[Question #9660] HIV transmission + Pep + Symptoms + Anxiety
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30 months ago
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Hi Doctors,
On 12/11 I messed up a bad decision under the influence. I went on app and met up with someone to receive oral sex. I got there and the person i found out ended up being a transexual. Being drunk i decided to go with it still. During the encounter I received protected oral sex and not getting an erection, I decided to go. At this time I removed condom and started examining my penis with my foreskin pulled back. She ended up straddling and started performing "frontage/mutual masterbation". I froze and freaked out. I let go of my foreskin as her penis head touched mine. the top of my foreskin hole sort of wrapped around the tip of her penis but not all the way. She grabbed the foreskin and attempted to move more of the foreskin over her penis head. I got out of my frozen state at this point and left. I did not see any semen from her to my knowledge, however i am learning the term "pre-cum" and i am afraid there could have been some i had not seen. I am now understanding the urethra and underside of the foreskin are HIV transmission sites, I am scared a transmission could have occurred.I went to urgent care two days later and due to insurance issues i got Truvada+Tivicay(30 days) @ 54h.
On pep at day 23 from exposure (waking up early + dentist). I felt abnormally tired for two days + headache + feeling hot. I checked temp no fever.
Day 43.5 after exposure and 13.5 after PEP i tested HIV 4th gen + other STDs results were negative
CBC blood count types: WBC 7.8 ABSNuets6.36(81%) ABSLyphs .82(10.5%) ABSMonos .53(6.8%), ABSEos .4(.03%) ,ABS .03Baso(.4%)
Day 53(23 post pep) afternoon swallowing a lot. Next day wake up mucus in throat. Runny nose for next 4 days. Roommates also felt sick.
Day 60(now) i feel fine.
During this time i have had an eczema flair up on elbow crease(size of thumbnail) that comes and goes in intensity(had flair up on day 43 test). In past winters i have had exczema in same spot(half inch lower in past)
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30 months ago
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IQuestions:
1. Could the day 23 event be something that was not picked up on day 43.5 test?
2. My CBC for Nuets and Lymphs are abnormal. I was soo soo stressed out the days leading to, day of, and immediate hour leading to test, could that have affect on numbers + should I be concerned at the counts ? I understand the could indicated a virus of some sort, or at least something going on
3. Was the runny nose at day 53(23 post pep) sign of conversion/ARS?
4. The exczema/(could be fungal?? hard to tell but due to my history let's say exzcema) is localized and size of thumb nail right above elbow crease. I had a flair up on day 43.5 when i tested. Could this be indicative of the "hiv" + "ars" rash + something to be concerned about
5. How much/dangerous is the exposure described ?
6. i know on the forum you mention 6 week after pep test. Would 13 days after pep test be indicative of anything. Like 50% hopeful or something?
7. At day 43.5 test(13.5 after pep). Would 4th gen test still pick up antigen at this point, with the idea of antibodies potentially being surpressed or does it simply not matter
Thanks!
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30 months ago
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And for CBC RBC 4.6, and Hgb 13.6 g/dL , Hct 38.9 . I was anemic like 10 years ago. This is the first blood test i have had in sometime so no full history
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H. Hunter Handsfield, MD
30 months ago
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Welcome to the forum. Thanks for your confidence in our services.
CDC has published estimates of HIV transmission risk for most kinds of sexual contact (e.g. penile-vaginal, -anal, -oral) but not for direct penis-penis exposure. As you describe it, I agree there is HIV transmission potential, if your partner had untreated HIV at the time of exposure. However, I would guess it is no higher than for penile-vaginal, for which the estimated risk -- for the penile partner if the female/vaginal partner is infected -- is one chance in 2,500. In other words, quite low. You can disregard your receipt of oral sex: there has never been a scientifically documented case of HIV transmitted oral to penis; and the CDC estimate (base on how people thought they had been infected, which itself can be very uncertain) is one infection in 20,000 exposures -- equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. But not knowing your partner's HIV status, it probably was reasonable to get PEP based on the penis-penis contact.
Your illness at day 23 of PEP for sure was not ARS. It's probably impossible to have symptomatic HIV infection while on PEP, especially since your later test (day 43) was negative. Antibody always is detectable within 3-4 days of onset of ARS symptoms. It isn't HIV itself that causes symptoms, but the body's immune response. A negative antibody test more than a few days after onset of symptoms doesn't necessarily exclude HIV entirely, but it does prove that any symptoms were not caused by HIV.
Those comments get a good start on your numbered questions, but to be explicit:
1,3. Your day 23 and day 53 symptoms had nothing to do with HIV or the sexual exposure. ARS does not cause nasal congestion, runny nose, etc. It's cold season; probably a minor virus, or maybe Covid as also implied by similar symptoms in your roommates.
2. Your CBCs were entirely normal; and in any case CBC is never useful in judging presence or absence of HIV infection, no matter how normal or abnormal it may be. There is no need to repeat it again.
4. The rash of ARS is entirely different, and fungal skin rashes do not occur so early in HIV infection. I see no reason to doubt a flare-up of your previously diagnosed eczema.
5. The exposure: See above.
6. Your negative result at 13 days probably is more reliable than 50%. Although 6 weeks post-PEP is advised, most people infected despite PEP probably have positive AgAb (4th generation) test results by 2 weeks.
7. This question reveals a misunderstanding about the AgAb tests. The antigen and antibody components are not independent of one another. It is the antibody that clears antigen from the blood. It is not possible to have antigen become negative in absence of antibody. In newly infected persons, the universal sequence of results is Ag-pos, Ab-neg; a brief interval (up to a few days) with both positive; then Ag-neg, Ab-pos which persists for life. Contrary to some alarmist online claims, there is no "secondary window", i.e. a negative-negative period before antibody is detectable.
Follow through with a final AgAb test 6 weeks after completing PEP (or whatever intervals advised by your treatment doctor or clinic). You can count on negative results.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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30 months ago
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I am also paranoid that someway pre-ejaculate may have gone unnoticed on my penis head, and would have been in contact with my inner foreskin when i ended up unretracting. I assume is is a very high transmissible event?
About the rash...it is dime sized circle and looks different from past skin issues at site. It has been persistent, although it has fluctuated in intensity and color since my first postPEP test. Forgot how many days prior it appeared, but has been around at least 30 days.I put ACV day ago it seems to have somewhat started to help. I was extremely nervous, stressed(still am), to original test. As was present on initial post pep test, and your guess likely not due to ACR. Could HIV trigger a chronic rash this early in a hypothetical infection or is it more in individuals with chronic HIV?
If Peps goal is to suppresses the virus(then remove it?) I still don’t understand true failure cases. Is it because the body needed more time to get rid of the virus, or was it a losing battle to being with? In my case I have been abstinent and was strict taking pep
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30 months ago
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Thank your for your time and verbose responses as well! They are very clear!
Also would those generally be asymptomatic after PEP if indeed infected due to the suppression due to PEP? I just dont understand why some people do and dont have symptoms
Thanks!
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30 months ago
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And forgot to mention. I understand at this point its A or B with regard to me being infected or not and only the test will show. My PCP wanted to meet in April but i will look to schedule something sooner post day 45 (friday) and mention rash
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H. Hunter Handsfield, MD
30 months ago
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My replies above already discuss the likely risk of HIV from penis-penis contact, which includes exposure to pre-ejaculate fluid. As I said, probably there is some risk, but probably it is quite low risk.
Nobody understands why some people with new hIV infection have symptoms of ARS and others (about half) have no symptoms at all. But it's the same with innumerable infections. Half of all people with covid-19 have no symptoms; many colds, influenza, and many other infections are possible and common without symptoms. ARS is no different.
As for "I still don’t understand true failure [of PEP]", it's happens because HIV has attacked susceptible cells in the body, and integrated its genetic material into those cells, before PEP was given or before high enough levels of PEP drug were achieved in the blood, the cells at risk, etc. But all in all, PEP is more than 90% effective in successfully preventing HIV infection
I would suggest following your doctor's advice about follow-up and testing. However, if she is available to see you and order your next AgAb test at 45 days, feel free. You can expect the results to remain negative. It is very unlikely you have HIV.
That concludes this thread. I hope the discussion has been helpful. Stay mellow as you await your final test results. With the negative tests so far, almost certainly you are not infected and your further tests will be negative. Best wishes and stay safe.
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