Worried Sick about Oral.

[braduf]

On Wed Aug 2nd, I was driven home by someone who was an aquaintance of a friend because I had been drinking and he had not.

After arriving back at my place the person began to get fresh and in my drunkeness he kissed me and I didn't resist (ignorant). One thing led to another and to my total and utter stupidity.

I ended up doing 2 incredibly stupid things that have me worried sick.

I gave him oral sex and when trying not to swallow, he pushed harder and I ended up having to swallow to breath.  The second time happened in the middle of the night then I was awakened to him shoving his **** into my mouth and cumming, only this time I ended up running to the bathroom and spitting the *** out and rinsing with water.  I do NOT know his HIV status.

This sounds as though I am placing the blame on him, but not at all so.  I should have never placed myself in this situation.

These 2 incidents are absolutely and positively my only risk for years and years.  I have only had anal sex 2 times in my life maybe 15-20 years ago. I am 44.

I am a gay male and have been in a relationship for nearly 20 years and I have not ever had anything similar to this happen.  

I get tested regularly only because we have always done so with my checkups.  I had a negative test just last month and for all previous test for 10+ years.

I have a friend who is a doctor.  I told him of the incident on Monday Aug 7th (4.5 - 5 days after possible exposure because I had some diahrea and stomach churning) and he prescribed 6 weeks of Combivir at my begging after he told me that it was a line of treatment for healthcare workers exposed by needle sticks and such. He seemed to think I was more worried than I should be but no one knows until they have been in this situation how much of a mental rollercoaster it is.

One last point. I can't remember if I brushed my teeth before going to bed but I think I did. I don't have sores or anything in my mouth but have had extensive dental work in the past year replacing old crowns and sometimes bleeding occurs when I brush.

Thanks for all of your great forums.  I have read many of your answers to questions and haven't found the answer to this one.

I would like to know how worried I should be (risk factor) and what you would suggest I do from here.  I am worried sick and want to get tested as soon and as often as I need to in order to help with my worry.

Thank you.

[who_is_this]

The risks of PEP are low, but not nonexistent. In my case, the infectious disease fellow said that my risk of a serious side effect from PEP was higher than my chances of getting HIV from this particular exposure.  

(the person was eventually contacted and returned for an HIV test and was negative, so it was all a moot point anyway.)

[H. Hunter Handsfield, M.D.]

If everyone with your level of risk (and even substantially higher) took PEP, much of the population would be on Combivir or related drugs at any point in time.  That in turn would markedly increase the risk of HIV resistance to the drugs, with immense harm to both currently infected and future infected people.  And although the risks of serious side effects from modern antiretroviral therapy are low, that risk probably is higher than the chance of catching HIV from a single episode of receiving oral sex, especially when you don't even know your partner was infected.

HHH, MD

[braduf]

Thank you for your comments.

I understand that you, the Dr. and others don't believe that PEP was/is warranted.  I guess what I am trying to figure out is why.

Seems to me that if there is any minute possibility that PEP would in any way prevent a seroconversion that it should be done.  How am I wrong here?  Aside from the fact of cost, as I have said, I paid from my own pocket about $1,100.00 for my Combivir for 90 tablets/6 weeks.  How could spending that, although significant, amount of money not be worth it on the possibility it could lower my risk even if 1 in 1000.  As someone else said in one of the threads.  Someone has to be the 1.    

Am I missing something?  Is it the money? Is it that the PEP does not work after exposure?  Or why?

I am not argueing with you or the Dr., I am only trying to find the answer for myself and others on the site.

I am still taking the Combivir and so far (1 week today) I haven't had any major side effects.  A slight headache about 1 hour after taking it, but I think I have resolved that with eating a sandwich or meal prior and lots of water during the day.  Some stomach upset but not much. A few small things that may be me just worrying.  Even though I will have to say that this site and the Dr. have helped tremendously with my worry.  The encouraging words are really helpful.

I have noticed that I am napping more during the day and sleeping soundly at night.  I contribute that to the Combivir as it is not my normal pattern.

The way I look at it is what is 6 weeks of 2 pills if it helps at all and doesn't hurt my health.  I haven't been able to find anything that tells me that the Combivir is harmful to me other than the side effects while taking the medication.  If the Dr. told me I was harming my body in some way, I would reconsider taking it based on my risks.

Please tell me where I am wrong.

I am now feeling that I am either using precious resourses that others can't get??? or keeping someone who may need them more than me (is the medication scarce?)  or that I am in some way harming myself by taking the medication.

I am going to talk to my friend/doctor today again and ask if he wants me to stop the Combivir.  You know that Drs. say that when you are prescribed medication you should take it all until it is completely finished.

Thanks for all of the supportive words.

[who_is_this]

PEP will not change your test results or delay a positive.

You absolutely did not need PEP, as Dr. HHH said in his answer.  Your provider friend succumbed to your "begging" against his better judgement.  These drugs are powerful, and not without side effects themselves.

I'll give you an example.  I was stuck deeply (healthcare worker) by a large bore, blood containing needle from a person with unknown HIV status once.  The person had already left the ER.  No way to test the person immediately (you have to have permission in my state).  The infectious disease doc on call would not give me PEP.  Said the risk of PEP was not worth the  possible benefit.

So certainly YOUR exposure was much, much less than that.  You didn't need it in the first place.  PEP will not change or delay your results, either.  You did not get HIV from the exposure you described, either.  Period.

[braduf]

Doctor,

I didn't get an answer from the previous post, I hope that I am not asking to many questions.

I have been unable to locate the person to ask HIV status.

Also, in reading the forums I am confused as to whether or not the PEP will change my window of testing.

Thanks.

[freddy999]

and even that figure was guessed at...

[monkeyflower]

Well, I personally think a risk of one in 10,000 (CDC, 2005) is pretty darn low (and that's oral with a *known* HIV infected person).

[braduf]

Doctor, may I ask the question another way.

Please understand I would not make any changes in my medication without consulting my doctor/friend first.  I have continued the meds since Monday.

I also am not asking that you repeat yourself.  I fully understand all but one part of your answer.

What I am trying to futhur understand is whether you feel that my risk is at a low enough level that the PEP is unwarranted or if your opinion is that that it would not help in my case.  I understand that I didn't start the medication until approximately 4.5 - 5 days after possible exposure.

From my lay point of view, I would think that any possible lowering of risk would be warranted however small as long as the risk of the medication is not greater than the benefits.

I will say for the record that I have no history of drug use either legal or illegal. Maybe 3 aspirin per month for headache from a night out. Again this was my only stupid sexual mistake. Except for poision ivy from my dogs, I am in otherwise overall good health except slightly elevated chelsterol.

Thanks.

[H. Hunter Handsfield, M.D.]

Sorry, I can't give such specific medical advice, in particular will not advise someone to not follow another provider's recommendations.  You should discuss it with your own doctor/friend (or get a second opinion).  You may factor my general opinions into the discussion, but I'm not the one to make the decision.

HHH, MD

[braduf]

Thank you Doctor.

Should I stop the Combivir?

Is is hazardious for me to continue other than the wierd feeling and stomach upsets?

Thanks.

[mpo131]

Besides the nasty side effects associated with HAART medication,  no problems if short term.

PEP is HAART medication given to individuals with a High risk exposure (anal/vaginal sex) with a known or highly suspected HIV infected person.  It's used for 4 weeks and is somewhere around 70% effective in stopping HIV infection.

[braduf]

Sorry, Each time i read your response I have another question.

I have only taken 6 tablets of the Combivir (lamivudine 150mg/zidovudine 300mg) so far.  I started Monday 7th Aug with one pill in the afternoon, 2 on Tuesday, 2 on Wednesday and 1 so far today with 1 left to take this evening.  It makes me feel a little wierd, but is worth it if it helps in my situation.

Should I stop?  Will it not help if i had an exposure?

You mentioned "waste of resourses" and i take that as you think the risk is low.  Possibly so, you must know my worry.  I am paying for all of this out of my pocket even though i have insurance.

[braduf]

Is it harmful for me to take Combivir if I were not exposed?

What is PEP?

Thanks.

[braduf]

Thank you for your reassuring words.  I have had NO, NO, NO other risk that I know of.

I want to test for my own mental health.  I have never had any mental health issues until this week.  I just worry that if the person were HIV+ that it may have seeping my gums or blood at the base of my teeth if any were present or something in my stomach.

I probably will never drink again as I am only a recreational drinker with friends.  It just simply isn't worth the stupidity that comes from it in my case.

As for the medication, i told my doc friend that i wanted to do everything possible.  He didn't really want me to go through the meds, but i said if there were any possibility, i wanted to do everything i could.  I believe it is giving me diahrea or the worrying is.

[mpo131]

Good Afternoon!

Now if you don't know already, your situation is considered very low risk. While it is possible to be HIV infected this way it is VERY unlikely.  You would have to be extremely unlucky.  Scientific research following serodiscordant couples over a number of years proves this. Personally, If this is your only risk in years I am not even sure if testing would be necessary if only to relieve your anxiety over your situation.  You can definately locate this study on the web somewhere, it might help relieve some of that anxiety.

The fact that antiviral medication was prescribed is really surprising as well and a waste of resources.  Also, this very well could delay your window period but I am not completely sure.  I know the guidelines recommend testing three months after your 4 --not six- weeks of PEP is complete.  So, as far as a reliable testing time, I am of no help.  If on the other hand you did not take PEP, 8 weeks is very, very close to conclusive, and depending on what state, (Cal, NY, or Mass) four.

[H. Hunter Handsfield, M.D.]

The risk of catching HIV from any single episode of oral sex is very low (less than 1 chance in several thousand) even if your partner is infected, and regardless of tooth brushing, dental work, etc.  Your doctor/friend was absolutely right that you were more worried than necessary; he overreacted in prescribing post-exposure prophylaxis (PEP), which you did not need.  Clearly his clinical judgment was negatively influenced by your friendship and "begging".  

The obvious thing for you to do now is find out your partner's HIV status.  Just call and ask; most infected people do not lie about it when asked directly.  If he is positive, have an HIV test; one test 6 weeks after the event is all you need.  Otherwise, put this behind you and go on with life.

Best wishes--  HHH, MD