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Post Exposure Prophylaxis
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Post Exposure Prophylaxis

I realize from the Community section that my post is exhaustively long and I apologize. But I reassert that providing the entire picture is detrimental to fully understanding the situation and ensuring no mistakes or errors are made due to incomplete information.
I would like to tell a story, so I can give a complete picture of what exactly happened. I will start with what happened exactly and my health at that point, then I will explain the measures taken, and will ask the questions I wanted to ask.

I am a 26 y/o male with no health problems whatsoever and have never contracted any STD (perhaps because I was abstinent for 3 years and only had sex when I was married). I also had corrective jaw surgery close to two weeks ago (I mention this to give an accurate picture of the gum healing, and possible bleeding. There hasn't been any bleeding for about a week now, so I assume the gums and inner cheek are healed).

I decided to get a massage yesterday at a massage parlor from an older, surgically enhanced, asian lady with questionable habits and obvious promiscuity. Things became a bit interesting and stupidly (isn't this always the case) the following happened. We started fooling around a bit and touching and feeling. No condom was involved, but there was NO penetration, or Oral sex from either side whatsoever. So neither of us performed Oral sex and I did not penetrate her vaginally. We kissed a few times, but she had her mouth completely closed and clenched shut during this time and she was being cautious so I am assuming she is vigilant and doesn't allow kissing so she doesn't contract anything (or at least I hope). I didn't get a chance to kiss comfortably either since my jaw was wired shut. So, for all intensive purposes, NO saliva or tongues were in contact. Then I proceeded to suck on her nipple for a few minutes, but as I said she is an older lady with obvious breast implants, so I am certain she was NOT lactating and I did not see/notice any discharge. As a matter of fact, she was very dry around the nipple area.

Here is the kicker, and this is my major concern, for a brief window of 30 seconds to a minute the head of my penis was rubbing against her vagina continuously with no barrier between us. My penis was in direct contact for a very short period of time (like I said) with her vaginal fluids. But no penetration occurred through that route in any way. However I did insert a few fingers a little deeper in her vagina for a minute or two. Everything was very fast (again, perhaps due to my abstinence. It didn't take much to ejaculate). I cant remember if I held my penis with the hand that had fingers in her vagina, but if I did then I am sure it was very short since it was the left hand and I usually use my right hand to hold my penis or do anything of the sort.

As soon as I ejaculated on her stomach. I wiped my penis dry with tissue and then she brought a hot towel that she used to lightly clean my penis. ~30 minutes later when I realized how stupid what I had done was, I got some antibacterial and proceeded to clean the entire penis with it momentarily and then dried it again with tissue.

I became extremely paranoid. Lets face it, I am not Casanova, so she obviously had done this with a lot of men. Although, I would like to point out that she was healthy and did not have any sores or any general symptoms indicative of an STD. I understand that some STD's are asymptomatic at times.

So, within 2 hours of the incident, I was in the ER talking to the doctor and explaining what had happened and told him I wanted the post exposure prophylaxis since I dont do this often and this is a one time thing, and I dont want to get HIV or HSV for a stupid moment that didn't even include actual sex, just momentary rubbing genitals together.

I explained to the doctor that I had just finished my amoxicillin course that was prescribed by my surgeon to prevent any infection after the jaw surgery. So, within the two hours of the incident, he gave me some pills and a hip shot. I received Azythromycin and Acyclovir, but cant remember which was a pill and which was the shot.

I told him I wanted to get tested for STD's but he said they dont do it in the emergency room and that I have to do it in a county facility. The incident was 8:30PM and these medications were given to me around 10:30PM. I was not given anything else to take home or a prescription to fill. He wanted me to go get tested first.

This is stupid because HIV and HSV, my obvious main concern, since the other STD's are curable, wont show up that early. So the following morning I went to see my primary care physician, since county told me it would take 10 days to receive the results, and I explained to him what had happened exactly as I am telling the story just now. He examined my penis under white light for any lesions or tears around the urethra and along the shaft and told me he did not notice anything.

He was surprised the hospital didnt prescribe a course of antibiotics and antivirals as a precautionary measure, so he prescribed a 5 day course of Acyclovir with 400mgX3times a day as a preventative measure for any herpes infection and Azithromycin 400mg once a day for 3 days for Chlamydia. He then proceeded to give me the blood test for HIV and HSV (again I dont know why, if they dont show up that early. Maybe to shut me up). He told me it was very unlikely that I would contract an HIV infection since the scenario I described coupled with his examination were not indicative of an increased risk for HIV. And the lady did not disclose anything that indicates she has any STD's. He did not prescribe any PEP for HIV because he thinks that since only her vaginal fluid was in contact with my penis at that point, that the chance of receiving an HIV infection, if she had one, would be VERY low. Perhaps less than 0.0005% but I could be unlucky I suppose.

As soon as I left his office, I picked up the medications and took the first doses at around 2:50PM, and have continued taking them throughout the day today. And here I am now a little after midnight writing this.

After ALL of this:
-Should I be worried?
-Why did he test me for HIV and HSV bloodtests if its too early? was he going to run PCR tests this early or will he be using an antibody, eventhough it way too early for my immune system to develop anything? Or was it to just shut me up?
-Is it probable that I will receive an HIV or HSV infection (or both)?
-I am getting an independent full STD check tomorrow that my doctor doesnt know about. I wanted to establish some base lines just in case. How accurate are HIV PCR test below the 28 day mark? What should I do? I dont want to spend the entire month putting my life on hold because I DIDN'T have sex!
-How soon can I test for HSV and HIV after a possible exposure? And when would be a good time to stop worrying?
-Do I have to wait the entire 3-6 months for the HIV test? I dont want to ruin my own life after so much hard work.
-When can I get a DEFINITIVE answer through testing? When can testing be completely reliable without having to get re-tested?

ONE MAJOR question. The Acyclovir he prescribed as a PEP will that KILL a possible Herpes infection since its less than 24hrs post a possible exposure, or will it just slow it down and prevent any possible outbreaks? He told me not to worry and that after the 5 days Acyclovir course I shouldnt even bother testing for Herpes since the antiviral will take care of it. But I dont understand what he meant by take care of it. After taking the entire course so soon after a possible exposure, will I ever have a Herpes infection because of this incident? Will it be latent in my body with no symptoms or outbreaks, is that what he meant? Or will Acyclovir be strong enough to kill it so soon after exposure that I just wont have an HSV virus in my body?

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