[Question #6920] HIV Transmission Risk

63 months ago

I am a middle-aged man with genital herpes.

In November, I had protected sex with a woman, She bled from her period, it got on my balls, waistline. This happened 2-days after I started taking PrEP. I freaked and started to take PEP within 48 hours.

While I was on PEP, mid-December, we had protected sex again and this time I was trying to go behind her but she was face down on the bed. I heard a pop and the condom broke. I was not sure if I was inside her or not. She said no. But I believe I had a lesion on my penis that was healing and I wasn’t sure if it was exposed to her or any vaginal fluids or not. So, I assumed I was. She knows I have GH.

PEP ended after Xmas and I had a blood test and a 4^thgeneration POC ab/ag test and they were negative from the original blood incident. But it wasn’t 28 days after the condom broke incident.

January I restarted PrEP again but stopped it b/c I was not having sex anymore.

I waited until the first week of Feb to have the POC 4^th generation ab/ag test for the condom incident, but the person doing it was a newbie and unsure of herself. She was being trained but she did bump the test on the desk about an inch and the blood/solution mixture moved a little bit maybe about 5 millieters I guessed.

The test was negative but I didn’t trust the results b/c she bumped it and then a seasoned person looked at it and said it was a good test and said I was negative. But it still bothered me.

Then, I took an Oraquick Home HIV Saliva test on April 18^th. It was also negative. But I might have been on PrEP at the beginning of the 3-month window period, which would’ve be around January 18^th. I stopped PrEP around the 25^th.

The woman insisted she was tested and did not have HIV. Should I still worry about this exposure from the condom breaking? Would the Oraquick Test be accurate? I was not on anything when I took the Oraquick test. Is the ab/ag test from February be accurate? Are those tests hard to mess up?

H. Hunter Handsfield, MD

63 months ago

Welcome to this component of the forum. I see you've had several recent discussions with Terri about your herpes.

There's a lot of information here, but it boils down to three issues: 1) A low risk exposure which was condom protected--and even if you were right that the condom break occured when in your partner, the exposure time after that was obviously very brief. And all this with a woman who is confident she doesn't have HIV. The blood exposure did not elevate your risk. 2) The PrEP/PEP drugs further lowered your already miniscule risk of catching HIV. Had you asked before now, I and most experts would have recommended against either PrEP or PEP in this situation.

3) Most important, you have had conclusive HIV test results, done long enough after the exposure -- and long enough after taking anti-HIV drugs. You can be sure you don't have HIV and I do not recommend any further testing. (My final comment is to say I'm scratching my head about your blood specimen being "bumped". Why would you think such a thing might have any effect on test reliability?? Of course it did not.)

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

HHH, MD

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63 months ago

So you don't think me doing another home Oraquick Salava test would be neccesary? Are those tests accurate?

One thing i didn't mention: Around the time I had the POC (Point of Care) 4th generation ab/ag rapid test done the first week of February I did have some kind of infection. I went to my ENT and he found what looked to be a virus type thing in the back of my throat. All my blood work was fine. No flu or anything. Could that be HIV seroconversion? I was just very nervous. No fever, just a sore throat and ear pain.

H. Hunter Handsfield, MD

63 months ago

The timing of your tests in relationship to completion of PEP isn't clear to me. If the April 18 AgAb test was 6+ weeks after completion of treatment, it probably is conclusive, especially given the near zero risk of the exposure itself. However, some experts recommend testing out to 3 months after completing PEP treatment. That should be an AgAb test. The oral fluid test is the least reliable of all HIV tests, missing 2-3% of HIV infections no matter when testing is done. If you have any more testing, it should be another AgAb test.

Your current symptoms are not suggestive of ARS, and also are occurring much to late.

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63 months ago

The condom incident occurred during PEP before December 22. I finished PEP around December 22. I did continue PrEP for about 2 weeks after that I believe. I took the 4th generation ab/ag test rapid POC test for the condom incident around February 3rd and the Oraquick Saliva test on 4/18. I did the Oraquick as a backup to the 4th generation rapid test.

So with all that I have said you would think overall I'm probably ok?

63 months ago

The Ars symptoms occurred around Feb 1

H. Hunter Handsfield, MD

63 months ago

Nobody ever catches HIV while taking anti-HIV drugs; the event while on treatment was risk free regardless of condom failure.

As for "The Ars symptoms occurred around Feb 1", it is imposssible that the symptoms were caused by ARS.

I have already made it clear that, all things consdiered, there is no realistic possibility you have HIV. But anxious persons -- which you seem to be -- often are more reassured by negative test results (at a time the test is conclusive) than by professional opinion, no matter how expert. You're the only one who can decide whether this includes you. If you're going to continue to wonder and worry, then you should have a final AgAb test 3 months (or more), after completing your PEP treatment. (One of the downsides of PEP is that the need for delayed testing prolongs the period of uncertainty. In the future, think twice about taking either PrEP or PEP in relation to such low risk sexual exposures. In most areas of the US, heterosexual exposures rarely necessitate PrEP or PEP.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe!

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