[Question #5964] Risk of HIV/STI

17 months ago

Hi Doctor,


I am a Chinese male in age 40’s,  my sexual life is always clean with single partner, however, I went back to China (Peking) in August,  and one day (8/18), after dinner,  my friend invite me to a club, after a lot of drink, I had taken a CSW to a hotel (23 year old female).  We had vaginal intercourse using condom about 10 ~ 15 minutes and pull out without Ejaculation. then I had taken off condom and let her licked my scrotum not the Penis. (I didn’t check the condom intact, but I think it didn’t have noticeable broken (70% confidence)),  A few minutes later, I start to masturbate her Labia (not inside just on the surface.

Here is the bad part.  Then I masturbate myself using the same hand with some vaginal secret for 5 minutes till Ejaculation.


I know that it is a low risk exposure,  but I was very conservative guy,  so 9 ~ 10 hours later,  I had seen the HIV/STI specialist in Peking and started to have PEP. (Have HIV test before having the PEP, result is negative)


Then 3 days later, I took the CSW to the clinic and did the HIV/syphilis test, it comes back as negative.

But since I already started PEP, I continue to have it to prevent the situation (she could be in the window period).


Everything looks good,  However, two days ago(09/03), she start to complain about her fever, headache, chili, lots of ARS symbols in her social network, it makes me nervous, since I know it has higher possibility Of HIV transmission during the window period.  


Here are my questions.


  1. Assume she has infected by HIV,  during the first 1 ~ 7 days, HIV is easier to spread to others, can you quantity it, how many time easier?
  2. I am taking PEP (Emtricitabine (200mg) and Tenofovir(300mg), raltegravir potassium (400mg)), how effective that is? Is it also recommended in US?   
  3. What is the risk that I have in your opinion to get HIV infected? Does it worth to have HIV test, if so, what is the best time?
  4. I don’t have ARS symbols till now (18 days after exposure), will PEP delay the ARS?
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Welcome to the Forum and thanks for your questions.  I'll be glad to comment .  Before I do however, a few comments.  The exposures you describe did not put you and ANY risk for HIV. No one has ever acquired HIV from transmission of infection on their hands, from rubbing a woman's labia without penetration, or from having their scrotum licked.  In addition, your use of a condom make your penetrative sex safe sex as well.  I would not have prescribed PEP for you if you had seen me in consultation.  Further, you added to the no risk nature of your exposure by proving that she was not infected by having her test.  The idea that she could of been in the window of seroconversion at that time is extraordinarily low.  Bottom, line, this was a no risk exposure.  Your partner's more recent symptoms have a less than 1% chance of being the ARS. If your partner has now developed flu-like symptoms, if she is now tested for HIV the test will be positive.  I certainly would not be worried if I were you. 

  With this background, I'll address your theoretical questions:

  1. Assume she has infected by HIV,  during the first 1 ~ 7 days, HIV is easier to spread to others, can you quantity it, how many time easier?
Your assumption that she could be in the window period is almost certainly wrong. If she was, you are correct, that during the seroconversion/early period of infection, transmission of infection is more efficient because there is more virus in the blood stream.  There are no specific data to evaluate the risk of such and exposure but it is certain that the risk for infection would be less than 1% if she were infected.

  1. I am taking PEP (Emtricitabine (200mg) and Tenofovir(300mg), raltegravir potassium (400mg)), how effective that is? Is it also recommended in US?   
This is highly effective therapy. You can be confident it would be effective PEP.

  1. What is the risk that I have in your opinion to get HIV infected? Does it worth to have HIV test, if so, what is the best time?
Please see above.  I think your risk is infinitesimal and should not concern you at all.   as far as testing is concerned, the correct time to test is about 4 weeks after completion of your PEP.  I am confident that when you test, your test will be negative.  

  1. I don’t have ARS symbols till now (18 days after exposure), will PEP delay the ARS.

Possibly

Bottom line, this was a no risk event and you have overreacted.  My advice is to please not worry.  EWH


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17 months ago
Thanks Dr Edward for quick reply.

I actually find out that my partner has Hepatitis B 

Her HBsAg  and AntiHBE are positive, I plan to get HBV test this afternoon when I visit my family doctor.

More questions:
1. what the risk level that I get infected of HBV in this exposure
2. Her HIV test using (HIV antibody, ELISA), is that good enough?




Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Thanks for the additional information.  Hepatitis B is transmitted through direct, unprotected genital or ano-genital sexual contact.  While not specifically studied, the risk for infection from the activities that you describe above is quite low, perhaps zero.  Hepatitis B often cures itself and many people who have had it do not know it.  Getting tested, both for hepatitis B antibodies and the HBsAG is a good idea.  Let me know your results and I will be happy to comment.  

Yes, that she was tested and negative with an ELISA and found to be negative if fine and indicates that your exposure, involved in the activities you describe was essentially a no risk event. EWH
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