[Question #740] STD risk, Continued, esp re HIV

89 months ago
Hi doctors,

An update: 10 day test (including RNA test for HIV) came back negative for everything, and save for what appears to be some dermatitis on my penis that's clearing up nicely, I have no symptoms. The escort told me last week she'd been tested and all was well. I don't know whether that's true though.

I'm still on PEP though. Today is day 28 post-encounter, day 27 of PEP. My lower back has begun to ache (became persistent a couple days ago), which I suspect is related to PEP after reading up on side effects. I was thinking I should get a final test at 4 weeks (tomorrow probably). Here are my questions:

1. Is the ache in my lower back a signal of anything other than that a side effect of PEP?
2. Do I need the test at 4 weeks? 
3. Should I just stop the PEP and move on? I don't want to keep taking it if I don't need to, and even though I only have 3 days left I'd rather let my body return to normal if it's something that I really just don't need.

You both have told me you'd resume unprotected sex after the 10 day test (and before that, given the risks you see), so I guess I'm just looking for a little final guidance.

Thanks! And again, you gentlemen provide an invaluable service!
H. Hunter Handsfield, MD
89 months ago
Welcome back -- but I'm sorry to see that your anxieties are continuing despite the repeated, reasoned, science-based reassurance you have had in your two previous threads, and probably your own doctors.

People rarely lie about HIV status when asked directly. It was always doubtful your escort partner had HIV, and her recent statement tends to confirm that she does not.

1) Back aches is not a symptom typically caued by either ARS or by PEP drugs. Probably it is unrelated to those things or your sexual exposure.

2) One of the downsides of PEP, especially for particularly anxious persons, is that if it doesn't work, it may prolong the window period and thus the duration of uncertainty and until negative testing is conclusive, and most experts recommend final HIV testing at 3 months or even 6 months after exposure. Four weeks is definitely too soon; at a minimum you need to wait until at least 4 weeks after completing PEP. You should speak with the doctor or clinic managing your PEP treatment about when they suggest final testing. Don't get me wrong:  you were at nearly zero risk for HIV from the exposure described two threads ago, and I don't expect you to ever test positive assuming no further exposures.

3) As discussed previously, Dr. Hook and I would have recommended against PEP in this situation. But since you're almost at the end of PEP, I would suggest completing it.

89 months ago
Thank you, Doctor Handsfield.

I'll finish the PEP, and I take from the mountain of advice you and Dr. Hook have given me that there's no reason for me to worry any further about HIV. I'll put this behind me then, and move on. I'd like to get back to my normal life with the woman I love...finally.

I appreciate the help very much.

89 months ago
Hi Doctors, 

Last couple of clarifying questions. (I'm no longer worrying, as I've reconfirmed that the escort was tested 2wks after our encounter and she told me that she was negative).

1. What are the side effects of PEP? I've read it can have an effect on the liver. The dull ache I've had in my back is generally on the ride side, beneath my rib cage. It isn't persistent, just comes and goes. I've also felt some intermittent pain around my right testicle. Again, nothing terrible, just kind of a dull ache that comes and goes with no predictability or obvious correlation with anything else.

2. Strictly out of curiosity, how effective is PEP? I read that in animal models it's 100% effective. What does the data tell you about humans?

3. Will PEP do any damage that I should watch for, in the short or long term? 

Thank you for helping me move on. I truly appreciate your help and insight, and it's nice to be back to my regular life (sexually and otherwise).

Thanks again!
88 months ago
Final question. My fiancĂ©e had a mild case of BV for which her OBGYN gave her an antibiotic a couple weeks ago. It was prescribed before we had sex after my encounter. She finished her course last Thursday (8 days ago). 

I am using a topical cream (cordan) for dermatitis on my penis. 

We finally had sex on Tues and she experienced immediate swelling in her vagina and now has an intermittent itch. I washed my penis off beforehand to be sure j didn't have any cream left. Did I miss an std I might have picked up (Trch or something)? Recall I had azitjromycin, rocephin and penicillin g. 

Any thoughts about what could be going on here? 
H. Hunter Handsfield, MD
88 months ago
Any side effects of PEP are transient -- since you have finished it, no further concerns; it doesn't cause long term problems with any significant frequency, but I can't quote a percentage. The various symptoms you have don't suggest anything serious. There are no good data on PEP effectiveness in humans. It appears to work well, but that's partly because the large majority of people treated with PEP have little or no risk anyway (like you). There will never be conclusive research, because of course unlke animals it is ethically impossible to treat some exposed persons and not others in order to observe any difference.

Your partner's BV is unrelated to any of this or your penile dermatitis; it is not something she acquired from you. Her irritation after sex suggests she may have a yeast infection, which could have been triggered by the antibiotic used for her BV. And maybe your dermatitis is actually a yeast infection as well. She should see the doctor treating her for BV, if her genital irritaiton continues.

That completes the two follow-up responses included with each new question, and so ends this thread. Thanks again for your confidence in our services.