[Question #6418] Uncircumcised / unprotected vaginal sex - PrEP suggestions

16 months ago
Hi Drs,

I just met a Korean CSW here in San jose. I'm circumcised 28 yrd male. We had unprotected oral sex for a while before I did something stupid. I had unprotected vaginal sex for 30 seconds and ejaculated in her. 

She is in her 20's. She is a "porn star experience " provider, meaning which the customers have an option to engage in unprotected vaginal sex. She is part of a Korean Org where all the girls offer this service.  She looks healthy and clean but I'm worried about catching any STI or STD as she may have had unprotected sex with others who may have STI or STD

Please advise me on PREP and also let me know any suggested PREP centers in bay area California.

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

Welcome to the Forum.  I'll do my best to help.  You ask two questions- one about your risk from a recent unprotected sexual encounter and one about the use of PrEP going forward.

Regarding the 1rst question- this was not a no risk event but the risk for infection is relatively low.  Most commercial sex workers do not have STIs and even when they do, your risk for HIV infection is lower than your risk of other, more common STIs such as gonorrhea or chlamydia.  Even for STIs like gonorrhea and chlamydia, I would estimate your risk for less than 1 in 10.  FYI, if your partner did have untreated HIV (this is improbable) your risk from a single exposure is less than 1 in 1000 (in other words, even if she had HIV, there is a 99.9% chance that you were infected).  I would recommend that you have a urine test for gonorrhea and chlamydia at some point soon.  At any time more than 2-3 days after the exposure, such tests will provide reliable information.  For HIV, testing with the most widely used, 4th generation tests will provide reliable results at any time more than 6 weeks after the test.    There are several other approaches here- if you can have your partner tested and she is negative for HIV, then you can be sure you will not be infected.  Alternatively, if it has been less than 72 hours since the exposure, taking anti-HIV medications (this is called Post-Exposure Prophylaxis or PEP) will reduce your risk of infection still more.  PEP is widely available, albeit sometimes rather expensive at Emergency Departments and other medical facilities.

PrEP (Pre-Exposure Prophylaxis) is readily available in the San Jose area through your local health department or other health care providers.  Taking it is a personal choice, is well tolerated and highly effective for prevention of HIV in persons at high risk. 

I hope this information is helpful.  EWH

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16 months ago
Thanks for the reply Dr. Hook, 

"Your risk from a single exposure is less than 1 in 1000 (in other words, even if she had HIV, there is a 99.9% chance that you were infected). Did you mean 'were' or 'were not' in the sentence? 

Yes, I think my question is about PEP. Since it's been less than 24 hrs since exposure, should I get a PEP. Would it have any side effects? 

As suggested, i shall test for chlamydia and gonorrhea in 3 days. 
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

I meant to say there is MORE than a 99.9% chance the you DID NOT get HIV, even if she was infected.  Sorry if that was unclear.

PEP can be relatively expensive, depending on where you get it.   In addition, there are side effects, most of which are gastro-intestinal upset.  As I said above, the choice about PEP is a personal one and personally, were I you, I would not seek PEP.  If you are going to seek PEP, the sooner you start it the better and, as I mentioned, there is no meaningful benefit to PEP when begun more than 72 hours after an exposure. 

Hope this helps. EWH

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16 months ago
Thanks for the answer Dr. Hook. I shall end this thread with one last question. 

I'm convinced that my risk of catching an HIV is low. So i shall not go for PEP. I'll update my chlamydia and gonorrhea results here in 3 days.

Not that I intend on having risky unprotected vaginal sex in future, but if I take up PrEP (pre exposure prophylaxis) now, would it warrant against HIV only in future? Would I still be at a risk of other STIs? Also are there any side effects of PrEP , like in case of PEP?


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

I am supportive of your decision to not pursue PEP.  That is precisely what I would do.  I also support your decision to test for gonorrhea and chlamydia and anticipate that your tests will be negative but understand that negative tests will be reassuring. 

Regarding the future, PrEP tends to be well tolerated and is very, very effective for HIV prevention.  It DOES NOT prevent other STIs.  Further, because of considerations relating to PrEP such as side effects (mostly gastrointestinal upset), cost and need, you need to decide just how high your risk for infection is, based on variables such as numbers of partners and the likelihood that they have HIV.

I hope that this comment is helpful.  Normally this would complete this thread and it will be closed.  We will keep the thread open for a few days however so that you can report your results (and thank you for your willingness to post your results- others who read this post will learn from you).  There will be no further responses however.  Take care.  EWH

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16 months ago
Hi Dr. Hook, 

Just realized my latest comment from few hrs ago did not go thru. Retyping below.

My results from chlamydia and gonorrhea will be available by end of this week ( delay due to holidays).I understand that my risk was relatively low for several sti's and higher risk was for gonorrhea and chlamydia.

I'm not being paranoid and have respect for your time and efforts. But since a couple of days,  i.e 10 days after exposure, I have could, cough, slight body temperature and chills occasional thru the night.  I've been taking Nquil. Are they symptoms of any STI? Or just a coincidence. I decided not to Google my symptoms as it would only cause further concerns and confusions. With due respect please note the above symptoms are not due to me overthinking. 


Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
Congratulations on your decision not to go to the internet to evaluate your symptoms.  Doing so would have unnecessarily increased your anxiety.  Cough is NOT a symptom of HIV of any other STI and as you might image, low grade temperature and chills are non-specific and rarely are due to any STI, including HIV.  You current symptoms are coincidental, nothing more.  EWH
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