HIV - Prevention Expert Forum
Multiple Issues
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Multiple Issues

I requie ur advice please  I met a friend in Hong Kong that has been working on/off as a CSW. She is brazilian and caters only to high end clients.  We saw each other 2 nights ago and we had unprotected vaginal for a long time and unprotected anal sex (i think) for 5 minutes. We then had unprotected vaginal sex again the following night.  She was also at the tail end of her period so there was blood. The next day she explained that she has not had unprotected sex since her last check 3 mths and has been postive before, but never had a break out.  She also told me that she had been working a lot lately, which i was upset about. 18 hours after the last exposure she went out and got tested for everything.  She came back with a bordeline postive of HSV2  and a possiible ureaplasm.  Everything else was negative and the HIV test was oraquick-sure test.  I went to a clinic and they gave me doxy-7 days, zmax-2 Grams and PEP.  I started the PEP 60 hours later from the act, and all my tests came back negative.  Now that we have the results, here are my questions. 1.  If i where to get HSV2, when would a likely break out appear and what are the odds of me getting it, given she has told me she has never had a breakout that she is aware of being positive before and is at the low end of the positive range, not the middle range and her reading was a 22.7.  2.  About the ureaplasm, should i continue with the doxy or given that she was negative for everything else, i can stop that now.  I took 2 grams of zmax . 3.  Now that we have a negative HIV test for her, should i continue taking the PEP.  How much are my odds improved from the 1/500 for insertive anal sex, given at the worst we know that she is in the window period and 5 weeks ago at least she was neg.  Does her menstration make a difference in the odds? I was heavily intoxicated, butshe promised me we did not perform anal, and I tend to believe her. I dont know if anal happened, she says it did not.  TY.      
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Welcome to the Forum.  I'll try to help.  To summarize you had unprotected sex with a partner who has worked as a commercial sex worker but who, after your encounter, was tested for HIV and STDs and, other than a borderline positive test for HSV-2 and ureaplasma, had negative tests including for HIV and for other STDs.   Thus this was a low risk exposure.  

On to your questions.
1.  If i where to get HSV2, when would a likely break out appear and what are the odds of me getting it, given she has told me she has never had a breakout that she is aware of being positive before and is at the low end of the positive range, not the middle range and her reading was a 22.7.  

I am not familiar with tests that give values of the sort you report however, most people with "positive" blood tests for HSV do not have herpes but have falsely positive tests. Even if she has HSV however, in the absence of lesions there is little risk to you of infection, the risk being less than 1% and probably closer to a 1 in 1000 chance of getting infected.  This is not something to worry about.

If you were to have acquired HSV, you could expect for an outbreak of lesions to occur at a site of exposure, most likely on your penis.  

2.  About the ureaplasm, should i continue with the doxy or given that she was negative for everything else, i can stop that now.  I took 2 grams of zmax .

Ureaplasma is normally present in the genital tract and that she had a positive test is not a surprise.  This does not mean that it is an STD and in most circumstances here in the U.S. we do not test for ureaplasma and if someone happens to test for it, we do not treat it.  With negative tests there is no reason for you to continue to take antibiotics.

3.  Now that we have a negative HIV test for her, should i continue taking the PEP.  How much are my odds improved from the 1/500 for insertive anal sex, given at the worst we know that she is in the window period and 5 weeks ago at least she was neg.  Does her menstration make a difference in the odds?

I would not have recommended PEP for you and see no reason for you to continue to take it.  If your partner had a negative tests, there is almost no chance that she was infectious and would infect you.  That she was menstruating makes no difference in your risk or in my assessment.

I hope my comments are helpful. As I said above, given your partner's test results, this was a very, very low risk exposure.  I would not worry and would not continue to take PEP or doxycycline.  EWH
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Dr.

Thank you for you timely advice.  My friend got her results back after another test and it was positive for ureaplasm.  Should i stay on the doxy, or per your previous advice, go off it and this does not matter?  Also, is the reason I do not have to worry about HIV infectiion is that for someone to transmit the disease, they at least need enough of the viris in their body so it can be contagious and given she was negative on her test, i have nothing to worry about.  Accordingly, the window period does not matter?  Thanks!!!!!
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300980_tn?1194933000
Perhaps you missed it. In my original answer I said "Ureaplasma is normally present in the genital tract and that she had a positive test is not a surprise.  This does not mean that it is an STD and in most circumstances here in the U.S. we do not test for ureaplasma and if someone happens to test for it, we do not treat it."  Accordingly, I would not bother taking the doxy.

As for HIV, the chance that your partner was in the window period is statistically so small that while theoretically a possiblity, that possibility is so small as to not be a concern.  EWH
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