[Question #8012] Blacked out, random gay sex

49 months ago

Hi, I’m a male in my early 20s and made a big mistake on Friday 6/25/21. I was blacked out and ended up hooking up with two random men.

6/25 4am- Random sex with man. I was bottoming and it was very rough, I slightly noticed the condom slipping, and not entirely covered at the base. But I couldn’t see it very well and didn't see if it was completely on. We both performed analingus and oral on each other with me swallowing his cum.

6/25 6am- Random sex with different man. We performed the same acts as I mentioned except he came in the condom when I was bottoming.

When I sobered up I went to the ER and received the following meds and scripts:

6/26 3am- Rocephin 500mg injection

3pm- PEP meds Truvada and Isentress for 28 days

3pm- Doxycycline 100mg twice daily for 7 days

10pm- Flagyl 2 grams single dose

Questions:

Are there any other prophylactic meds I should have been given? I’ve read about preventing syphilis with a Penicillin injection

When should I get tested for chlamydia, gonorrhea, trich, syphilis, Hep C, & Mgen?

When should I get tested for HIV since I’m on PEP for 4 weeks, and which type of HIV test?

I want to do an IGG test for Herpes but I know it takes 12 weeks to be most accurate, will the PEP meds of Truvada and Isentress I’m taking interfere with getting an accurate Herpes test at 12 weeks since the meds are anti virals, could they delay my antibody response or seroconversion?

Are there any other tests or recommendations you have for me? Thank you

H. Hunter Handsfield, MD

49 months ago

Welcome back. Directly to your questions.

1. You were over-treated already -- in particular, no need for metronidazole (Flagyl); the only infection it prevents or treats is trichomonas, which is a strictly heterosexual infection -- doesn't occur without having female partners. In any case, there is no need for any additional treatment.

2. There is no point in testing for gonorrhea, chlamydia, or syphils; all would have been eradicated by the antibiotics you had. Also no need for trich or M. genitalium (which also is a strictly heterosexual infection as far as known -- and in any case, it's never tested in asymptomatic persons.

3. Conclusive HIV testing will need to wait until 6 weeks after completing PEP. At that time have an AgAb (4th generation) HIV blood test.

4. Testing for herpes is never recommended after any particular exposure, except with a known infected partner -- and even then probably best not to test. But if you insist, you need to wait until 12-16 weeks after exposure. The anti-HIV drugs have no effect on herpes or its diagnosis.

My main other recommendation is that you ask your doctors about on-demand pre-exposure prophylaxis. It requires only 3 doses of anti-HIV drug -- a few hours before sex and two more doses in the next day or two afterward. It's probably even more effective than PEP, and doesn't require the additional time until accurate testing for HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---
---

49 months ago

Thanks for the quick response, I do have some more follow up questions:

What is the likelihood of having contracted an STD during these encounters?

What is the likelihood of having contracted Herpes HSV 1 or 2 during these encounters?

I know you said there is no point in testing, but for my peace of mind when should I get tested for chlamydia after the 7 day supply of doxycycline, gonorrhea after the rocephin shot, trich after the Flagyl and tested for syphilis, just to be sure for my peace of mind?

Also for peace of mind, I’d like to get tested for Hep C, when should I get tested for this?

I’ve also read that the treatment or prophylactic treatment for Syphilis is a Penicillin shot, or a 2 week supply of doxycycline. Is this warranted? If so, after completing the treatment when should I test for syphilis?

Thanks for all your help.

H. Hunter Handsfield, MD

49 months ago

It's hard to predict the chance of infeciton. You know little or nothing about your partner(s), and apparently do not know for sure whethere the exposure(s) were condom protected. If unprotected, receptive anal sex (bottom) with other men -- especially ones you don't know well -- is about the highest risk kind of exposure there is. But you also were treated for most common infections and are on PEP. All things considered, you probably were not infected.

Herpes is always low risk after any single encounter. Probably under one chance in a thousand.

Of course you're free to be tested, even if it makes no scientific sense. But you should wait until at least 3 weeks after the event. You would need rectal swab testing, but there is no test for rectal trichomonas, and of course no point in urethral or urine testing if your genital tract was not exposed. All these tests will be a waste of money.

Hepatitis C is also too low risk to warrant testing, but if you do it, 6 weeks would be the right timing.

It is true that penicillin or 2 weeks doxycycline are required to TREAT syphilis once infected. But to PREVENT syphilis if exposed. both ceftriaxone 500 mg and doxycycoine for a week are 100% efective. You should not test for syphilis, for the reasons already discussed.

---

49 months ago

Hello, I am deeply distraught right now. Yesterday, which was 8 days post encounter I noticed a huge rash on my back that is not itchy, it seems to resemble a HIV ARS rash. Today it looks even worse, with it now on my shoulder/upper arm and slightly on my chest/upper stomach, also not itchy. I've been on the PEP meds for 8 days now. I haven't had any other symptoms I've noticed, other than some fatigue, diarrhea (which is pretty normal for me) and about 10lbs of weight loss which could be due to my extreme anxiety but I am unsure. Please any guidance on what I should do would be greatly appreciated, I am in uncharted waters right now, very concerned that I have contracted HIV.

I started PEP approximately 36 hours after my first exposure, how effective is PEP at 36 hours?

H. Hunter Handsfield, MD

49 months ago

I understand your concern. However, it is unlikely you have ARS. You don't describe the rash, but ARS is primarily red spots, which you don't mention. Second, it is very unlikely you would develop ARS symptoms while taking PEP: if PEP fails, ARS appears after treatment has been completed, not while still taking the drug. This could happen if you were infected with an HIV strain resistant to your PEP drugs, but that probably is unlikely. Third, rash alone usually is not the only symptom or sign of ARS; typically there is also some combination of fever, sore throat, and inflamed lymph nodes.

If I had to guess at a cause, I would consider an allergic reaction to doxycycline or your PEP drug(s). Are you in a sunny environment? If so, is the rash primarily in body areas exposed to sunlight? And does it resemble sunburn? One of the most common side effects of doxycycline is photosensitivity, i.e. easier burning from sun exposure. And the PEP drugs certainly can cause allergic skin rash.

You need to see a doctor, preferably one experienced in HIV and its prevention and diagnosis; or the doctor/clinic where PEP was prescribed. I am confident they would confirm my comments.

Normally threads are closed after two follow-up exchanges, but I'll leave this open for one more round. I suggest you wait until your rash has been professionally evaluated and let me know what your doctor says.

---

49 months ago

Hello, I went to the hospital to see an Infectious disease doctor, he said it didn't resemble a HIV ARS rash. My rash looked like red lines/streaks all across my back and upper arm/shoulders and slightly on my chest. They gave me steroid injections for a few days and the rash slowly faded, although there is still some slightly there. They thought the rash was poison ivy although it didn't itch, hurt, or anything. I ended up staying in the hospital for 8 days and at the Psych unit to help control my horrible anxiety about all of this, I don't know whether to believe the docs about the rash. I was on PEP last year and never developed a rash.

Secondly, while I was staying at the Psych unit, they were screwing up my PEP meds. They gave me the Isentress properly, but the hospital didn't have the regular Truvada pill just the two ingredients that make up Truvada. So they were supposed to give me one capsule and one tablet to equal a Truvada, but they were only giving me the capsule, so I was only getting half of the Truvada, this lasted for 6 days. I'm now back to my normal routine taking the medicine properly. I am very concerned about the 6 days I wasn't getting the whole medicine.

How much will this impact the effectiveness of PEP?

Should I take the medicine for longer than 28 days now?

I am still very concerned about the rash does it sound like it resembles HIV ARS rash?

Any other input/recommendations you have for me would be greatly appreciated, I'm in a dark place right now.

H. Hunter Handsfield, MD

49 months ago

I'm sorry you're "in a dark place" -- but it's a place where this or any other online forum cannot help. Anyone with sufficiently serious psychological or emotional problems to require hospitalization for psychiatric care needs to address such concerns with their mental health providers. All I can add is that 1) I am of course not surprised that your doctors agree your rash isn't due to HIV, and that you do not have a new HIV infection. 2) In addition, your PEP treatment issues are also too complex for this or any other online forum.

I would advise you to take the Truvada as you have been instructed, and also follow your doctors advice about follow-up HIV testing. I have no further "input/recommendaitons" about your rash except to reemphasize the evidence that you do not have ARS. In addition,it is not possible to have ARS symptoms while taking anti-HIV drugs for PEP.

That concludes this thread. Please do not post a new question about these topics: we are not going to be able to help any further on these issues, and anxiety-driven repeated questions on the same topic are not permitted. This being your second, an additional question on these topics would be deleted without reply, and without refund of the posting fee. Thank you for your understanding. But I do hope the discussions have been helpful. Good luck and best wishes to you.

---
---