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Unprotected Vaginal Sex With Sex Worker - Now on PEP
Okay, here is the story. I was very drunk and I picked up a sex worker. She was 20 years old, and later told me she had been "working" since she was 15. We started with protected sex, but because I was having a hard time with erection, she took the condom off. She did oral. Then there was some UNPROTECTED frottage and VAGINAL SEX for about 2-3 minutes. I pulled out and before ejaculation.
- I then applied hand sanitizer on my penis because I was already anxious.
- I asked about her HIV status, and she said she was clean. She said she was tested 2 weeks ago but that I should be careful because a lot of girls have HIV.
- I am circumcised
- I called a clinic the next day. They told me to come in and gave me TRUVADA AS PEP FOR 28 DAYS.
My question is:
1) If she had HIV, would I have been infected as soon as there was contact with mucous membrane of the urethra?
2) Would the fact that I ejaculated short after exposure have any affect? Pushing fluids out?
3) Was it a bad idea to use the hand sanitizer? I thought the alcohol would kill the virus on impact, but it can also cause inflammation and increase risk. Would this matter if it was AFTER the exposure? Did I make the situation worse by doing this?
4) I have read that nPEP is thought to be helpful, but there are no studies. Should I keep going with PEP? If I am infected, will it cause drug resistance?
5) Would an antibody test at 4 weeks still be 70-80% accurate if I take PEP?
Please help.
- I then applied hand sanitizer on my penis because I was already anxious.
- I asked about her HIV status, and she said she was clean. She said she was tested 2 weeks ago but that I should be careful because a lot of girls have HIV.
- I am circumcised
- I called a clinic the next day. They told me to come in and gave me TRUVADA AS PEP FOR 28 DAYS.
My question is:
1) If she had HIV, would I have been infected as soon as there was contact with mucous membrane of the urethra?
2) Would the fact that I ejaculated short after exposure have any affect? Pushing fluids out?
3) Was it a bad idea to use the hand sanitizer? I thought the alcohol would kill the virus on impact, but it can also cause inflammation and increase risk. Would this matter if it was AFTER the exposure? Did I make the situation worse by doing this?
4) I have read that nPEP is thought to be helpful, but there are no studies. Should I keep going with PEP? If I am infected, will it cause drug resistance?
5) Would an antibody test at 4 weeks still be 70-80% accurate if I take PEP?
Please help.
MEDICAL PROFESSIONAL
There simply are no data; we don't know. I would think testing would be pretty accurate 4 weeks after completing PEP, but really can't say more. Sorry.
I meant the END of treatment. So it would be 8 weeks after exposure. Would 4 weeks after exposure with PEP still be fairly accurate?
MEDICAL PROFESSIONAL
It's splitting hairs to worry about 28 days from exposure or treatment. Presumably your PEP was started within 3 days (most experts don't recommend it after that) -- and there probably is no measurable difference in test performance between 25, 28, or 31 days. Just follow your PEP provider's advice about it.
Thank you for the response.
I know the conclusive results are 3-6 months after PEP treatment has ended.
How comfortable can I be if I take an antibody test at the end of 28 day PEP treatment? You said the 70-80% seemed right. But is that 4 weeks after treatment or after exposure?
Thanks
I know the conclusive results are 3-6 months after PEP treatment has ended.
How comfortable can I be if I take an antibody test at the end of 28 day PEP treatment? You said the 70-80% seemed right. But is that 4 weeks after treatment or after exposure?
Thanks
MEDICAL PROFESSIONAL
Welcome to the (correct) forum. I can help.
Assuming you are in the US or other industrialized country, the average chance any particular female commercial sex worker has HIV is no higher than 1% (1 in 100) and usually more like 1 in 1,000. In this case, however, the risk could be higher; starting sex work at age 15, it seems a reasonable bet she has been abused, perhaps orginally forced into prostitution, etc -- a high risk situation. That said, most people, even CSWs, don't lie when asked directly about HIV status.
If a woman has HIV, with unprotected vaginal sex the average transmission rate to male partners is once for every 2,000 exposures. Still, the advice you receive PEP was not unreasonable. Such decisions depend a lot on local epidemiology, i.e. the frequency of HIV in CSWs locally. If your clinic or doctor felt this exposure was sufficiently high risk to suggest PEP, I respect that decision.
To your specific questions:
1) See my comments above about the 1 in 2,000 risk. HIV is not instantaneously transmitted.
2) Ejactulation during or after sex has no known effect on HIV transmission from female to male. (But ejaculation in the vagina probably increases the female risk if the male partner has HIV.)
3) Good question; you have done some useful research. There are indeed theoretical reasons that using alcohol or other disinfectants (or even washing with soap) may increase the risk of HIV if exposed. But if so, it's a small effect and this doesn't alter my judgment that you are at low risk of HIV.
4) True, there are no studies in humans to prove that PEP works to prevent HIV after sexual exposure. That doesn't mean it doesn't work; it's just a very difficult thing to study and the strong consensus among experts that PEP works. Once started, don't stop; it's early cessation of treatment that increases the risk of HIV drug resistance , so that would be exactly the wrong thing at this point.
5) There are no good data on the effect of PEP on time to reliable HIV testing. My guess is that your numbers are about right for a test at 4 weeks. Because PEP may delay antibody development if the drugs are not successful, most if not all experts recommend that testing after PEP be carried out through 6 months after exposure. (It's one of the downsides of PEP -- potential prolongation of anxiety until definitive results are available. However, most experts also agree that the results at 8-12 weeks remain reliable; the last test at 6 months is just a precaution.
The doctor/clinic that prescribed PEP should be the main source of any additional questions you may have. For sure follow their advice about how long to continue treatment and testing over the next few weeks or months. But I hope this information has been helpful.
Final word: Next time use a condom, for goodness sake!
Regards-- HHH, MD
Assuming you are in the US or other industrialized country, the average chance any particular female commercial sex worker has HIV is no higher than 1% (1 in 100) and usually more like 1 in 1,000. In this case, however, the risk could be higher; starting sex work at age 15, it seems a reasonable bet she has been abused, perhaps orginally forced into prostitution, etc -- a high risk situation. That said, most people, even CSWs, don't lie when asked directly about HIV status.
If a woman has HIV, with unprotected vaginal sex the average transmission rate to male partners is once for every 2,000 exposures. Still, the advice you receive PEP was not unreasonable. Such decisions depend a lot on local epidemiology, i.e. the frequency of HIV in CSWs locally. If your clinic or doctor felt this exposure was sufficiently high risk to suggest PEP, I respect that decision.
To your specific questions:
1) See my comments above about the 1 in 2,000 risk. HIV is not instantaneously transmitted.
2) Ejactulation during or after sex has no known effect on HIV transmission from female to male. (But ejaculation in the vagina probably increases the female risk if the male partner has HIV.)
3) Good question; you have done some useful research. There are indeed theoretical reasons that using alcohol or other disinfectants (or even washing with soap) may increase the risk of HIV if exposed. But if so, it's a small effect and this doesn't alter my judgment that you are at low risk of HIV.
4) True, there are no studies in humans to prove that PEP works to prevent HIV after sexual exposure. That doesn't mean it doesn't work; it's just a very difficult thing to study and the strong consensus among experts that PEP works. Once started, don't stop; it's early cessation of treatment that increases the risk of HIV drug resistance , so that would be exactly the wrong thing at this point.
5) There are no good data on the effect of PEP on time to reliable HIV testing. My guess is that your numbers are about right for a test at 4 weeks. Because PEP may delay antibody development if the drugs are not successful, most if not all experts recommend that testing after PEP be carried out through 6 months after exposure. (It's one of the downsides of PEP -- potential prolongation of anxiety until definitive results are available. However, most experts also agree that the results at 8-12 weeks remain reliable; the last test at 6 months is just a precaution.
The doctor/clinic that prescribed PEP should be the main source of any additional questions you may have. For sure follow their advice about how long to continue treatment and testing over the next few weeks or months. But I hope this information has been helpful.
Final word: Next time use a condom, for goodness sake!
Regards-- HHH, MD
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