[Question #9693] Dating partner Living with HIV

30 months ago

I am a gay man who met a guy a few months ago. We dated three times and the first two intimate acts were ONLY kissing. The last time we engaged in deep kissing and masturbated. Before engaging in substantial sexual activity, I tested him using the HIV In-Home Test and he was HIV+. I was so shocked that I hurry to the clinic for PEP. I was very thankful that I did not have any kind of anal or oral sex with him.

After 28d PEP I had a HIV Ag/Ab test, and a syphilis specific antibody and syphilis non-specific antibody test, they are all negative. The day after finishing PEP, our local CDC confirmed that my dating partner had HIV and also syphilis, both untreated.

1. I have read many articles tell that kissing and masturbation cannot transmit HIV. Does this mean I can safely move on with my life?

2. I didn't know my partner had syphilis until 30 days after exposure. I went to many hospitals and was told that the four week results were so close to conclusive that they did not think I needed prophylactic treatment. Is my current four week result strong?

H. Hunter Handsfield, MD

30 months ago

Welcome to the forum. Thank you for your confidence in our services.

Sorry to hear of your exposures. However, they were low risk, despite your partner's newly diagnosed HIV infection and syphilis. HIV is not transmitted by kissing or by hand-genital contact, so there was little if any risk. Syphilis can be transmitted by kissing, but it is uncommon. To your questions:

1. If PEP fails to prevent HIV, the time to positive test results is delayed. A negative HIV AgAb at the time PEP is completed really doesn't mean very much. Most experts advise an HIV AgAb test 6 weeks after the last dose of PEP, and some even advise 3 months. Because the exposure risk was very low, you can expect your future tests to remain negative, but you should have those tests just to be certain.

2. Most people with new syphilis would have positive blood tests by one month, but not all of them; it can take up to 3 months. Most experts -- including official policy in the US (from the Centers for Disease Control and Prevention, i.e. CDC) is that all known contacts of someone with infectious syphilis be treated with benzathine penicillin, even if they test negative. If you and your doctor choose not to treat you at this time, you should have repeat syphilis blood tests 2 months and 3 months after your last exposure with your infected partner.

I would further advise that you cease any and all sex (including kissing and hand-genital contact) until he has been started on treatment with anti-HIV drugs, and testing documents he no longer has HIV detectable in his blood. Once undetectable, any and all sexual practices with him will be safe. But that time might be a few months away.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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30 months ago

Dr.HHH:

Thanks For your reply.

1. I am in China and doctors do not always treat according to guidelines. I went to the hospital this morning and was strongly urged to have an injection of benzathine penicillin. Fortunately they gave me 2.4 million units of benzathine penicillin. I would like to know when should I have a blood test for syphilis if I am treated? Is it still at 8 weeks after exposure as well as 12 weeks?

2. I have always thought that kissing does not transmit STI, so I am not in the habit of giving each other an HIV test before kissing. Even the doctors at the clinic learned that my only exposure was kissing and masturbation and they did not agree to issue me a PEP, but I insisted. I now know that kissing has the potential to transmit syphilis, but is unlikely to transmit HIV, and I am hoping that I will be HIV Ag/Ab negative in 6 weeks.

Regrards

H. Hunter Handsfield, MD

30 months ago

1. I'm glad to hear you have been treated appropriately. As a result, you do not need any further testing for syphilis. Even if you were exposed and potentially infected, treatment prevents the test from ever becoming positive.

2. As you now realize, there was no need for PEP. Its only effect is to delay the time until you know for sure you were not infected. Your AgAb test will be negative, however. Don't be worried while you wait.

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29 months ago

1. my boyfriend has started antiviral treatment (TDF+3TC+EFV). I would urge him to change to a regimen that includes an integrase inhibitor, such as Biktarvy, as soon as possible.

2. I do not think it is realistic to stop all sexual contact with him for nearly 6 months. I would like to have some low-risk contact, such as kissing, while on PrEP. Can I use PrEP immediately or wait 12 weeks for a conclusive negative result?

3. my doctor has recommended PrEP with TAF + 3TC. he believes that TAF has fewer side effects than TDF and that the price of TAF and 3TC alone is much less than Descovy or Truvada in China. is this option appropriate?

H. Hunter Handsfield, MD

29 months ago

1. You should not be in charge of your partner's HIV treatment. Let the professionals in charge of his care select the best regimen for him. In any case, this forum does not advise particular HIV treatments over others.

2. Once he has been on ARV treatment for a couple of weeks, it is likely he will no longer be infectious, or at least the transmission risk will be much lower. Kissing is safe in any case; and condom protected oral or anal sex probably safe as well, especially if you continue PrEP. Here too, I suggest you and your infected partner discuss the situation with his doctor(s) and follow their advice.

3. All these standard PrEP regimens are equally effective, or close enough that it really doesn't matter. It's up to you and your (or your partner's) doctor.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.

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