Hi Drs,

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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Thanks for the reply Dr. Hook, 

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

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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Hi Dr. Hook, 

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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