[Question #7913] Oral sex-PEP

51 months ago

Dear sir , thank you for kind help

Iam 42 years old male ,16 days back i received unprotected oral sex from massage lady ( do not know her status ) , she put my penis her mouth , then ejaculation was out

it was 1st and last time . after that i was highly panic blaming my self , i decided to take PEP and contact family medicine physician he provides me medication called veropil (dolutegravir+tenofir disproxil ) , is started pep after 36 hours , there was minimal rash and diarrhea that improved with time after taking the medication .

i did blood work 1st day and 4 th day every thing was normal after starting the medication

today i did blood work that showed some abnormailites : creatinine :111 ( N: 62-106) -urea 4.3( N: 3-9.2)-SGOT 27.40(N:0-38)-SGPT :21.50( N:0-41) -bilirubin normal -CBC showed basophil 13.9(N:0-1)- Eosinophils 7.2 (N:1-5)

i have this time after 14 days of pep abnormal investigation especially elevated kidney function for the first time in my life and high basophils

-- i am very confused sir , should i continue PEP or stop it ? already i received 14 pills for 14 days ?

-Do i need to do HIV test ? if needed which test and when ?

i need expertise opinion and advise

thank you sir and sorry for elongation

Edward W. Hook M.D.

51 months ago

Welcome to our forum and thanks for your questions. Thanks as well for your confidence in our services. I’ll be glad to comment on the laboratory abnormalities you mention however, before I do, let me preface my comments by telling you that the exposure you hadn’t was very, very low risk and I would’ve recommended against taking PEP for it. I say this because most commercial sex workers do not have HIV and, even if your partner did have untreated HIV, the risk of acquiring HIV from receipt of oral sex Is essentially zero. There are no proven cases in which someone has acquired HIV from receipt of oral sex from an infected sex partner.

Regarding your laboratory abnormalities, these changes are not characteristic of recently acquired HIV. There is however a possibility that they could be related to the PEP which you were taking. The elevation and creatinine that you note is minimal and unless it progresses is not something to worry about. And elevated creatinine could certainly be related to the medication you were taking but it also could be related to dehydration or simply day today variation in the level of creatinine in your blood. The elevations in your basophil and eosinophil counts could well be related to the medications that you are taking. My advice is to discuss these changes with your doctor and together to make a decision as to what to do. One very reasonable possibility, particularly given the close to no risk nature of your exposure, is to stop taking PEP. If you decide to discontinue your medication, I would wait a few days and repeat the tests. I would anticipate that they would move towards normality.

I see no medical or scientific reason to test for HIV at this time.

I hope the information I have provided it’s helpful to you. If any part of my comments are unclear where there are further questions, please use your up to to follow up questions for clarification. Please don’t worry. EWH

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51 months ago

Thank you Dr.Hook

Appreciate your expertise advise sir

Will stop the medication and repeat the blood work after some times sir as you advised

DO i need to do HIV test later sir ? if needed will be when and which test ?

What about my relation to my partner ? I can resume normal activity or to wait for negative results ?

Thank you sir

Edward W. Hook M.D.

51 months ago

I think stopping PEP is a good idea.

The events you describe are virtually no risk. I see no read for concern or for additional HIV testing. Although I see no need for further testing, if you choose to test again I would suggest waiting until 6 weeks after your last dose of PEP. At that time I would have a 4th generation combination HIV antigen/antibody test performed.

Your partner is not at risk for infection from the encounter you have described and I see no reason related to that exposure to avoid unprotected sex with her related to it. EWH

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50 months ago

Thank you Dr.hook

This forum is very helpful

I have a question Dr.hook , most of google search and papers and website confirm that hiv does not survive in saliva and at same time same those papers and website confirm that oral sex transmit hiv . This looks very strange if hiv does not survive in saliva so how does oral sex cause hiv even some of them went for high percentage. ! Does hiv survive in saliva or no ? If yes so how risk of transmission is only very low ? If no so why risk is not zero?

Thank you sir .

Edward W. Hook M.D.

50 months ago

Thanks for your follow up questions. It sounds like you have been looking for information on the Internet. This is a problem as it is difficult to determine what is and is not true on the Internet. Much of what is said there is incorrect for many reasons.

Regarding oral sex, you need to first differentiate between giving and receiving oral sex. HIV can rarely be acquired by performing oral sex on and untreated HIV infected man (estimated to occur about once in every 20,000 exposures) however to our knowledge there has never been a case of HIV proven to have been acquired from receipt of oral sex. Thus while small amounts of HIV may sometimes be found in saliva (rarely) it is inactive and should not concern you in your situation.

I hope the information I have provided has been helpful. As you know, we provide up to three responses to each client’s questions. This is my 3rd response and therefore this thread will be closed shortly without further responses. Take care. EWH

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