I’ve asked him if he did or didn’t, but obviously he replied with he never did (although I think he may be lying to avoid trouble) and I asked when he got last tested and he said that exact month which I find a bit too convenient. I do know he has a medical condition that would require him to test every 6 months however. 

Basically I panicked and went on PEP the morning after. My doctor wasn’t very great on instructions and didn’t mention what to do in case of throwing up after taking the medication. My regiment is one truvada per day as well as 2 Isentress. Well I took my truvada and Isentress in the morning, threw up maybe 20 minutes after and didn’t think much of it. 12 hours passed I took my Isentress. Another 12 hours passed and I took my truvada and Isentress in the morning the next day again. 

It wasn’t until after I realized the missed dose of truvada may be problematic. Would this render the entire month I spent taking PEP otherwise diligently useless? 

All in all what would you consider my risk for HIV? 

I do live in Florida if that makes any difference. Thank you. 

First and maybe most important, you describe a zero risk exposure for all practical purposes, even if your partner has HIV -- which probably he does not. There have been no known cases of HIV transmission by fingering or by genital-genital contact without penetration. Had you asked before starting PEP, I would have advised that there is no need. However, going to your main question, missing a dose or two of PEP drugs is not likely to have any effect, i.e. little or no reduced effectiveness. Also, PEP is effective when started 48 hours after exposure, so even if the clock doesn't start until the next day, i.e. when you began taking the drugs on schedule, you can be confident it would prevent HIV if you actually were exposed.

We do not provide direct treatment advice, and therefore we recommend that any changes in PEP be decided between the exposed person and her health care provider. That said, you might want to re-discuss PEP with the doctor or clinic who prescribed it, or another provider, ideally one with substantial experience in this area, such as an infectious diseases or HIV/STI specialist. A downside of PEP, which people often don't consider when starting, is the delayed certainty, which can be a problem for anxious or worried persons:  if PEP doesn't work, the time to conclusive testing is delayed to 6 weeks after the last dose of PEP, not the time of exposure. Thus the total time to conclusive testing is extended to 10-12 weeks instead of 4-6 weeks. Something perhaps for you to discuss with your doctor(s).

The bottom line is that with or without PEP, there is little or no chance you have HIV. You really should not be at all worried.

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

HHH, MD

I’m aware fingering is 0 risk however my concern is that he may have briefly penetrated my vagina with his penis. Hence the sharp pain I felt. If he did penetrate for a couple of second and taking in all the previous mentioned factors into consideration, what is my risk? 

Also to be clear I basically went 47 hours without truvada specifically, but I did take Isentress. This happened maybe 2 and a half weeks into PEP. Are you sure this wouldn’t have a great effect? 

I’m asking you because unfortunately the doctors in my area aren’t very knowledgeable on PEP. 

As for testing that was actually my next question. Would it be ok to RNA test 10 days post completion of PEP or would it be better to wait until 14 days? Thank you. 

If you continue PEP, I would agree that having a PCR 10-14 days after completing PEP would be OK; there's not much difference between 10 and 14 days in test performance. And also an AgA test 6 weeks after completing PEP.

Or you could contact your partner and has him to be test at this time. If negative, you'll know you couldn't have been exposed and would not need either HIV testing or PEP.  In the meantime, stay relaxed. In the 15 years of this and our preceding forum at MedHelp.org, with thousands of questions from peoople worried about possible HIV exposures and infection, not one has yet reported thwy tested positive for HIV. If and when that happens, probably it will from a truly high risk exposure -- which yours was not.

Night before- Isentress 

That morning- truvada and Isentress 

10 minutes later- threw up 

That night- Isentress

Next morning- truvada and Isentress

Would that be considered one missed dose or two missed doses? If this exact situation happened twice, would that greatly effect the effectiveness of PEP?

And I agree with your recommendation to have my partner test but he’s still claiming he never even penetrated and doesn’t want to speak to me so unfortunately that is not an option. 

As for testing myself would a 10 day rna and 4 week ag/ab test be highly reassuring? I understand it can’t be conclusive until the 6 weeks. 

If you mean 10 days and 4 week after completing PEP, the results should be highly reassuring. However, following some experts do recommend a final AgAb test 3 months after the last dose.