[Question #5120] Risk assessment

25 months ago
I had an encounter with a transsexual escort about 24 hours ago.  She/he penetrated me for a few minutes while wearing a condom.  I checked and the condom did not break.  What worries me tremendously is that I gave oral sex while deep throating for maybe 5 minutes.  There was no ejaculation and if there was precum, it wasn't much.  I had a small blister on my lip.   I'm a nervous wreck.  I have slight sore throat and having chills which I realize could be anxiety related.  If you recommend testing, what else should I test for besides HIV?  Would you recommend Prep in this scenario?   Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Welcome to the Forum. I'll do my best to help by providing some facts and figures. The exposure you describe was low risk.  Ideally you should see if you can find out the HIV status of your partner.  While HIV is relatively common among transsexual women, the majority are not infected.  Did you ask your partner about her status?  Can you reach her?

Even if you cannot determine her HIV status, the exposure you describe was low risk.  Condoms are highly effective for preventing HIV acquisition and it sounds like your condom worked well and did not break.   That leaves the unprotected oral exposure.  HIV is only very rarely transmitted to persons performing oral sex on an infected person.  Current estimates suggest hat, if your partner had untreated HIV, your risk for infection would be about 1 infection for every 10,000 sex acts.  (I should add that, in answer to your question, the pre-ejaculate does have HIV in it).  

As for your symptoms, this is too early following exposure for your symptoms to be due to HIV.  

Considering the low risk for infection and the fact that you do not know your partner's HIV status, you will need to decide whether or not you want to seek PEP or not.  This is a personal decision.  PEP is typically well tolerated but it is also expensive and may have modest side effects for some people.  I hope the information I have provided will help you in your consideration of what to do.  If you choose to start PEP, the sooner you do it, the more effective it is believed to be.  There is no clear benefit from starting PEP if 72 hours have passed since the exposure.  EWH
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25 months ago
I asked her a couple of times and she said she has "nothing."   I know it's a personal decision but from a rational standpoint, would you do PEP?  
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Great, I'm glad you asked.  It would be good to have more detail like when was the last time you were tested but this is helpful.  Personally, I would not but again, this is something that only you can decide.  EWH---
24 months ago
Dr., how reassuring is it that I didn't have any symptoms for 3-4 weeks?  Given that my risk was low would you still recommend testing for hiv and other stds?
thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
STIs can be asymptomatic but your risk for infection is low.  The decision about testing is a personal one.  personally, I would not be worried.

This is my 3rd reply to your questions.  Thus, as per Forum Guidelines, this thread will be closed shortly without further replies.  I hope the information I have provided has been helpful and will allow you to move forward without concern.  EWH
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