[Question #6157] Testing Confusion And Intense HIV Anxiety

16 months ago

Hello Dr.

I’m 23 yr male in US. Here’s my story:

 

Day0: Had barber cut on my neck. Saw some blood. Was told the razor blade was new but trimmer not cleaned.

Day1: At clinic. NP said 1) risk was theoretical 2) chances on HBV/HCV 3) whether to take PEP is my decision. I took it at 24h.

Day31: Finished 30-day regimen (Truvada + dolutegravir). Had 4thGen Lab test + Alere Ag/Ab rapid test. Both negative. NP said no more test needed.

I was given PrEP (Truvada) but didn’t start, bc I want to test at later time. I asked if PEP delays seroconversion. They said NO.

Day56/26d post PEP: Started PrEP.

Ordered a sex toy (TPE fake vagina) earlier. It arrived this day (about 36 hrs). Package intact. I assumed clean + used it directly w/out condom. Sense unpleasant smell meantime. (Not sure if it’s the material.) Scary thought: what if someone used it before and left HIV+ body fluid in it? Checked inside. No visible blood stain, but not sure of semen/pre-seminal stains. Anxiety at peak. Little sleep.

Day57/27d post PEP: Inquired the risk at a specialist. He said no data available on sex toys/barber but assumed low. He assigned a PCR for me and said I may stop taking PrEP but not a must.

Went to clinic for sex toy concern. Was told no risk + no more tests needed.

Day63/33d post PEP: Waiting for PCR. Living in huge fear.

 

Questions:

1.     Please assess my risks.

2.     Will the virus remain infectious for 36 hours in that case, assuming someone may use it before? The inside of the sex toy is almost an enclosed area (not entirely)+ the texture is like porous, air may not dry everywhere inside. Unlike table surface.

3.     Should I keep taking PrEP? Does it play a role in testing?

4.     What’s my future testing plan?

5.     Is there a way to know the result without another 3 months?

6.     Having headache and fatigue since day57. ARS?

 

Apologize for the long story. PLEASE HELP! I am so scared. Worried my life will be ruined. I’m only 23. Not even married yet. This has stuck in my mind for weeks. PLEASE HELP! Thanks!

Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

Welcome to our Forum.  Thanks for your confidence in our service.  I'll do my best to help.   I fear that you may misunderstand how HIV is transmitted and have over reacted to very low or even no risk events.  HIV is transmitted to others only through DIRECT sexual contact or injection of infected material deep into tissue.  The virus becomes non-infectious almost immediately upon exposure to the environment outside of the body.  Any risk of acquiring HIV from a razor cut or nick from a barbershop is theoretical and I am unaware of any proven instances in which the virus has been transmitted in the manner you describe.  Similarly, while IMMEDIATE exposure to shared sex toys has resulted in transmission of STIs, including HIV, this is rare.  There are no cases of HIV transmission which have occurred as the result of use of a sex toy that had been used by another person several days earlier.  None!!  If you had asked me about your need for PEP, I would have recommended against it and would have been unwilling to prescribe it for you as the risk for side effects would have been far, far greater than any risk for infection.  In answer to your specific questions:

1.     Please assess my risks.

The risk for the activities you describe are virtually zero.  I am not clear on why you chose to take PrEP after completing PEP.


2.     Will the virus remain infectious for 36 hours in that case, assuming someone may use it before? The inside of the sex toy is almost an enclosed area (not entirely)+ the texture is like porous, air may not dry everywhere inside. Unlike table surface.

See my comment above.  HIV is NOT transmitted through the sort of exposure you describe.


3.     Should I keep taking PrEP? Does it play a role in testing?

You were mis0informated.  PrEP is useful for prevention of infection in at risk persons who are exposed.  I am not sure why you are taking PrEP. 


4.     What’s my future testing plan?

I would advice you to stop the PrEP unless you have ongoing risk fo the sort I describe above.  Then you should re-test at 4-6 weeks after stoping the medication.  I am confident hat, unless you have other unmentioned risk, you are not at risk.


5.     Is there a way to know the result without another 3 months?

Yes, a 4th generation test will provide you with entirely reliable results at 6 weeks.  If you feel you need a result earlier, an RNA PCR test would be reliable sooner although precisely how much, given your taking or PrEP is unclear.


6.     Having headache and fatigue since day57. ARS?

Headache and fatigue are not signs of ARS.


I hope this information is helpful.  EWH


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16 months ago
Hello Dr. Hook,

Thank you very much for your response. I really appreciate it.

Your words have truly gave me some peace of mind.

My PCR test result is available. Not detected.

The specialist I visited thought the result was conclusive for both exposures and no further tests were needed. The PCR test was taken 26 days after PEP and 16 hours after I touched the sex toy. I said to him that 16 hours might be too early for any tests to reliably give a conclusive result. He responded that the test he gave me was the most sensitive test available, which isn’t affected by the window period.

Here is some information about the test that the specialist assigned to me (All information taken from the report sheet):
HIV-1 RNA was quantitated by the COBAS AmpliPrep/ COBAS TaqMan HIV-1 Test, Version 2.0. The quantifiable range of the assay is 20 - 10,000,000 copies of HIV-1 RNA/ml of plasma. An internal control was added to the specimen before viral nucleic acid extraction to rule out PCR inhibition.
A “Not Detected” result means that  HIV-1 RNA was not detected and the internal control amplified in the specimen.
A result of “HIV-1 RNA detected. Less than 20 HIV-1 RNA copies/ml” means that HIV-1 RNA is detected, but its level is below the quantifiable limit of the assay.

As for the use of PrEP, some NPs suggest that I can take it because it reduces the chances of catching HIV. Some NPs thought I didn’t need it. The specialist says I may use it because no virus were found in the PCR test.

Here are some follow-up questions.
1. Is my PCR result conclusive for my both of my exposures? Do I need further tests?
2. I put water into the sex toy and left it alone at about 80F. The sex toy has a little pinhole at the bottom. However, there were still water remaining in it after 48 hours. Since I received the toy in 36 hours, I was concerned that if there was moisture body fluid inside, the virus may remain in the liquid. Does that change your opinion on the survive of the virus in the sex toy assuming someone might used it before?
3. My current situation is I have used PrEP for a few days. At this point, both the specialist and some NPs recommend me keep taking it because they think no more tests are needed. However, I’m not sure if I should stop PrEP to take more tests. Please help me assess. And if further tests are needed, would you consider HIV RNA test + 4th Generation Duo conclusive 4 weeks after stop using PrEP.
4. In general, how does the virus enter the body through penis in vaginal/anal sex? Is it from the urethras or small wound on the surface or small wound in the urethras?

Thank you so much!
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
In reply:
I agree that you do not need to be taking medication for the exposures you described.  PrEP is for persons whose sexual activities regularly put them at risk for HIV.  Nothing you have described suggests that you are in that category.  I suggested earlier that you do not need PrEP at this time.  I still feel that way from what you have described.

1.  You did not need testing to begin with so asking when your result is conclusive is of little benefit.  I urge you to believe your test results as validation of my earlier replies.   There is no need for additional testing.
2.  No, my answer remains the same.  No risk for infection from the sex toy you described.  No infectious virus would be present.
3.  I see no need for further testing.  If you choose to test again, the combination of a PCR and a 4th generation test at 4 weeks after cessation of PrEP will be conclusive, will verify what I have already told you- that the events you describe did not put you at risk and you were not infected.
4.  It is assumed that most infections in men which occur as a result of penile sex enter the body through the urethra.
EWH
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15 months ago
Hello Dr. Hook,

Thanks you so much for your previous response! It truly helped me release a lot of my stress.

I am sorry I come back after a month. I was really trying to move on with my life, but recently the doubts and uneasy thoughts have came back to me again.

After reading from different sources on how long the virus can survive outside the body, I noticed different types of explanations. Some say the virus dies instantly outside the body, whereas some, such as the website Healthline, quotes on other studies that the virus can survive for days on dry surfaces even it is out side the body. (https://www.healthline.com/health/how-long-does-hiv-live-outside-the-body#in-the-environment)

Link: “HIV surviving for more than 15 days in wet conditions and up to 3 days after drying.

CDC study says the drying the process will inactive the virus. Here's the link. (Especially the section “Survival of HIV in the Environment”)

However, like I mentioned before, when I put a small amount of water in the toy, the water did not dry in 48 hrs, which indicates if someone ejaculated in it right before the toy was sent, the body fluid would not dry completely when I start to use it for the first time. Considering the material is porous, it makes it even harder to dry in a short time.

I apologize for bringing up a question like this but I’m just not very confident to convince myself that the virus would die out in semen in a relatively sealed space made of porous material after reading those articles, although 48 hrs have passed when I received the toy. This has made me scared of finding new relationships and moving forward with my life. I am thinking about getting more tests done. However, the idea of more tests give me extra pressure.

Questions:
1. Will the virus die out in 48 hrs even in a space made of porous material? Will it create a syringe-like environment for the virus? Those studies show that the virus don't die very easily, which makes me worried.
2. Do things above change your opinion on my chances of getting infected?
3. Can I safely find new relationship and have sex?

Thank you so much for your time.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

I'm sorry my earlier response did not do more to help your anxiety.  My answer is not going to change.  I would urge you to re-read my earlier responses to you.  My sense is that you are looking to the internet for answers.  If that is the case, I am confident that this will only fuel your anxiety.  Much of what is on the internet is taken out of context, is out of date, or is just wrong.  Even what is there from official bodies such as the CDC is written in a manner to be correct in the broadest sense and to not discount even theoretical possibilities.  This does not help persons such as yourself. 

There is a difference between non-infectious in the real world and viable as defined in the laboratory.  Please understand that in the laboratory conditions can be manipulated so that damaged, non-infectious virus can still be recovered with specialized laboratory methods. 

Thus, in answer to your questions:

1.  Please see above.  To be honest, your question is a bit paranoid from the outset.  No one has ever been shown to acquired HIV in the manner that you suggest.

2.  My opinion and advice is unchanged.  The testing you had proved that you did not acquired HIV.

3.  There is nothing in the incidents that you described that suggests any reason for concern about having HIV.  This sort of concern should not hinder you from pursing new relationships which include unprotected sexual contact. 

I hope these final responses are helpful.  As per Forum guidelines, with this 3rd response this thread will now be closed.  Take care.  Please don't worry.  EWH

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