I am a gay male . I got tested last year in October  Negative .

I have not indulged in anal sex or blowing anyone in the last 2 years . However recently i met a masseur on an app and he gave me a massage and handjob .

He also fingered me and things got intense when we kissed . Later i noticed a tiny bruise on my lip , when i saw it .

I panicked a lot and started with PeP within 24 hours . 

I completed the Pep already , it’s been about 10 days . However now i have started to feel very fatigued and weak since last 2 days . My throat also pains when i eat at times. I feel extremely tired and i am very stressed that i may have exposed myself to hiv or some STD.

Request your advise please . Thanks 

You describe a zero risk exposure in regard to HIV, which has never been documented to be transmitted by kissing, hand-genital contact, or fingering. Receiving unprotected oral sex might be a bit more risky, but still near zero:  here too there has never been even a single case of HIV that was scientifically documeted to have been transmitted oral to penis. Based on how some people THOUGHT they were infected, CDC calculated a possible risk of one transmission for every 20,000 events with known infected partners. That's equivalent to receiving BJs by infected persons once daily for 57 years before infection might be likely.

Accordingly, I'm surprised to see you were prescribed PEP in this situation. Some providers will prescribe PEP just for the asking, but the more professional approach is to assess risk and advise the patient accordingly. Had you come to me or my clinic, we would hae refused to prescribe PEP in this situation.

But that's water under the bridge. Now what about your tymptoms? They are not suggestive of acute retroviral syndrome (ARS, i.e. initial HIV infection). And no other STD causes such symptoms -- and they started much too late to be from an STD other than HIV.

For reassurance, you should follow up with your doctor, or whoever prescribed the PEP. You could be tested now for HIV, using an antigen-antibody (AgAb, 4th generation) blood test. It's too soon to be 100% certain about HIV; that requires testing 6 weeks after the last dose of PEP. However, a negative test at this time will prove your symptoms are not due to HIV. It isn't possible to have ARS with a negative blood test. (It isn't HIV itself that causes symptoms, but the immune response to the virus. And the immune response is reflected in the antibody test.) After your negative result, you can have a final test 6 weeks after your last dose of PEP to prove 100% you don't have HIV.

Stay mellow in the meantime. There is no realistic possibility you have HIV. (In nearly 20 years of this and our preceding forum, with thousands of questions from people worried about HIV, nobody has turned out to be infected. If and when that finally happens, it won't be someone with such near-zero risk exposure, and it won't be someone who had PEP. In other words, you won't be the first.

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

HHH, MD

Thanks for your response .

Had a few follow up questions :

1. Would taking pep delay ars symtoms ? For example would pep cause someone to experience symtoms once they completed the one month course of pep ?

2. Sinxe i go the gym ,

i continued with whey protein while on pep , would that affect the efficacy of pep?

3 Sinxe the past 3 to 4 days , i have been feeling extremely fatigued and dizzy . Also i have been feeling itchy and my skin feels sensitive . Are these symtoms related to hiv?

4. Finally, you mentioned that this is not a risky exposure . Would testing be compulsory post this exposure ? 

5. Finally, is kissing risky in the presence of a bruise ? I noticed a tiny bruise after i kissed and hence i got worried after this exposure . There was NO anal sex , nor did i blow that person.

Request you to please advise . Thanks 

2. No, these things would not change the effectiveness of PEP.

3. No, there symptoms do not suggest HIV.

4. No, testing was not at all "compulsory" after such an exposure. As I said, you didn't need PEP -- and you didn't even need testing. 

5. Kissing has never been known to transmit HIV, with or without a bruise.

Thanks for your reply .

I have also been feeling slight shivering or tremors during the day , though i don’t feel cold ? Is this a symptom of hiv or some std ? I am very worried 

Also i was curious to know , how can we be sure that. no case had been attributed to kissing or fingering ? Since people who kiss must be also having sex and it is difficult to attribute what activity put them at risk ?

Finally:

1. Should i consider taking prep if i am just going to have oral sex ?

2. Could you explain if prep on demand is effective and how does it work ? Thanks 

1. Most experts would not recommend PrEP if oral sex is the only potential exposure and neither would I. However, many who plan on only one sexual practice get caught up in the moment and "things happen". You're the only one who can judge how likely that might be for you.

2. PrEP on demand has been reported as highly effective, but is not yet formally recommended by CDC or most other public health agencies. I'm not intimately familiar with the research study outcomes, but it's being used with increasing frequency. It's simple: Same drugs as PEP, one dose taken in the hours before potential exposure and two more doses afterward (I forget the exact recommended intervals.)

I've never heard of OTC or other informally available ARVs that were counterfeit or otherwise ineffective. I doubt the source of your drugs makes any difference.

"Shivering or tremors during the day" doesn't suggest ARS. And as noted above (I think), you cannot have ARS symptoms while taking ARV treatment.

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