[Question #9759] Insertive heterosexual anal & vaginal HIV risk assessment

29 months ago

Hi Doctor,
Can't say I'm happy to be back here, but its always nice to get your opinion.

Yesterday I had one night stand with a girl of unknown HIV status. It started with a condom but it came off in the "heat of the moment".
The whole ordeal lasted 15-20 minutes with both unprotected anal and vaginal intercourse. I realize I may have potentially been exposed. Is the high risk enough to go on PEP?
If yes, is Truvada alone sufficient for PEP as I don't have access to the other med?

Edward W. Hook M.D.

29 months ago

Welcome back to our Forum and thanks for your questions. The answer to your question relates to the likelihood that your partner had untreated HIV. Throughout much of the world, relatively few heterosexual women have untreated HIV. In terms of your risk if she was, each of the unprotected sex acts you describe is associated with a less than 1 in 1000 risk for acquiring HIV. Your risk for more common infections such as Gonorrhea or chlamydia is substantially higher.

Bottom line, your risk for HIV from the exposure you describe is quite low, possibly less than 2 in 100,000 (assuming a 1% HIV prevalence and 2 sex acts). Taking PEP is a personal decision. If you decide to take PEP, the sooner you start the better. Truvada alone is not a recommended PEP regimen. Most experts recommend 3 active drugs and Truvada is just 2.

EWH

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29 months ago

Thank you for your prompt reply Dr. Hook.

Assuming she had untreated HIV, my risk would be 2 in 100,000. While this bottom line is rather assuring, the risk is still present I suppose.

So I shall be getting tested for gonorrhea and chlamydia at 2 weeks and HIV for at 1 and 3 months. Please feel free to let me know if I should test for anything else.

What I get out of your answer is that PEP would be overkill for this case even when assuming she had ARS. Considering the sides of meds like Truvada, I want to avoid PEP as much as possible.

I even considered using it as on demand PrEP but didn't think it was worth it.

With that being said, what would a person of your expertise in the field would do in such a scenario? Go for PEP or get a rapid antigen/antibody test at 18 days?

Edward W. Hook M.D.

29 months ago

You can get tested for gonorrhea and chlamydia any time 4-5 days following your exposure and anticipate conclusive results.

I cannot answer your question as to whether or not to get PEP. I can tell you however that if you can arrange for her to be tested with a 4th generation test at this time, if the test is negative, you can be confident you were not exposed and therefore, there is no need for PEP. Persons whose partners test negative at the time, of after an exposure are not at risk for infection.

I hope this perspective is helpful. EWH

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29 months ago

I understand Doc. For the record I went against PEP because I hear it may often cause whats called a immune reconstitution syndrome. I'm no expert but that sounds very bad. Does this always happen, even for on demand PrEP?

For HIV, just going to have to hope the the favorable odds were favorable indeed...

Edward W. Hook M.D.

29 months ago

Thanks for your follow-up. I would have made the same decision based on the information you provided.

FYI, the immune reconstitution syndrome can be severe but only occurs in persons with existing, longstanding HIV infection. It would not occur in someone who had just recently been exposed to the infection as is your case.

The odds are quite good that were not infected. Please don't worry.

This completes this thread. EWH

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