[Question #9737] Risk Assessment
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29 months ago
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Hi Doctor, I've been having massage sessions over last couple of weeks where the masseur gets half-naked and ends with a handjob. I'm worried about the risk of infection if the masseur had a previous client with semen or other fluids on their hands.
Additionally, during one session, the masseur rubbed her naked body and vagina over me (including crotch), followed by fingering each other with lots of cream, and then using the same hand to stroke my penis. My doctor prescribed PEP because there is a low risk of HIV transmission, but I'm worried about the side effects of Dolutegravir 50mg Emtricitabine 200 mg Alafenamide 25mg. I checked with my doctor and he said there are no long-term side effects, but I'm still unsure if it's worth it. Can you give me an expert opinion?
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29 months ago
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I had to trim my question for the last post so not sure if my concern is conveyed. I am worried about my last exposure which was 2 days back which had the possiblity of my penis being exposed to vaginal fluid. All other sessions only had hand penis contact beside my concern with stoking with unwashed hands which had some infectious fluids from previous client.
I am largely confused by my doctor who I believe is more into making money out of my misery than giving me an expert opinion. He is telling if I stop taking PEP he could have me tested for PCR for which I would don’t have to wait for 28 days (only 11 days for RNA PCR). I am confused with continuing PEP for this exposure considering any potential side effects in the future.
Also wanted to add I am an uncircumcised male., to add to ur risk assessment
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Edward W. Hook M.D.
29 months ago
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Welcome to our Forum and thanks for your comments. I’ll be glad to comment. The encounters you describe are classified as no risk encounters which do not require testing and certainly are not a reason to receive PEP. HIV is transmitted ONLY through penetrative sexual contact or injection of infectious materials deep into tissue. HIV becomes non- infectious upon exposure to the environment. Circumcision status makes no difference. Specifically HIV in NOT transmitted by contact with genital secretions transferred from person to person on the hands during masturbation. All major pubic health organizations, the CDC, the WHO, and NIH AGREE on this.
I see no medical or scientific reason for you to take PEP related to the encounters you describe. For that matter I see absolutely no reason for testing of any sort.
I hope this assessment is helpful to you. EWH
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29 months ago
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Thank You Doctor.
1)The local doctor that I referred said that there is a possibility of microscopic cuts in fingers or penis which would increase the odds. Per him, there are documented evidence of people acquiring HIV. And he used the same logic that microscopic cuts in my finger or penis could be exposed which she was rubbing her genital fluid or vagina over my body. I don’t remember of any visible cuts but I can’t be sure of microscopic cuts right?
2) what are the possible side effects of PEP? Any documented long term damage.. I have read couple of comments in other forum where it states SERIOUS SIDE effects. Is it related to kidney or liver damage?
3) just to confirm, if I was your patient you would advice me to discontinue taking the PEP from the exposure I mentioned - multiple handjobs from different masseur and episode of mutual masturbation where my uncircumcised penis was exposed to vaginal fluid without any penetrative sex involved (assuming all the masseurs were of high risk status)? Does it make any sense to continue this PEP medicine? Does the risk (side effects) outweigh the possibly little benefit?
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Edward W. Hook M.D.
29 months ago
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Straight to your follow-ups:
1. I respectfully disagree with your physician. Rubbing and masturbation by definition involves friction and so-called “microscopic cuts and scrapes” are common. This in no way changes my assessment. In my opinion, your doctor is being overly conservative.
2. All the medications have occasional side effects, and sometimes those are serious. That said, modern PEP is typically very well tolerated and has few long-term side effects.
3. This is a repetitive question. My answer is not going to change. I would not have recommended PEP nor been willing to prescribe it to you given the encounters you describe.
Just a reminder, this is your second follow up, you have one follow up remaining. EWH.
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29 months ago
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Hi Doctor- I will use my last follow up Only to make sure that your assessment also covers the risk of using the vaginal filled hands to massage my Penis. My concern is just not limited to fingering or vaginal fluid exposed to finger but using the hands that was used for fingering (covered with Vaginal fluid) over my penis shaft. During my last exposure, both myself and the masseur used the same hand that was used for fingering the vagina to massage my penis and handjob. And apart from this, she did rubbed her vagina over my crotch. Would it lead to increased risk?
You might have already covered this point in you assessment but wanted to double check with you that you had not missed this out. I plan to stop the PEP unless if you say otherwise based on the latest response. I really thank you for the service.
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Edward W. Hook M.D.
29 months ago
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This is a repetitive question. Repeating the question will not change the answer. The exposure you described was a no risk event with no reason for concern. No need to be taking PEP, no reason for even testing at all.
As you know, this concludes this thread. Take care. I hope you will be able to move on without continuing concern. EWH.
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