[Question #7786] HIV Risk (you prob get that subject a lot)

23 days ago
Hi Doctors:
I know I have asked two previous questions in  ashort amount of time and will keep this as my last for awhile.  

Basically, I am a 44 y/o white straight male and I had unprotected vaginal sex with a 40 y/o Dominican female.  That's all we did and it wasn't more than 5-10 minutes of intercourse.  There was no fore play either. 

I have HSV-2 (Genital Herpes) (I haven't had an outbreak in over a year and a half and take Valtrex everyday) and Genital Warts (but they cleared up a couple months ago) and I told her ahead of time.  She didn't really know much about herpes but I explained it to her and the risks and non-risks.  She said ok.  She did ask me if I had HIV and I said no as I was recently tested negative. She said ok good because she didn't want to get that (HIV).

 I checked my penis and I had no herpes outbreaks and no lesions from what I could see.  I did shave recently down there and a hair follicle would bother me when I touched it.  But I didn't see anything open.

I wasn't expecting to have sex with her and I *think* she wasn't expecting to have it with me.  I met her via a legit dating app about 2.5 weeks ago.  We had 4 dates.  She does have two older kids.  But a previous boyfriend who I suspect she had contact with recently and wasn't sure how careful he is or is she is up on HIV and testing and window periods.  That has me on alert.  She is also stepping back which leads me to believe it was just sex for her and that makes me wonder if she does this a lot.  

So my questions are:
1) How likely am I to get HIV from unprotected vaginal sex (we had unprotected sex twice) from her?  Insertive male to receptive female

2) Would you recommend a PEP regimen for this encounter?
Edward W. Hook M.D.
Edward W. Hook M.D.
23 days ago
Welcome back to the firm. Thanks for your question and your clear description of the circumstances. The encounter you described was very low risk. It is very unlikely that your partner had HIV (or any other STI for that matter) and in the unlikely event that she did have untreated HIV, your risk of infection is very, very low.  I would estimate that the likelihood that this woman had HIV is less than 1%. In addition, the risk of acquiring HIV from a single episode of unprotected sexual intercourse is substantially less than one in 1000. Just adding those two probabilities together, your mathematical risk of HIV is substantially less than one in 100,000 (in other words there is a 99.99% chance that you would not be infected).  Given these figures I would urge you to not worry and would absolutely recommend against taking postexposure prophylaxis. If you presented to my clinic with these concerns, I would be unwilling to prescribe the medication for you.  Thus, in response to your specific questions:

1.  See above.  Very unlikely 
2.  No

I hope that these responses are helpful to you. Please don’t worry. EWH
21 days ago
Thank you Dr. Hook.
My anxiety got the best of me.  I went to my PCP, who always takes the time to answer my questions, no matter how odd they may be, just like yourself.  I appreciate it so much.

So based on my exposure my DR did put me on PEP after I had a meltdown in his office.  I did it before I talked to you.  It's Tivicay 50mg and Emtricitabine and Tenofovir Disoproxil Fumarate Tablets 200mg/300mg.  As stated earlier she said she didn't have it and while she probably thinks she doesn't, it's her previous partners I don't trust and her lack of knowledge about my Herpes that made me a nontruster.

I started it 37 hours after exposure.  My question is this: I was on PEP back in December 2020.  Although that time one of the drugs for PEP was the generic of Descovy.  This time I'm on the generic of Truvada.  

1) I am on it again now in April, will that make my body immune to it?  Will it not work?  I know it's a short time between PEPs.  3 months at least.  After this exposure I do plan on going on PrEP and making sure I ALWAYS have a condom.  I'm just so mad at myself. I also know it's make reliable testing longer.

2) Would PEP interfere with an HIV/RNA test?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 days ago
Straight to your questions:

1.  Taking PEP repeatedly does not make it less effective.
2. No. other than prolonging the time until you can be tested reliably,  PEP will not interfere with the ability of HIV RNA tests to detet the virus.  

Hope this helps.  EWH

7 days ago
Hi Dr. Hook!
Thanks for always responding.  I enjoy the detailed responses. WebMD doesn't do that.  No context.  It's why I come here.

I have been getting conflicting reports from my doctors.  I have two. One said being on PEP doesn't affect the HIV ab/ag test but would affect an RNA test.  My other doctor said the opposite.  One said I can get tested after I finish PEP and one said the opposite and then I read what you wrote earlier.

1) Would you recommend getting an HIV RNA test during PEP?

2) What would happen if one is exposed to HIV while on PEP via vaginal sex? What would have to happen with PEP or afterwards?  I don't plan on putting myself at risk just a question I have. Would I be protected as one of the drugs I am on is also used for PrEP and am at least 7 days in? 

3)  I had the first two doses of my Hep B vaccine in Feb and March.  My last is due is August.  My DR performed a Hepatitis B Surface AB, Pre/Post HBIG Infusion blood test she said to see if I have any immunity.  I didn't have the antigen test.   It came back at 293.  Below that is saud Reference Range: > OR = 10 mlU/ml
Is it positive because I had the 2 doses of vaccine? 
(My last Heb B test was negative just before my first Hep B vaccine dose in February.  The only person I had sex with was the unprotected woman 16 days ago.)  

4) If I have more questions can I pay again? I realized I asked a couple in a short amount of time.
Thank you Doctor!

Edward W. Hook M.D.
Edward W. Hook M.D.
7 days ago
Oh I’m sorry to hear that you remain so worried about this very low risk exposure. As you know, we provide up to three responses to each client. This is my third response.  Following this response the thread will be closed shortly there after. In general repetitive, anxiety given questions are Answered with brief responses, if they are answered at all.

1.  Taking PEP will delay your ability to get conclusive HIV test results by the duration that you take PEP. In other words after taking 30 days of PEP, your test results using a fourth generation combination HIV antigen/antibody test will not be conclusive until six weeks after that (I.e, 72 days in total).  In the unlikely event that you were infected, or the even more unlikely event that you were infected and your PEP  failed, an HIVRNA test would be positive at the time of a failure, whenever that occurred.  Soon thereafter the fourth generation test would be positive as well.  Unless you were to develop symptoms suggestive of recently acquired HIV, I see no reason for testing until your results would be conclusive.

2.  If you were exposed to a partner with HIV while taking PEP, Your risk of becoming infected would be virtually zero.

3.  I would presume that your positive hepatitis B synthesis antibody test is due to your vaccination.

4.  I would discourage you from further questions. Should you post again, whoever answers that question will consider what sort of response to make

He’s mentioned above, that concludes this thread. Take care. EWH