[Question #4061] Vaginal fluids in Penis opening/PEP

30 months ago
One night stand with woman who stole money from me while I was in shower. I assume she was a prostitute.  light kissing. Then she fingered herself and repeatedly licked her fingers then five minutes later she spit on the top of my penis to give handjob. No other contact. No knowledge whether she was HIV positive. In high risk area of the southern us. Went to ER and they gave me PEP because they said it falls into mucotaneous contact. They said higher exposure than vaginal sex. Specific questions: is HIV transmitted by spitting vaginal fluids onto head of penis? How effective is the truvada and tivicay taken within 19 hours of exposure? I've heard many different answers from Drs on each of these topics. I am seeing an infectious disease specialist soon. Please help.
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome to the Forum.  I'll be glad to comment. The doctors you saw over reacted following what was a no risk encounter.  HIV is not transmitted through kissing and no one has EVER been proven to become infected through contact with saliva or masturbation, even when saliva is used as a lubricant for masturbation and even when genital secretions are spread around (even to the genitals) during the course of masturbation- no ever even though people have been looking.  While PEP is a personal choice, had you asked me for it I would have declined to prescribe it.  I am confident that the ID specialist you speak with will tell you the same thing.  Feel free to share my opinion with him/her as I too am an ID specialist.

As far as PEP effectiveness is concerned, the sooner it is started, the more effective it is.  Thus, even if you had been meaningfully exposed (you were not) the PEP would have been highly effective, reducing you risk for infect somewhere in the range of 95%.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
I just noted, this question is a repeat of your earlier question.  Repeating the question will not change the answer and if you were looking for comments from Dr. Handsfield' s comments,  I can assure that his answer would be precisely the same.  I hope you will get over your misplaced concerns and move forward.  EWH
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30 months ago
Thank you. I was not looking for the other Drs opinion as I'm sure you're both very accomplished. The reason for this question is that in #3 of your response to my previous question, it noted the mucousal areas of the penis are far more susceptible than the surface of the penis. But my concern is that indeed vaginal fluids did come in contact with the mucousal areas when directly spat upon. Does #3 matter on my situation? I assume not, particularly due to fragility of the virus, the biological complexities I do not understand, and the benefit of loss of infectivity upon transfer. Please confirm. As a follow-up can you comment on studies widely available on the net that do find at least some correlation between fellatio and HIV? Do you believe in this risk?
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
You are correct.  Whatever saliva might have contacted your urethral mucosa would not put you at risk for the reasons you have mentioned.

Widely available on the net does not mean accurate.  Much of our time on this Forum is spent correcting misinformation found on the net which is out of date, taken out of context or just plain wrong.  Acquisition of HIV from performance of fellatio is well documented but extraordinarily rare making it hard to assemble sufficient numbers of cases to determine much beyond the fact that it does rarely occur - the estimated risk of infection from a single exposure in which unprotected fellatio is performed on an infected person who is not on treatment is less than 1 infection per 10,000 acts of fellatio (like performing fellatio on an infected person once a day for over 27 years).  In contrast, there are no credible reports of receipt of fellatio leading to acquisition of HIV.  If you have a link to one report that you'd like me to look at I will provide a brief comment.  EWH
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30 months ago
Thank you I'm satisfied with your response to the fellatio question. In regards to the 95 percent or thereabouts effectiveness of pep, I'm reading that there was an observational study of healthcare workers who were pricked w needles, the effectiveness was 81 percent. Study was by cardo dm, Culver dh, et Al, A case controlled study of HIV serocon version in healthcare workers after percutaneous exposure. Is there better or more recent evidence than this study?
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
The are good points and bad about studies of the effectiveness of PEP.  The best situations for documenting who is known to have been exposed are persons who have had a needle stick from an infected person.  The problem with using these data however is that a needle stick is a far more direct and biologically effective means of transmitting HIV than sexual transmission.  Thus, it is probable that PEP for sexual transmission is more effective than PEP for needle stick exposures.

This is my 4th reply to your questions.  We typically allow three replies for each client's questions.  Thus, as per Forum Guidelines this thread will be closed shortly.  Take care and please don't worry.  EWH
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