[Question #6695] HIV during on demand PrEP

14 months ago
Hi I started on demand PrEP since a month . I take pills before sex then next 2 days as  2- 1 -1 . Although I didnt do real anal sex yet.  It was 2 weeks back 8th feb saturday i took 2 pills at 8 pm & I met one guy in pub at 11.30 pm we had mutual materbation but no ejaculation No oral no sex.  But we had a good time in cuddling and hugging with out cloths. Then next day I met another guy he gave me oral job with condom.  When we again did some frottage I realised during this  my condom was fell down.  Bit scared what if during frottage  for a short instant my penis touched his anus. As Couple of times my penis touched his buttock not really penetration. I continued my PrPE till next two days and left. After 2 weeks now I have swollen lymph node in neck and pain in the armpit it comes and goses. I am really scared is it hiv starting???  I was following prep 2-1-1 as mentioned. What's your opinion should I go and get tested  if yes which test will be conclusive? On net I see RNA test?I have also experienced little swelling in neck 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back to the forum. Thanks for your continued confidence in our services. And congratulations on your careful and safe approach to sex with your male partners.

As discussed with Dr. Hook a few months ago, oral sex is low to zero risk for HIV, and all the kinds of contact you describe above are risk free. Penis simply touching anus is 100% risk free:  until your penis actually enters a partner's rectum, or a partner's penis inside your rectum, you will remain at little or no risk of getting HIV, whether or not you are taking PrEP. In other words, as long as you do not move on to anal sex, you really don't need PrEP.

Since you apparently are planning to start having anal sex one of these days, it makes sense for you to continue PrEP. And of course keep condoms handy, but understand that they are important primarily for anal sex, not oral. If a condom slips and you have brief penile contact with your partners, you will remain at no HIV risk until and unless you have anal sex. Even then -- e.g. if you start anal sex and a condom breaks -- that's why you're on PrEP. Nobody ever gets HIV while taking PrEP. (Failure of PrEP only occurs when people forget to take the drugs.)

The symptoms you describe are not typical for a new HIV infection (called acute retroviral syndrome, or ARS). You may not have an enlarged neck lymph node, since self examination for nodes by medically untrained persons is very unreliable. Anyway, ARS would not cause a single enlarged node or armpit pain. You should not have HIV testing at this time. This really isn't something for you to be worried about.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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