[Question #700] Continued re: STD Risk

55 months ago
Hi Doctor,

I earlier asked a question re an encounter with an escort. Your answers were incredibly helpful and informative, and I'd like to ask a couple more questions.

1. The dark spot you said might be a blood vessel mole has a tiny black head in its center. It's still not raised, itchy or painful. But the thing at its center looks almost like a pinprick, or a bit longer than a pinprick depending on the angle. It's still purple, and it's not something I've seen before. Sounds like it's not warts or herpes, which is great, but could it be something other than the blood vessel mole you suggested (since it definitely is new)? It's just so weird, and it's on my genitals, so my vigilance is high.

2. I had a panel run on day 10 through stdcheck.com. All negative (though I know that's unhelpful for HSV and HIV, both of which you think are pretty low risk for me at this point). I did have PEP prescribed though, and I'm wondering if I can stop taking it after the early-detection RNA test comes back (that's going to take a couple more days). I can't imagine that's good for me (Truvada+Tivicay), so would like to stop taking it whenever I'm truly in the clear. Or do I have to wait to 30 days post-encounter to get tested?

3. Sounds like you think I'm relatively in the clear for HSV, which is the only other thing I think I have on my mind at this point. If the RNA test comes back negative, when do you think it would be safe to resume sexual activity?

4. I know you're going to tell me I went overboard. You're probably right. I just want to make sure I cover my bases and put no one at risk.

Thanks again! Your advice is invaluable, in case you don't know that!

Best,
Me.
Edward W. Hook M.D.
Edward W. Hook M.D.
55 months ago

Welcome back to our Forum Keith. As you know, Dr. Handsfield and I answer questions interchangeably and I happened to pick up your follow-up question.  In preparing to answer this question I reviewed your interchange with Dr. Handsfield from earlier today and agree entirely with all that he told you.  As you surmise, I also think you have gone overboard here and hope that you will not have side effects from the drugs that you are taking unnecessarily.  Let's go straight to your questions:

1.  Dr. Handsfield explained to you that the pigmented lesion you have noticed does not sound like the lesions associated with any STI.  I agree,  I suspect that the indentation you have noticed may be a hair follicle.  Lesions of this sort are quite common on the scrotum and it is my guess that you either inadvertently pinched yourself or the lesion has been there and you have not noticed it in the past.  If you want someone to take a look, I would suggest a dermatologist who may be able to provide you with a name and who, I am confident, will tell you that it is normal.

2.  Since I do not think you needed PEP in the first place, I am in favor of stopping it.  A negative HIV RNA would be further strong evidence that you were not infected.

3.  I think you can resume unprotected sexual activity at any time.

4.  I understand your anxiety.  I hope my additional comments have been helpful.  EWH 

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55 months ago
That's really helpful, Dr. Hook - thank you. 

So you think the HIV RNA test is effective then, when taken 10 days post encounter? I wasn't sure whether you and Dr. Handsfield believe it is appropriately sensitive and specific. 

Thanks again. 

Keith 
Edward W. Hook M.D.
Edward W. Hook M.D.
55 months ago
This is not the test that Dr. Handsfield or I recommend as the data for its reliability are not as strong as the data for recommended tests such as 4th generation Duo tests performed 4 weeks after exposure.  The RNA test at 10 days however would certainly detect that vast majority of infections and, in your situation following a solitary, relatively low risk exposure, provides strong evidence that you were not infected.  Were I in your situation, following a negative RNA test I would move forward with no further concerns.  EWH
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