Hello Doctor, I have some questions. Recently I had sex on a spa and after that, when I removed my penis from her vagina I found that the condom was not on me but it was on her vagina, not all the way in but I can still see the the condom on her vagina, the open end of the condom through which the penis is inserted is still outside her vagina and its not stuck all the way in. Is this something to be worried about? And before that I also had some brief moment of oral sex with her, and now I am worried that I had a mouth ulcer which was getting healed but not fully healed. After all this incident I have contacted a clinic and I lied that I have unprotected sex just to get the PEP because I was really scared. And they prescribe the T Telula after having it for a single day I am starting to experience vomiting nausea and dizziness. And just now one doctor whom I met in online help service told me that I don't need to take the medicine since it was a low risk event. So I am posting here again just to confirm from you guys if I don't need to worry about hiv or should I continue with the PEP?

My questions are:

1. Do I need to worry about the type of sex I have even though it was protected, when I remove my penis the condom was not on me but on her?

2. Do I need to worry about the oral sex I perform on her despite the mouth ulcer?

3. Do I need to continue the PEP?

4. What test can I perform quickly that can confirm my HIV status?

I understand your concerns. However, all things considered, I agree with the more recent online doctor you found:  this was a low risk event that does not seem to warrant PEP. That said, this forum does not provide direct medical care or give conclusive advicd about treatment. But my risk assessment should be reassuring. First, the chance any particular female sex worker has HIV is low:  it is unlikelyyour partner is infected. Second, for vaginal sex, protection is considered complete when the penis withdraws from a condom that remains in the vagina. As for oral sex, that's always low risk, regardless of whether or not there are ulcers or other sores in the mouth. There has never been a proved case of HIV being transmitted mouth to penis. That doesn't prove it can't occur, but it is obviously extremely rare if it occurs at all.

Those comments address your first two questions. Question 3:  Should you continue PEP? That's something to discuss with your own doctors. If you had come to my clinic, I would not have prescribed it; and it also seems reasonable to assume your nausea, vomiting etc were caused by the PEP drug, giving another reason to consider stopping it. But for a final decision I would recommend you discuss it further with the clinic that prescribed it (after you give them the true details about the sexual exposure).

Question 4, HIV testing:  Highly reliable but not quite conclusive testing can be done 2-3 weeks after exposure, with a plasma RNA test for the virus. However, for truly conclusive results you also will need an antigen-antibody (AgAb, "due", 4th generation) HIV blood test at 6 weeks.

Finally, the testing question raises another issue about PEP, often forgotten both by exposed persons and their doctors. PEP is hihgly effective in preventing HIV. But for someone in the unlucky minority in whom PEP doesn't work, i.e. they get HIV anyway, the time to conclusive testing is delayed. Wiht PEP, the clock for reliable testing starts when PEP is complete -- i.e. 6 weeks after the last dose. And some experts recommed testing out to as long as 3 months after completing treatment. For those reasons, the period of uncertainty and anxiety is prolonged:  it takes a lot longer to know for sure. That risk is definitely reasonable for a truly high risk exposure. But maybe not for one that had almost no risk of infection to start with.

The most important thing here is that there is almost no chance you have HIV, and I hope these comments help you stop worrying. But you'll need to return to your own doctor or clinic for final advice about continuing or stopping PEP. Thanks for your understanding. Please let me know if anything isn't clear.

HHH, MD

Thank you for a very detailed and thorough explaination. You guys are not only educating people but truly helping people out.

I do want to go back to the clinic but it was on another city and it would not be possible now. The incident happen on the day I was returning to my city so I got very nervous with the limited time I had. Anyways I had some few silly questions please forgive me if they are stupid,

1. Suppose when I remove my penis if the tip of the penis had touched the vagina even for few moments, should I worry about contacting hiv?

2. I have read that PEP is only recommended to patient with high risk group, why is it so? Is there long term side effects or anything that let it considered only as an emergency used. I see that you have already answered this question but I just want to know if there is any other reason?

2) Medical prevention strategies of all kinds properly balance the risks and benefits of prevention versus risks of not using them. Some people shouldn't get routien vaccinations because the risk of doing so outweighs the benefit. HIV and PEP is no different. PEP drugs are not completely harmless, and there also are the emotional aspects of delayed testing I already discussed. There also are costs in real dollars (for the patient and/or his or her medical insurance). On the other side of the argument, some people are so devastated by the risk itself that the rwassurance factor is worth it even when the risk is nearly zero. But in general nobody should get PEP if the risk of HIV is very low.

Thank you. I believe this is my last post. I want to add that the oral sex I did was cunnilingus and not on penis. I took the PEP around 30 hours after exposure and after taking a single pill I decided to stop it. After 36 hours stopping it I started to have common cold like symptoms. Is it something to worry about? Do you think it is also the side effects of the drug?

And at last I want to thank you for clearing my doubts and worries.

PEP drugs don't cause cold-like symptoms, and any side effect symptoms would begin a lot sooner than 30 hours.

Far and away the most common cause of nasal congestion and other "cold like" symptoms these days is COVID-19; and being in a spa and having a massage (and sex) obviously are high risk for coronavirus infection. Unless you have been vaccinated or previously had COVID, you need to be tested and self quarantine. I'll leave this thread open for a couple more days in case you'd like to report that test result. Good luck.