[Question #2846] Hiv follow up question

42 months ago
I am following up on a previous question:

1.  On August 6, I had protected oral and vaginal intercourse with a csw. Status unknown.

2.  On September 11, I had a mutual masturbation encounter with a ts csw.  She masturbated herself and ejaculated on her stomach.  Soon after I touched the ejaculatory fluid and masturbated myself.  Some of the fluid touched a small cut (2mm/1mm) cut on my finger that was bleeding 2 hours prior. 

3.  After the encounter, on September 11th I grew anxious and went to the hospital and got on PEP.  Before putting me on PEP they tested me using a 4th generation it was negative,

4.  I recently finished PEP, and was tested again using a 4th generation on October 11th  and it was negative,

5.  Would the 4th generation test on September 11th (37 days past exposure) have picked up any Risk from the incident on August 6?

6.  Would the 4th generation test on October 11th (67 days past exposure) picked up any risk from the incident on August 6?  Would the PEP from the September 11th have of effected this in anyway.

7.  Can conclusively rule out any risk from the August 6 incident?

8.  What do u think my overall risk from
Both incidents is.

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome back. You have apparently changed your sign-in, i.e. username and/or the email address used for your previous question(s). Please provide that information, or the number(s) and date(s) of your previous question(s), so I can find your previous thread(s) and respond more accurately to this one.

Thanks--  HHH, MD
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42 months ago
It was question 2699-  cut
42 months ago
Hello?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Patience, please. The moderators generally are online once or twice a day, but not 24/7.

Perhaps your previous thread was deleted at your request. Because one of the forum's man purposes is education of readers other than those who post questions, generally we don't do that unless there was an obvious confidentialiity problem, e.g. including identifying information by mistake. I don't see that sort of problem this time, so you should expect this thread to remain.

1-4) In the US, the large majority of female sex workers do not have HIV -- on average, under 1% and in most areas of the country, under 1 in a thousand. So the first exposure would have been low risk for HIV even without conddoms. (And oral sex is zero risk anyway. There has never been a proved case of HIV transmission mouth to penis.) As for the second encounter, mutual masturbation -- i.e. hand-genital contact, fingering, etc -- are no risk for HIV or any other STD. You did not need PEP on account of that exposure, and in my opinion the doctor you saw should not have prescribed it (assuming you described the exposure as you have here). Had you come to my clinic, we would not have given you PEP.

Taking PEP would not have prevYour negative However, now that you have had PEP, you'll need to wait until 3 months after the second exposure for valid testing. That's one of the downsides of PEP, and one of the main reasons it should not be used except for truly high risk exposures. There is a possibility that if PEP fails to prevent HIV, it could delay the time to positive testing, and most experts recommend that a 4th generation (antigen-antibody) test be done at 3 months in this circumstance. 

5-7) It takes up to 6 weeks for the antigen-antibody (4th generation) tests to become positive, so the Sept 11 test was a bit early. (We used to advise 4 weeks, but new data now suggests that on rare occasions it takes up to 6 weeks.) The October 11 test probably was conclusive, but we don't really know for sure if PEP taken 4+ weeks after exposure might on rare occasions continue to delay the window period.

8) Your "overall risk" of HIV was zero, even before PEP. As implied above, the only effect of PEP in this case is to delay the time to conclusive testing. Be very clear:  I don't think testing is necessary at all, and if somehow I were in your situation, I would not be tested (and certainly would not have sought PEP). However, your questions suggest you are going to need conclusive testing to move beyond all this -- i.e. that my reassurance alone may not be sufficient. So if you would like the security of conclusive testing, I suggest you have another 4th generation test 3 months after the second exposure, i.e. around December 11. You definitely can expect a negative result, so stay mellow in the meantime.

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

HHH, MD

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