[Question #4951] Unprotected insertive fellatio.........PEP a mistake

26 months ago
At the outset, I would say that I have severe anxiety/OCD with HIV. I have seen my cousin die with this disease. I am EXTREMLY careful with my sexual life. I NEVER get intimate with anyone, unprotected or otherwise, without being mutually tested for HIV.  I am 45 years, uncircumcised.

I went to an escort and asked for a massage with handjob/happy ending. I explicitly stated that DON'T give me a blowjob. However, in the middle of giving me a handjob, I noticed her doing exactly that, blowjob, unprotected. I immediately stopped her. She must had my penis in her mouth for about 10 seconds. Then she continued with handjob (pretty rough at times with her saliva all over my penis) until completion. I didn't check if there was blood on my penis or in her saliva.

I got VERY anxious. I went to the ER. The doctor offered me PEP and I decided to go for it. They recorded the case "sexual assault". I realized that is exactly how I felt. Assaulted and violated. I took the first dose within 36 hours. Tivicay 50 mg and Descovy 200mg/25mg.

I then came on this forum to educate myself. I was here earlier about 2 months ago but for another situation. After reading up a little, I realized that there is no realistic chance that I might be at risk for HIV. So I decided to stop taking the medication.

The next day, I actually called up the escort and took her out on a date. I discussed with her the HIV situation and asked if she had been tested. She said she had never been. She (and I) freaked out. She agreed to test. I bought her a HIV 4th generation and HIV RNA package. She tested exactly a week after our incidence and came out negative. I asked her dental health and she said that she bleeds everytime she brushes her teeth.

My logical mind tells me that I should be fine. I notice that you do not even recommend testing in such situations. I discontinued PEP, and I have been relatively mellow all this time. This is how far my logical mind can take me. I would want to test and put this behind me asap. So my questions are:

1] I know taking PEP medication prolongs the duration for conclusivity of test results. I took PEP for 1 day. I am at 18 days after incidence. Would RNA be as conclusive as it would be at 14 days in my case if I go and get tested now.
2] For combination of RNA and combo test, I have read on this forum that combo should be taken 4 weeks or later. In my case, this needs be delayed by what time? Assuming I go for RNA now.
3] If I decide to just take the combo at 6 weeks, how much do I need to delay this test to account for the PEP I took?
4] Once the RNA test is +ve, does it ever turn -ve once the immune system kick in. In other words, if you test with RNA a little too late (maybe 20 days out, for example), would it turn negative even if someone is infected?
4] Finally, one may theorize that the girl might be in window period for the combo test when tested and came back negative. However, if the girl was infectious during my encounter, is there a realistic chance that she would come back negative on an HIV RNA 7 days after the incidence? Is is at all possible, theoretically/practically. Doesn't this itself put me in the clear?

I really appreciate your advice.
26 months ago
If I just do RNA now 18 days after the event, can this test be conclusive in itself if it comes out negative........Thanks so much, I really feel VERY grateful
26 months ago
BTW, I find a couple of lymph nodes to be swollen around my neck. I am not checking and looking for any more, so I don't know. There was some pain in my knee while walking when I woke up today. Other than that, so far so good.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome back to the Forum although I must say, I am sad to see that you felt he need to return.  Your OCD has lead you to make a series of bad decisions.  Receipt of oral sex is a no risk event for HIV and you proved that the masseuse was not infected with HIV and therefore could not have transmitted infection to you.  No PEP was needed, nor was any testing.  Worrying about when results will be "conclusive" is a waste of time as there was no risk to worry about.  

In answer to your specific questions:
1.  See above.  You did not need testing.  One day of PEP is unlikely to change your results  Believe them.
2.  There is no need for testing at all. much less any reason to delay testing.
3.  See answer to no. 2 above.
4.  Once an RNA test is positive, it will remain positive from then all in persons who are not taking therapy for HIV.
5. Yes, the girls test results DO put you in the clear.

Your worries are similar to you worrying about whether or not you could be pregnant- you were not exposed and have no reason to worry.  You do not need further testing, you do need to see someone to help you with your OCD.  I hope my direct comments are helpful. That is my intent.  EWH

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25 months ago
I felt very reassured after your reply and am out of my concern phase and am not going to test. I have been able to simply move on.........thanks! I do have a couple of general questions though and would appreciate your response.

1] I am in a phase of my life where I don't want to do traditional dating for a while. I found sugar dating and I am with a girl a few months and it is working out well. We both are happy. Going forward though, if and when this girl moves on, I want to make sure that the next girl is free from HIV and everything else before I get intimate. My approach is that neither of us know each other well enough to either trust or not trust each other. So I am thinking that we would both get tested for everything including HIV (combo test for HIV) when we meet. Assuming that we both are negative on everything, there is still a chance that one may be in the window period for HIV. So then I would ask that the girl tests on HIV RNA 14 days after the initial test. So once she is in the negative on this too, this should be conclusive that she is in the clear and I may have unprotected sexual relationship going forward. Is my thinking right? Does this testing plan assure that she is in the clear without any doubt whatsoever as far as HIV 1 is concerned from theoretical and practical perspective? I am not going to worry about HIV 2.

2] This is a very generic question out of curiosity. I understand that the sooner HIV is diagnosed, the better are the outcomes for treatment. The combo test makes one wait till 6 weeks for conclusive result. Much better than the previous 3 months. But I suppose if it may be further shortned, it might be preferable. From this perspective, do you think in the future RNA might become the standard? As technology moves, this test might get cost competitive with the combo test. And as more and more people get tested using this and solid data accumulates to develop confidence in the results, could this happen? Have you ever seen/heard/read of any instance where if one tests after a sufficiently long period of time after exposure using this test (which it seems is 14 days based on what I read on the forum) and comes out negative, then such person later turns positive on a combo test after 6 weeks? I know this test deals only with HIV 1, but at least for HIV 1 it may become the standard and they might come up with another test for HIV 2 as well. I am curious on what your thought are on this.

Thanks to you both for this wonderful forum.
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
1.  Good plan.  The only question is whether or not she will have other partners after testing.  If this is a possibility, condoms should still be part of the interactions.  Personally, if she is negative on a combination HIV test, the chance that she is in the window period and might have a positive HIV RNA test soon after is so low that I would not worry about it.  Y
2.  The RNA test does become positive earlier but the time difference between a positive test at 2-4 weeks and at six weeks will not make a significant impact on the benefits of early therapy.  further, I should point out hat the combination HIV antigen/antibody tests are more than 99% conclusive at 4 weeks and the proportion of additional positive tests that come up after that are a small proportion of 1%.

Hope this helps.  EWH
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24 months ago
Reading your words, I am seriously considering using condoms in my current relationship with my sugar baby. Not that I don't trust her; she says she is not seeing anybody other than me. Just thinking of condoms out of abundance of caution. However, she is allergic to latex condoms. Are non-latex condoms as effective as regular ones, in terms of strength/reliability and protection against HIV transmission? Are there specific non-latex condoms you may recommend for equivalent protection against HIV?

One last question: My oral thrush lasted for a while before it was effectively cured; probably around 3 months. As a result, my doctor says I have developed dry mouth/tongue. Does this mean that my mucosa is compromised in some way and my saliva is not sufficient or somehow not effective enough so as to put me at increased risk with cunnilingus, anilingus and deep french kissing in terms of HIV risk? If I understood everything relevant on this forum correctly, I don't think this may increase my risk as these are no risk activities. However, I would appreciate your advice. FYI, I came out negative on my routine HIV test.

I understand this is my last question. Thanks for everything. I really appreciate it.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Given your fears and concerns, condoms at least initially make good sense.  There are a number of non-latex, non-natural lambskin condoms many of which are made of polyurethane, polyethylene and other synthetic materials were are as strong, if not stronger than latex and no less sensitive.  We do not recommend specific brands.

You are correct, your residual dry mouth does not increase your risk for infection or other problems related to vulnerability to infection.

Glad to hear, but not surprised about your negative test.

As you point out, this will complete this thread.  It will be closed shortly. Take care. EWH
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