[Question #5926] Protected sex asian massage parlor and PEP. Hiv risk?

17 months ago
I made the worst mistake of my life on july 14. I went to an asian massage parlor and had the first sex of my life. The lady put condom with her mouth after I was hard. She was on top of me for about 4 minutes and after I was done, she removed the condom with a tissue and wiped me with a wet towel. I was worried since then that I might get hiv. 

I went a physician and got PEP and started using it from 60hours post the session. I got tests done at 10 days and tested negative for all Stds including hiv. Also, one week after the incident (i am uncircumcised), my glans had a rash and it gets very red on contact with water even now.  Could it be something?

I completed PEP on aug 13. One week after completing PEP, I have some mild pain in my right knee and thigh and feeling weak. 

Please help me if I have Hiv risk. I am growing very anxious and could not sleep at night. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your question.

You and your physician overreacted. This exposure was not nearly high enough risk to warrant PEP, unless your partner was known to be infected, or if it occurred in an area (or at an establishmen) known to have a particularly high chance of having HIV. The vast majority of women like your partner do not have HIV. And condom protected sex is entirely safe. If you had come to my clinic requesting PEP, it would have been refused. I say all this not to lecture your -- sorry if it seems that way -- but as a way of emphasizing that there was no risk of HIV from the events described.

Irritation under the foreskin is very common in uncircumcised men. It is conceivable you acquired a yeast infection during the sexual event, but probably not. In any case, it doesn't sound like an STD and certainly nothing to do with HIV. Same for your leg pain and feeling weak.

Having had anti-HIV PEP, however unnecessary, you should now follow the advice of the doctor who treated you about follow-up testing. Without PEP, you could have had a conclusive HIV test 6 weeks after the event, but PEP might prolong the time to test positivity if it doesn't work. Therefore, most experts recommend testing at 3 months (and sometimes 6 months) after exposure. You can count on a negative result, however. There is no realistic chance you have HIV. (Not only would I have not prescribed PEP, your risk wasn't even high enough to be tested for HIV!)

I hope you find this information helpful and reassuring. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Thank you so much for your response doctor. I was really worried until now after I started getting the pain in thigh. 

I had this incident in NJ in Morris county where the risk is relatively low. But I was very anxious that I was literally not able to talk. So the NP gave me PEP. Also, I read that the failure of condoms is very low and there are chances that PEP may not work. Given that I have used both, is my chance really zero?

Also, I got tested for all stds after 10 days except herpes. Is this a valid time to test for all stds after 10days or should I get it done again? And is there any chance I might have contracted herpes and not show any signs till now?

Thank you!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
I can understand the interaction with a nurse practioner who was influenced in a PEP decision by your anxiety. But that doesn't make it right. I repeat that there is no way I would have agreed to PEP if you had been my patient, and I'm sorry you took it.

It is true that condom failure (against HIV) is rare. It is also rare that PEP doesn't work. And yes, the chance you have HIV is zero for all practical purposes. I would guess that in the last 20 years, not one person in the US acquired HIV after such an exposure. You won't be the first.

You also didn't neec testing for "all STDs". Urine or urethral swab testing for gonorrhea and chlmaydia is valid at 10 days. However, no blood test becomes positive that soon. Any and all blood tests for STDs are invalid until 6 or more week after exposure.

It's really too bad you'e going thoough all this after your first sex. It seems you've had misleading education about STD/HIV risks. The sexual world isn't nearly as dangerous as you seem to have believed. You had safe sex, for goodness' sake! You ween't at risk! You could have a hundred exposures like this and never be at risk. And when you begin to really have sex, don't let this experience (or the terrible education you seem to have had) get in the way of romance and rewarding sex.
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17 months ago
Thank you so much doctor. Your words have reduced my anxiety a little since I started to get so worried since the last week. And also I have this little sore throat that started yesterday. But my roommate also got it so I believe this is not related to any symptoms. 

And one last question. If seroconversion does happen after PEP, how does symptoms looks like?

I cannot thank you enough for your input on this. Since I was worried like hell since the past month. Thank you so much. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
The symptoms of acute HIV infection after PEP (if PEP fails) probably are no different than without PEP. Roughly half of all people with new HIV get no symptoms at all. When symptoms occur, typcially they are some combination of sore throat, fever, skin rash, and enlarged lymph nodes in several areas (neck, under arms, grroin, etc).

It is not possible you developed any HIV symptoms, including sore throat, while taking PEP.

That completest he two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
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