[Question #7129] Unprotected Vaginal Sex

60 months ago

Dr. HHH,

I recently had unprotected vaginal sex with a stripper. I am Uncircumcised. The event took place in Dallas, Texas. The sex was quite vigorous and lasted around 15 to 20 minutes. I am worried because she has unprotected sex with other’s so she is obviously at a high risk of contracting STD’s.

Some information about the stripper. She is a 22 years old white female. I have known her for over a year. She got tested last year and was negative for everything. I felt comfortable having sex with her as I have known her for a while and knew about her test history.

After the sex, I started to get worried about HIV. I contacted a doctor online and asked for PEP. They agreed to prescribe it. I started PEP around 37 hours after exposure. My question is following:

(1) (1) Should I even continue the PEP? When I got it, I was in a state of anxiety but I have calmed down since then. I am considering stopping it. I haven’t experienced any side effects so far but it’s only been three days since I have been taking it. I really don’t want to continue taking if there isn’t a significant risk of HIV to me. Any advise will be appreciated.

(2) (2) I know that the fact that she has unprotected sex makes her at a high risk for STD’s. Additionally, I am uncircumcised which makes me at a higher risk of contracting HIV. But given her testing history, should I be particularly concerned?

(1)

H. Hunter Handsfield, MD

60 months ago

Welcome back to the forum. Thanks for your continued confidence in our services.

From all you say, it seems very unlikely your stripper partner and friend is extremely unlikely to have HIV. I would have recommended against PEP -- and if you were in my clinic, would have refused to prescribe it. However, if you want still more reassurance, why not ask her to be tested again? You may find she is just as worried about this event as you are -- and she would be justified. Statistically, her risk from any new male partner is much higher for HIV than it is for her partners. (With vaginal sex, HIV is much more readily transmitted male to female than F to M.) If you were both tested and negative, you would both know you were not exposued. To your specific questions:

1) As a matter of policy, on this forum we do not advise people to stop PEP once started, no matter that I would not have recomended it. This is something for you to address and make a decision with the doctor who prescribed it. As you consider that decision, also consider this: I believe you (and the prescribing doctor) ignored one of its major downsides. If PEP doesn't work, it prolongs the time to conclusive testing for HIV. Without PEP, you can have a conclusive test 6 weeks after the exposure. With PEP, experts recommend waiting 3 months, and some even suggest 6 months. So if you continue it, you're looking at another 3-6 months of anxious uncertainty before knowing for certain you weren't infected.

2) I agree such a person is at higher risk of STDs, including HIV. Still, even among the most sexually active women in the US -- e.g. commercial sex workers etc -- fewer than 1 in a thousand have HIV. It's a lot less common than you might have assumed. And when a woman has HIV, the average chance of transmission to a male partner is once for ever 2,500 episodes of unprotected vaginal sex. Which is why I would have recommended against PEP.

Being uncircumcised doubles the risk of HIV if sexually exposed. But perhaps you'll agree that 1 chance in 1,250 is still pretty good odds!

Of course your risk of other STDs is a lot higher than HIV. You should have a urine test for gonorrhea and chlamydia and, after 6 weeks, a syphilis blood test. Or, as suggested above, arrange for both you and your stripper friend to be tested for these along with HIV.

My final advice is to get into the condom habit!

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

HHH, MD

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60 months ago

Thank you for your reassuring response Dr. HHH. I spoke to my friend again and she told me that she got tested for all the STD's , including HIV, around three months ago and she was negative for everything. She reassured me that she doesn't have anything and asked me to not worry. I have decided to quit PEP as I don't want to needlessly take the medicine if I don't have to.

My plan now is to get tested for gonorrhea and chlamydia and after 6 weeks for Syphlis and HIV. It's been around six days and I have not experienced any symptoms so far for any STD. That's probably a good sign. Thank you for your help Dr.HHH!!

H. Hunter Handsfield, MD

60 months ago

Thanks for the follow-up comments. I agree you're making the correct and wise decisions. With no urethral symptoms (discharge, painful urination), you can be pretty sure you didn't catch gonorrhea and probably not chlamydia; those tests probably will be negative. So will your syphilis and HIV tests.

Thanks for the thanks. I'm glad to have helped.

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