I have been on this site before a very long time ago looking for some advice yet here I am again. Firstly I would like to thank you for you expertise and helping all us worried people. Right on the 16th of March I met up with a transvestite I was drunk at then time and got naked at her house laid on the bed and she gave me oral I also felt something near my anus so freaked out when I recollected my memory the next day. I messaged this man and he told me it was his tongue but I wasn’t sure about it so I went and got pep from the A&E at 63 hours post exposure they gave me a 5 day course which I had to collect the remainder 23 days course from the gum clinic after speaking to a gum clinic doctor. 

Going forward I’m absolutely frightened as to what has happened I woke up around 10 nights ago and noticed a red patch in the lining of my thigh and groin at the fold which really upset me could this be due to the medication or is this something to worry about. 2) I have asked the gay man if he had hiv he said he didn’t but wasn’t being to happy about answering the question so this has all got me worked up as I’m on day 16th of my pep. 3) if I ask him to test for Hiv and he agrees and comes out negative can I stop taking pep. 4) what are the chances of him taking medication to show a negative result only to please my mind so I leave him alone? Would it be worth while me paying for him to take a Hiv test and which one would be best for me to pay for so that i know he isn’t hiding anything like taking medication after the day he seen me. Please can you advise me on this thank you 

Looking at your three back-to-back threads a little over a year ago, I see that all reflected your overestimation of HIV and STD risks and more worry than necessary over the events described. The same seems true here. I'm a bit surprised you were prescribed PEP, assuming you described the events in the same way ash were. Having felt "something" near your anus doesn't suggest any significant risk. Had there been penile-anal penetration, PEP would make sense -- but doesn't it seem likely you would know if that had happened? In addition, people rarely lie about their HIV status when asked directly in situations like this, so it seems unlikely your partner has HIV anyway. In any case, it is not possible to have symptoms due to a new HIV infection while taking PEP drugs. Even when PEP is not successful in preventing HIV, symptoms of a new infection cannot start until several days after completing treatment. (Of course this assumes you have been taking the PEP as directed, not missing several doses.)

Those comments pretty well cover your specific questions, but to be explicit:

1) Even without PEP, the symptoms you describe are not typical for acute HIV infection or any STD. Probably they having nothing at all to do with the sexual event described.

2) See above:  Probably he doesn't have HIV.

3) We do not provide medical care, and once PEP has been prescribed, we provide no advice about whether or not to continue. That's a decision to be made with the GUM clinic, not here. I agree the GUM clinic would agree you could stop PEP if your partner tests negative, but you'll need to ask them directly.

4) There are no medications that turn HIV tests negative. People with HIV on effective treatment continue to test positive on all the standard blood tests.

I'm glad to hear your gonorrhea/chlamydia tests were negative. Of course those results were expected, given the nature of the exposure you have described.

The bottom line (no pun intended) is that you are at little or no risk of HIV, and almost certainly have no other STD either. Continue to work with the GUM clinic about partner testing, continuing PEP, etc. In the meantime, try not to worry about any of this!

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

HHH, MD

1) if he is negative on his test will that mean I was safe? So Evan if he started medication and he was untamsmissable his blood test will still be positive? 

2) I will speak to the clinic about it if he tests negative but I only have 12 days left on pep so might just ride it out..

3) so the pain and patch of inflamed redness on my groin will have nothing to do with hiv? Do you think I will be safe to continue sex with my wife or should I wait for the pep to finish… 

4) when Is the best time to test after pep 28 days or 42 days? 

5) on a percentage level how risky would this ha been

Thank you for help and all the best and I really appreciate your help once again.

3) I haven't changed my mind in the last hour. Yes, correct; because you are on PEP, it is not possible that any symptoms you have are due to HIV. And as I also said above, HIV doesn't cause such symptoms anyway.

4) The GUM clinic will advise you on test timing. In general, you can the test window as starting when PEP is stopped. A negative AgAb (4th generation, "combo") HIV blood test at 6 weeks after your last dose probably will be conclusive, although some experts continue to test out to 3 months. OTOH, if your partner is tested and HIV negative, I see no need for any additional testing at all.

5) Based on how you describe the encounter, I would say zero HIV risk even if your partner turns out to have HIV.

Thanks for the thanks; I'm glad to have helped. 

1) my groin is not itchy at all but feel like and looks like a hot iron has pressed me in the lining of my groin and thigh. Could this be something to worry about or could it be a side affect of the pep medication.

2) he has agreed to test tomorrow if he tests negative would you say it would be safe to sleep with my wife?

3) is it true if he had an exposure before me and he tests negative 21 days after my exposure could he be in the window period but could have infected me? Or is that me being silly? 

Thank you last few questions that were nibbling away at me? 

2) Yes, it will be safe to have sex with your wife in this circumstances.

3) This isn't exactly a "silly" concern -- but even if he was in a window period during your contact, he's negative result would be virtually 100% assurance he did not yet have sufficient viral load to transmit the infection at the time you were exposed.

Indeed this thread should have been closed last time -- but now it is. I hope the discussion has been helpful. Best wishes and stay safe.