[Question #4027] Unprotected vaginal and PEP

32 months ago
Dr's first of all I would like to commend you and thank you for the service you provide, it gives many of us so much comfort and keeps us sane in very worrisome times. God bless you for what you do.

Four weeks ago I had a lapse in judgement and had unprotected vaginal and oral sex with a Caucasian woman in her mid-50's that I met at a bar in Southern California, her status unknown. I am circumcised. I freaked out after the episode and got started on PEP (Truvada and Tivicay) ~66 hours after my exposure. The Dr. at the Urgent Care did not consider it was necessary, but she said ultimately it was my decision.

Today I finished my 28-day PEP treatment. My symptoms during the 4 weeks after my exposure were: a) A few canker sores that started 10 days after exposure with swollen and painful lymph nodes underneath one side of my jaw (this has been somehow normal form me when I've gotten canker sores in the past); canker sores lasts approx. 2 weeks; b) one episode of extreme diarrhea at 2 weeks; c) on-and-off mild sore throat weeks 1-4; d) on-and-off joint pain weeks 1-4; e) burning sensation in tongue/gums weeks 1-4.

After reading your many blogs, I understand that my one-time exposure was very low risk for HIV and that you would've not prescribed PEP just as the urgent care Dr. 

I already tested for all other STD's and thankfully they all came back negative.

Based on my type of exposure, the fact that I was on PEP for 28 days and based on my symptoms do you believe odds are really in my favor? (It's hard to believe at times). Now that I finished PEP what is the soonest I can test for HIV and what should that test be?
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Welcome to the Forum.  I'll be glad to comment.  I agree with the Urgent Care Physician and would not have recommended PEP either.  It is a persons choice however.  I'm glad you did not experience side effects.  None of the symptoms that you describe in any way raise concerns about HIV for me and they should not or you.  I would be flabbergasted if you were to have caught HIV from the encounter you describe after having completing your PEP.  In my opinion, there is nothing to be concerned about here.

For testing, your results will now be conclusive 6 weeks after your last day of PEP.  Having given you the "official" recommendation, let me also point out that at 4 weeks testing with a combination HIV antigen/antibody tests would detect over 99% of infections from the encounter you describe and in your case, would be essentially conclusive. 

I hope this information is helpful to you.  EWH
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32 months ago
Dr. Hook. Thank you so much for your response. It eases my worries and helps me get me through the days and weeks until I get tested. Again, I appreciate all that you do, it’s a very noble cause. 
32 months ago
Dr Hook sorry to bother you again specially after you said that in your opinion there is nothing to be concerned about.  However, my mind keeps playing the “what if game”! 

I finished PEP 15 days ago, the two symptoms that persist and keep worrying me are 1) a mild sore throat and 2) what I think is burning mouth syndrome. These two symptoms have not  gone away since basically week 1. You had said that these symptoms do not raise concerns to you about HIV  and I know  stress and anxiety are probably the culprits, but nonetheless they worry me. 

You recommended an antigen/antibody HIV test at week 4 but I was wondering if I could take an HIV RNA early detection test at this point rahter than waiting another 2 weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
These symptoms raise no concerns for me, particularly if there is no fever.  An HIV RNA test at this time would prove that your symptoms are not due to HIV and make it still more likely that you were not infected.  The problem with these tests however is that they have a higher rate of false positive results than other recommended tests and are more expensive.  Please don't worry.  EWH
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32 months ago
Dr. Hook I sincerely appreciate your response and your advice not to worry. It puts me at great ease. I will follow your recommendation and take the antigen/antibody test 4 weeks after my last PEP. Thanks again for the great service you provide. 
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Thanks for your thanks.  I'm pleased that my comments were helpful to you. Take care. EWH
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31 months ago
Dr. Hook I got the HIV antigen/antibody test done 4 weeks after my last PEP as you recommended and thankfully it came back negative.  Can I consider this conclusive and move on? 
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Yes.  Your results confirm that you did not acquire HIV from the low risk exposure you described above.  There is no reason for further testing.  You can move forward without any concern.

This is my final response your question.  As per Forum guidelines, this thread will be closed later today.  Take care.  EWH
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31 months ago
Dr. Hook thanks again for the great service you provide to society.  God bless.