Continue PEP or not

[pdyddy]

Hi Dr,

6 days ago I had protected vaginal sex with a AMP escort.
Afterwards I noticed a tear on my scrotum that was not bleeding but hurt a little.
The tear was underneath my testicles so I am not certain that if it came in contact with vaginal fluids..
I showered about 10 minutes afterwards and this is when I noticed it

Freaked out the next day I went to the emergency room.
At first they did not offer it but after my asking they offered a Hep B Vac shot and Travuda.
I followed thru with my primary physician and he said the idea of continuting was totally my call.
I hemmed and hawed and decided to continue.

Now I am concerned about damaging my kidneys/liver on a drug I might not even have to be on...I haven'nt called my primary back because I know the answer....the same haiku answer

To confound things the drug is starting to kick in and I feel like Im on a ride that I want to get off.
My dreams are bizarre I feel foggy and generally ill at ease.

Not holding anyone to anything but what would you suggest?

[pdyddy]

thanks for all your help dr

[Edward W Hook, MD]

You have little to worry about.  Your symptoms are very unlikely to be Hepatitis B. That said, it is clear that what I say means little.  I would suggest that you get a blood test for hepatitis B antigen. When this is negative, put this behind you.  This thread is over.  No more answers.  EWH

[pdyddy]

the problems with work have been there for 6 months now

i took time off to blow off steam but blew off a little too much

and then walked into this punch

i dont think i have HIV...but the fact that the girl was Asian concerns me with the Hep B
i realize that sysptoms most likely wouldnt even appear after 20 days

then I read stuff about the Hep B Vaccine and the mind wanders....

i should have refused both treatments from the get go
in fact i was about to leave but decide to be safe then sorry

what a mess

i appreciate your advice

[joggen]

It sounds like you are suffering from 'HIV anxiety disorder' and nothing else. And as is often the case, those suffering from this disorder had sex with a sex worker.

As the doctor indicated, most CSW's do not have HIV or HepB (and that is most as in >90%!). While assuming a commercial partner is infected is a safe approach as this helps motivate careful use of condoms, this assumption is wrong at least 9 times out of 10. And, despite having safe sex with a condom, you seem convinced you are infected with something because you found a tear at the bottom of your scrotum. You are having 'what if' thoughts about vaginal fluids leaking all the way down to the bottom of your testicles that are fueling your anxiety, that don't seem realistic to this objective observer.

So now, as is classic with HIV anxiety disorder, you are anxiously searching your body for anything unusual. But your 'symptoms' sound like nothing more than the usual psychosomatic variety of those suffering from HIV anxiety. I've read alot of similiar posts on this board and your focus on body sensations is typical of HIV anxiety sufferers.

It sounds like you will need another test (HepB) before you can convince yourself you are not infected. You might as well do so and collect another negative result, so you can get on with your life.

I hope this anxiety is not the cause of your problems at work. If it is, consider taking time off or a leave of absence and seek counseling until you are over this.

[pdyddy]

made a mistake in my question

i meant to say

I went to my primary dr and had my blood tested after getting off Truvada he said things looked fine....

[pdyddy]

Hi again Dr,

Im 20 days since my vaccination for the Hep B....

I have a slew of other problems at work....mainly that I could be terminated any day now
So it is difficult for me to judge which end is up....nerves or something else

In the mornings...my right hand...specifically the finger get cold...the sensation goes away by 11am most of the time....some days are better than others..the joints are tender

On my left side...my back when I lean back...driving or sitting...it feels sensitive
Walking around it does effect me as much

If there any possibiity the the Hep B vaccination has something to do with this

I went to my primary and had my lover tested after getting off the Truvada and he said things looked fine...

Could it actually be Hep B infection this early that the PEP treatment failed to stop?

thanks for your help

[Edward W Hook, MD]

The utility of PEP for prevention on hepatitis B is unknown.  It is designed to prevent HIV.  I'm not sure why you are worried about hepatitis B, your risk for that, ike your risk for HIV is very low.  You need to get past this and stop worrying.  EWH

[pdyddy]

One last question and then that its...

With the question of Hep B....I was given PEP treatment for Hep B...

Coming off the Truvada after 5 days would you anticipate problems..
there is a chance that I might be infected with Hep B...

the warnings for the Truvada was that coming off it might adversely affect those infected with Hep B......does someone like me count in that situation

what are the chance also the the Hep B PEP will stop the Hep B infection...is there was one?

[pdyddy]

thanks again dr

[Edward W Hook, MD]

The Truvada should not complicate your response to hepatis B vaccine.  EWH

[pdyddy]

Is there any thing that I should also be concerned with consider the I was vaccinated for Hep B as well...

After 5 days of taking Truvada is that long enough time to complicate matters if I was infected with Hep B>?

[pdyddy]

thanks Dr...I stopped yesterday

[Edward W Hook, MD]

You had a single protected exposure to a commercial sex worker (CSW).  You are worried however because you noted a lesion which MAY have been exposed to her secretions during the act and your concern lead to being put in antiviral therapy (something I would not have recommended following the expsoure you describe).  Your chances of having gotten HIV from this exposure are extraordinarily low.  Here's why:

1,  Chances are, your partner did not have HIV.  Most CSWs do not.
2.  Your chance of getting HIV, if she was infected and if you did not use protection is less than one in 1000 per exposure.
3.  You do not know that the sore you noted on your scrotum was exposed to her secretions. It would be an unusual location for exposure, anatomically.

When you put all of these facts together, your chances of being infected from the exposure you describe is less than one 100th of 1%.  My advice is that taking the antiviral therapy is a waste of time.  I would stop (actually, I would not have started).  Hope this helps.  EWH