to show that kissing doesn't cause it. I see that is more of an observed phenomenon that it doesn't happen - which is not scientific and the doubt persists.


Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
With all due respect to your doctor, there are NO proven cases of HIV transmitted by kissing.  The CDC and WHO have never seen or heard of such cases and unequivocally state that kissing is SAFE!!  If she has seen and proven such cases she needs to prove it for the scientific community who have studies millions of persons for HIV risk and have NEVER found kissing to transmit HIV.  I disagree with here assessment.

Irrespective, I remain confident that your tests will prove that you did not acquire HIV from the encounter that you have described.  EWH
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42 months ago
Dr Hook,

a. On my doc's advice I did 6 week post exposure test (which is 2 weeks post PEP). And she thinks this test is conclusive considering my low risk exposure. She also mentions that PEP or no PEP doesn't matter for testing 6 weeks after exposure. She then also told me to do a 4 month after exposure testing as per protocol. I am now confused.
Q. What is your advice on the matter above? I know you asked to do 6 week post PEP testing, but now I am growing impatient and tired of testing. It is affecting my personal and professional life.

b. Since my anxiety is skyrocketing I am thinking of doing a PCR (viral load) test.
Q. What do you think about getting PCR test? Will it end my anxiety and how good is this test - that is not showing false positives or negatives after 2-3 weeks post PEP?

c. I did HepC test at 6 weeks post exposure, which came back negative, and since I am vaccinated against HepB, no test was done. Though a test for HepB to see effectiveness of vaccination was done on day 2 post exposure, which was good. I am now awaiting Syphilis (blood test), throat Chlamydia (oral swab), and throat Gonorrhea (oral swab)  results 6 weeks post exposure.

I know you close the thread after 3 replies. I would request you to keep it open for me to report my outcome, and not to ask anymore questions.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
You are continuing to over react to a virtually no risk event.  

You impati nice will not change the facts.  You are not at meaningful risk for HIV, you did not need PEP,, and the fact is, the formal recommendation is that follow-up testing. After PEP should be performed six weeks after completion of PEP.  PCR tests are positive as soon as two weeks after an exposure ( or two weeks after completing PEP) but the chance of a false positive test is higher with PCR tests than other tests.

Your hepatitis C test is conclusive and your chlamydial, gonorrhea and RPR test will all be conclusive at this time as well.

This will conclude my responses to you at this time.  The thread can be kept open for another 30 days.  EWH
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42 months ago
Just for information:

1. Syphilis, throat Chlamydia and throat Gonorrhea came back negative
2. HIV RNA quantitative 16 days after completion of PEP came undetected

All these tests were done in US in a reputed lab.

Next will do 6 week post PEP test and report back. 
41 months ago
My doctor refused to do 6 weeks post PEP test, as she thinks that only test I need is 3 months post PEP (which is mid October). I am sorry I don't have any data to post at this time. I get some hope from 16 post PEP PCR RNA test being negative.
41 months ago
9 weeks post PEP did Alere HIV1/2 Ag/Ab rapid test - result negative
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
As predicted this proves that you did not get any STI, including HIV from the exposure you described.  No further testing is needed.

This thread will now be closed.  EWH
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