[Question #7333] Exposure risks

5 months ago

Hello, 

Almost two weeks ago now I hooked up with a guy I didn’t know at all. Very unusual for me and bad judgment as I am celibate to be safe. He used a condom, and it lasted a very short while as I stopped it. The condom didn’t break and there was no ejaculation in the condom from what I saw. I did notice before though that the condom didn’t seem to be lubricated I don’t think? Or at least not much. But I haven’t had sex  in so long that I don’t know how exactly they are supposed to feel .I have been terrified ever since. Should I be worried if this condom didn’t feel lubricated it felt and tasted like straight rubber to me? Could it have been old? I don’t know. I did see it and it was on. He doesn’t seem to care to want to show many any test results of his but claims he had given plasma recently but he hasn’t shown me any proof and isn’t interested in engaging with me this. I am extremely paranoid uncomfortable and worried. I live in atlanta, 1 in 53 people here have HIV and it is highly prevalent among the black community. I am black and he is Black. Originally born in Nigeria but an American citizen he is now. He is young. I am African American and from the west coast originally.  But because of this high rate among African Americans and African American men in this city and in the country it is huge cause of concern for me. Do you find this a concern in my case? I went to the doctor the day after and immediately got on pep , I haven’t been tested yet though. I can’t be tested until pep is over from my understanding. Then I will go in and probably get the rapid test. Since this sexual encounter I did get what seemed like a brief flu or something : I was sneezing like I never have nose congested and one day woke up with the uvula in the back of my throat enlarged so much so I could feel it after a few hours it went down. Are these signs of early infection? I’ve also had muscle pain, but this pep medication has made me so Sick that I have had so much diaharrea, nausea, tiredness that I don’t know if the muscle pain is related to the pep? I can’t tell what is what. I know muscle aches can be sign of early infection Then this morning I found about 5 red bumps each spread our far

Each other and this reminded me of what could be an early rash also associated with early infection. I’ve been on pep over 2 weeks I think and I can’t wait to get off of it. Are these bumps/ possible rash a concern ? The doctor didn’t say much about it . Which made me more paranoia and even caused me to cry. 


Please answer all of my questions and concerns and let me know if you think I have been exposed or anything to worry about it considering everything I told you. 


I also wanted to take an at home Ora quick swab test now or as soon as I’m done with pep or will this not be helpful as the medication is still in my system. ? I would like to know your suggestion on that as wel. I hate waiting for bloodwork because the wait gives me extreme anxiety to the point where I  go into full on panic attacks. 


I also wanted to mention that my last two sexual encounters were 2 years ago this time I was with another woman a one night stand she used a strap on with a condom over it and then before her it was a few years before her I was with another guy I didn’t know but he only rubbed his penis with a condom above and not where you would insert the penis into the vagina. Are either of these risks ? 


I am a 32 year old African American woman I believe he was in his mid to late 20s. 


Thank you. 

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

Welcome to the Forum and thanks for your thoughtful questions.  Congratulations as well on your careful approach and practice of safe sex.  I'll be glad to comment.  You are correct that the Atlanta area has relatively high rates of HIV, as well as other STIs.  the key word however is relatively and the fact is that most persons do not have HIV or other STIs, that most single encounters with infected persons do not result in infection, and that use of a condom throughout sex is virtually 100% protective for HIV and most other STIs unless the condom breaks.  Despite your reasonable questions about the condom used, if it did not visibly break, it did not fail.  When condoms fail, they break wide open leaving no doubt that they have failed.  I would not be concerned about the encounter you describe.

Other comments. 

Condom lubrication and age.  The lubrication present on many lubricated condoms may not be particularly obvious or apparent and the import of lubrication has more to do with comfort than anything else.  Further, the dating on condoms reflects a time when breakage begins to occur but most condoms somewhat past their "expiration" date will still work fine and not break.  You report that the condom appeared intact.  I suspect it was.  As I said above, if the condom appeared intact following sex, be confident that it was. 

The symptoms you describe are not those of HIV or other STIs.  Some of these symptoms may be due to the combination of medication side effects, possibly amplified by your own level of concern.  If you have respiratory symptoms at this time, they are almost certainly NOT HIV. (you might seek COVID testing however).

PEP.  PEP is highly effective.  From the description you provide, I doubt that you needed it but I understand that you likely acted out of an abundance of caution.  Currently, the recommendations are that follow-up testing after completion of PEP not be performed until about 6 weeks after completion of the medication.  Earlier testing is OK but not conclusive.  In your situation. I anticipate that you will find that you were not infected and urge you not to worry. 

The other two past encounters you describe were also no risk events. 

I hope that the information I have provided is helpful.  If anything is unclear, please use your up to two follow-ups for clarification.  Please don't worry.  EWH

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5 months ago
Hello Doctor,
Thank you for your response.

I am wondering if these are not signs of infection why are they listed as signs of early infection? 


As far as pep testing is concerned, I don’t think my anxiety could allow me to wait 6 weeks after finishing pep to take a test. Why did the doctor tell me to test after taking pep? I guess she didn’t specify a time from

But even yesterday she gave me paperwork to get a blood test since I came

In there all concerned about those few  red dots  on my skin that were a possible rash.  So any rapid blood prick test or Ora quick Swab test would not be useful during pep or immediately after? I do not like waiting for blood work. 


Also can you please tell me how affective and Ora quick at home swab test would be in my situation and after pep?  I asked that in my

Initial question as well. 


Is my loss of appetite due to pep? I believe the bad diaharrea and tiredness is

Associated with it.....? 


I forgot to ask if you think a dentist appointment could have been an exposure where they used something to numb my mouth, and also do you think anything the guy I hooked up witj could have possibly

Put in my drink could have caused exposure? I am extremely paranoid . I am highly doubtful he did anything to the drink I brought but have to ask. 


Also as far as the strap on the girl I used mentioned what If she (and this is paranoia ) maybe in the bathroom inserted her own strap on with the condom on in her vagina first and then used it on me... would that be exposure ? I do not believe she did as I don’t se why she would but wanted to ask. 


Also I read they are now recommending doctors to not prescribe the drug they generally combine with pep

Truvada, to ticvacay to to people and instead a new one due to some concerns about how it can affect . I think they said pregnant woman in the article. Have you heard of truvada and Tivacay which was used for prep for me being an issue and possibly not what should be used for pep anymore — as in it is no longer affective ? Article didn’t say that part but I wanted to ask. 


Also, I just don’t see how 1 in 53 people infected in atlanta is not considered “a lot”. That’s a  huge population, I would say....? 


Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
I certainly agree with you that slightly over 2% of the population represents a huge burden of HIV. That said, it’s still means that over 97% of persons do not have HIV. But let’s not quibble about whether the numbers are big or not. They are big.

I’m not sure where you’re getting your information regarding signs of HIV. Most Internet sites, including sites Ezra beautiful as the CDC, tend to worry about missing something and us are often overly inclusive. Sneezing is not a sign of recently acquired HIV, neither is respiratory tract congestion nor a swollen uvula.  Being overly broad list of symptoms found all too easily on the Internet all too often creates unnecessary anxiety.

I cannot tell you about the thinking of the Doctor Who prescribed your PEP. I can tell you as a generalization however that all too many doctors find it easier to simply prescribe PEP and walk away then to carefully consider and explain the nuances of this therapy to their patients. I wish that were not the case. When PEP is prescribed however it is reasonable to obtain an initial test for HIV in order to make sure that the patient is not already infected. Were that the case, PEP would be the wrong treatment.

V or a quick test for HIV is our least favorite test. While still highly reliable, it is an antibody only test and that takes longer to give conclusive results and has a slightly higher false negative rate than fourth generation HIV antigen/antibody tests performed on blood.

Categorically dental visits are safe and do not place you at risk for HIV. Obviously, I cannot comment on whether your partner drugged you or not but it seems unlikely- your memory is intact and there is nothing to suggest loss of consciousness. It does sound however like you are wearing an awful lot.

Regarding your previous partner and the strap on, if it has infected you, the HIV test that you have already had would’ve been positive. I think you are overthinking this.  

I know of no data to suggest that you should be concerned about the antiviral therapy regimen you have received.

Again, I hope these comments and information are helpful. EWH

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5 months ago
Good afternoon doctor, but doctor this now concerns me please clarify these last things(these first two are vitally important for me to know) 

1. I never took a test after the last encounter with the strap on.  So when you are saying “if they infected you” so there is a risk they could have? In the beginning I know you said it wasn’t but then what I said what if they/she had used it on themselves first.  I have no reason to think this but I still would like to know. Would that have been an exposure risk I should be concerned about? Again I have no reason to think she did just a what if . 

And please clarification on this:

I didn’t mean he drugged me I meant is there anything the other partner could have put in my drink that could have exposed me to HIV? Again there is no reason to think anything it’s another question. But my face was kind of numb and I couldn’t sleep immediately  after. But I didn’t lose conciousness or anything it wouldn’t have been that kind of drug. My reality wasn’t altered at all. 

My anxiety is now at a high and I am very concerned based on these last two responses of yours.


I understand every thing else you are saying. I was worried because it said online sore throat could be a symptom. 

So just to clarify an oraquick swab test would not be useful now or immediately after pep? Do you have any suggestions on what test I could do before the six weeks after pep is done that would be accurate and would help decrease my anxiety? 

And I’m assuming when you say almost certainly
I hope it truly
Means certainly. 

Pease doctor please let me know each of these things especially the top two and I will surely
be out of your way! Thank you again for your assistance. 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
It appears that your anxiety and self-described paranoia are causing you to misinterpret my comments and read between the lines looking for evidence or a suggestion that you have HIV. You are seriously overthinking this. The recent encounter you describe involved safe sex with a partner who stated he did not have HIV. Most people tell the truth. Even if he had HIV ( unlikely!!!) the condom that you used would have prevented you from getting HIV.  Had you come to see me requesting a prescription for PEP following the encounter you described,  I would have declined to do so. Your risk is virtually zero ( And before you get worked up over my use of the word “virtually” please realize that in science one can never say never. New information is being updated every day. That said, I have complete confidence that you are not at risk for HIV from the exposure you described.

Question 1.  The encounter with the strap-on you described occurred two years ago! You asked if there were any risk from this encounter. I stated no. I then pointed out that your recent HIV test, taken at the time you were prescribed PEP should serve to further reassure you that you were not infected two years ago because, had you been infected,  that test would’ve been positive.  That is not to say that the encounter you described was risky. Rather to provide you with what I thought was needed reassurance.

Question 2. Sorry if I misinterpreted your question. The answer to your clarified question is no. HIV cannot be acquired by drinking or ingesting the virus.  There is nothing you could have drunk which would give you HIV.

The sore sore throat that is part of the symptoms of recently acquired HIV is most typically described by patients as the “worst sore throat” of their life, and is accompanied by severe muscle aches and high temperature. None of which you describe.

These will be the final responses provided as part of this thread. Forum guidelines call for up to three responses to each client’s questions. This is my third response. I hope the information I have provided is helpful in helping to resolve your fears related to the encounter that you described. Nothing you have said suggestS any meaningful risk for HIV. EWH
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5 months ago
Doctor please you have misinterpreted my answer again, I have NOT been tested I was NOT tested before taking pep which I clarified since beginning. She gave it to me without testing me. I have not been tested for a long while and not after the encounter with the strap on, KNOWING THIS can you tell me if I should still be concerned about that incident and if there was a risk involved for me to have gotten tested for this. This is truly all I’m asking and I’ve said from the beginning I did NOT get tested before taking pep and I was never tested after the strap on sexual encounter. Please I am
Not trying to bother you but this question has not been answered based on the facts of this parodied situation. I am sorry for our misunderstanding please let me know. I will not bother after at all. 
5 months ago
Final, response. Somehow you have managed to corrupt the site. We’ll see if this answer. Comes through. You stated the doctor who prescribed your PEP gave you paperwork to test when she prescribed your meds. I presumed you went for the test. You did not tell me that it was for a future test or that you had not been tested. Bottom line, STIs, including HIV, are not transmitted on inanimate objects, including strap ones. The strap on encounter you describe was a no risk event. You need to. I’ve forward. My sense is that your unwarranted concerns are gettin the best of you. End of thr. EWH