Aa
Brief Dip, HIV Risk, PEP
Dr.
Engaged in frottage with another male who said they were STD and HIV-. He moved in such a way that I penetrated him (I am circumsized) for one stroke for less than 3 seconds. He also gave me oral. Went to doctor next day and started PEP (Truvada) 14 hours after encounter. 1 week later, got an STD (Gonorrhea, NGU or Chlamydia) that doctor treated me for. Sent person an e-mail letting them know they were not std neg and confirm they were HIV - and they blew me off so know I am concerned about their status.
1) Looks like chances to get HIV from insertive is 1 in 300 to 1 in 900. Would you guess my brief penetration would take that risk down?
2) How effective is PEP 14 hours after exposure? Not sure if my doctor is making me feel better, but he has seen alot worse risks and said he has prescribed PEP alot in the last few years and not one person who started within 24 hours tested positive.
3) Does the std increase risk? I did not have it before. I have read I would be at greater risk if I had std prior to encounter but not if I got from encounter. I do not have herpes or anything like that.
4) Lastly, my doctor will give me an HIV PCR DNA test 2 days after completing PEP. He believes a negative there is very solid since DNA would be effected within 30 days. I wanted to get your opinion.
I do trust my doctor and he has significant experience with HIV treatment and prevention but concerned with all the stuff I read on the internet.
Engaged in frottage with another male who said they were STD and HIV-. He moved in such a way that I penetrated him (I am circumsized) for one stroke for less than 3 seconds. He also gave me oral. Went to doctor next day and started PEP (Truvada) 14 hours after encounter. 1 week later, got an STD (Gonorrhea, NGU or Chlamydia) that doctor treated me for. Sent person an e-mail letting them know they were not std neg and confirm they were HIV - and they blew me off so know I am concerned about their status.
1) Looks like chances to get HIV from insertive is 1 in 300 to 1 in 900. Would you guess my brief penetration would take that risk down?
2) How effective is PEP 14 hours after exposure? Not sure if my doctor is making me feel better, but he has seen alot worse risks and said he has prescribed PEP alot in the last few years and not one person who started within 24 hours tested positive.
3) Does the std increase risk? I did not have it before. I have read I would be at greater risk if I had std prior to encounter but not if I got from encounter. I do not have herpes or anything like that.
4) Lastly, my doctor will give me an HIV PCR DNA test 2 days after completing PEP. He believes a negative there is very solid since DNA would be effected within 30 days. I wanted to get your opinion.
I do trust my doctor and he has significant experience with HIV treatment and prevention but concerned with all the stuff I read on the internet.
MEDICAL PROFESSIONAL
Good Morning
I think overall the risk is small, if at all. As you have discovered though, what people tell you in a sexual situation like the one you describe need not necessarily be correct.
The NSU you have had is likely to have arisen from you accumulating miscellaneous bacteria from the other guy's rectum into the tip of your urethra - resulting in a discharge etc.
The risk of acquiring HIV - if the other person has it - from insertive anal sex is calculated to be around 0.06% per episode.
You have asked the following questions and my answers are given next to each question:-
1) Looks like chances to get HIV from insertive is 1 in 300 to 1 in 900. Would you guess my brief penetration would take that risk down?
Yes, as I say the overall risk is around 0.06% if the other person was HIV positive. The fact that you penetrated for such a short period is likely to be in your favour.
2) How effective is PEP 14 hours after exposure? Not sure if my doctor is making me feel better, but he has seen alot worse risks and said he has prescribed PEP alot in the last few years and not one person who started within 24 hours tested positive.
PEP is established as being useful in post exposure situations. There are estimates of reduction of chances of transfer of HIV after using PEP by around 80%. There are a few reports at least where individuals have been inadvertently transfused HIV positive blood and given PEP immediately on discovery of the error and who have not gone on to develop HIV.
There are circumstances where HIV transfer is much more likely such as where herpes 2 infection also occurs and the HIV positive person is recently infected and consequently has a high viral load.
The problem with PEP is that we know that HIV exposure does not always result in infection - far from it and so judging whether the person has just been lucky and avoided infection or whether PEP has worked is difficult.
3) Does the std increase risk? I did not have it before. I have read I would be at greater risk if I had std prior to encounter but not if I got from encounter. I do not have herpes or anything like that.
No, you had an NSU which whilst sexually acquired in your case can be acquired from activities such as solo masturbation etc.
4) Lastly, my doctor will give me an HIV PCR DNA test 2 days after completing PEP. He believes a negative there is very solid since DNA would be effected within 30 days. I wanted to get your opinion.
I can understand where he is coming from with this although I would recommend that people have an ultra-sensitive PCR RNA test done after 7 days post completing PEP. The whole point about PEP is that is designed to subdue or prevent viral replication. If PEP fails then you can argue that PCR ; antibody ; and or p24 antigen testing will be positive. However the data on this is incomplete as yet. Therefore my logic is to do a PCR RNA test at 7 days after completing PEP followed by a 4th generation combined HIV 1 and 2 antibody test and p24 antigen at 14 days after completion and then to stick to the guidelines which say to test 4 months after completing PEP. In my experience, chances of an antibody test yielding a positive after the first two tests detailed above yielding a negative are zero.
best wishes, Sean
I think overall the risk is small, if at all. As you have discovered though, what people tell you in a sexual situation like the one you describe need not necessarily be correct.
The NSU you have had is likely to have arisen from you accumulating miscellaneous bacteria from the other guy's rectum into the tip of your urethra - resulting in a discharge etc.
The risk of acquiring HIV - if the other person has it - from insertive anal sex is calculated to be around 0.06% per episode.
You have asked the following questions and my answers are given next to each question:-
1) Looks like chances to get HIV from insertive is 1 in 300 to 1 in 900. Would you guess my brief penetration would take that risk down?
Yes, as I say the overall risk is around 0.06% if the other person was HIV positive. The fact that you penetrated for such a short period is likely to be in your favour.
2) How effective is PEP 14 hours after exposure? Not sure if my doctor is making me feel better, but he has seen alot worse risks and said he has prescribed PEP alot in the last few years and not one person who started within 24 hours tested positive.
PEP is established as being useful in post exposure situations. There are estimates of reduction of chances of transfer of HIV after using PEP by around 80%. There are a few reports at least where individuals have been inadvertently transfused HIV positive blood and given PEP immediately on discovery of the error and who have not gone on to develop HIV.
There are circumstances where HIV transfer is much more likely such as where herpes 2 infection also occurs and the HIV positive person is recently infected and consequently has a high viral load.
The problem with PEP is that we know that HIV exposure does not always result in infection - far from it and so judging whether the person has just been lucky and avoided infection or whether PEP has worked is difficult.
3) Does the std increase risk? I did not have it before. I have read I would be at greater risk if I had std prior to encounter but not if I got from encounter. I do not have herpes or anything like that.
No, you had an NSU which whilst sexually acquired in your case can be acquired from activities such as solo masturbation etc.
4) Lastly, my doctor will give me an HIV PCR DNA test 2 days after completing PEP. He believes a negative there is very solid since DNA would be effected within 30 days. I wanted to get your opinion.
I can understand where he is coming from with this although I would recommend that people have an ultra-sensitive PCR RNA test done after 7 days post completing PEP. The whole point about PEP is that is designed to subdue or prevent viral replication. If PEP fails then you can argue that PCR ; antibody ; and or p24 antigen testing will be positive. However the data on this is incomplete as yet. Therefore my logic is to do a PCR RNA test at 7 days after completing PEP followed by a 4th generation combined HIV 1 and 2 antibody test and p24 antigen at 14 days after completion and then to stick to the guidelines which say to test 4 months after completing PEP. In my experience, chances of an antibody test yielding a positive after the first two tests detailed above yielding a negative are zero.
best wishes, Sean
I really appreciate you helping me through this. Unfortunately, there is a pyschological component that makes it difficult and results in irrational people such as myself.
Regardless, I got my results back today and it was undetectable at 20 copies.
Thanks for being there Dr Cummings. Your compassion is unmatched. Wish i still lived in London so I could have been under your care.
My doctor agrees with your position that my risk is now zero.
Regardless, I got my results back today and it was undetectable at 20 copies.
Thanks for being there Dr Cummings. Your compassion is unmatched. Wish i still lived in London so I could have been under your care.
My doctor agrees with your position that my risk is now zero.
MEDICAL PROFESSIONAL
Hello
Good - I agree - I think the prospect of you ultimately ending up HIV positive in these circumstances with a negative ultrasensitive HIV RNA PCR test are zero.
Mervyn is a nice chap really!
We'll -( including Mervyn!) will keep our fingers crossed too - I think you'll be fine.
very best - and try and stop fretting about it.
Sean
Good - I agree - I think the prospect of you ultimately ending up HIV positive in these circumstances with a negative ultrasensitive HIV RNA PCR test are zero.
Mervyn is a nice chap really!
We'll -( including Mervyn!) will keep our fingers crossed too - I think you'll be fine.
very best - and try and stop fretting about it.
Sean
Approved - Yes. Available - looked/called on every test website, called the two major diagnostic test companies (Labcorp and Qwest Diagnostics) and neither have adopted the P24 antigen test. Availability is not the same as when I lived in London.
That is why I took the Ultrasensitive RNA test two weeks after last PEP dose. Finally got to speak to my Doctor (like you guys, lots of HIV experience) who said that they RNA would spike big time within a couple of weeks if I has infected after last dose of PEP. Now I will keep fingers crossed that it is negative.
Thank you for your time.
That is why I took the Ultrasensitive RNA test two weeks after last PEP dose. Finally got to speak to my Doctor (like you guys, lots of HIV experience) who said that they RNA would spike big time within a couple of weeks if I has infected after last dose of PEP. Now I will keep fingers crossed that it is negative.
Thank you for your time.
MEDICAL PROFESSIONAL
I did indeed read the post....the FDA seems to think that a p24 is available in the USA....see the linke here....http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm216375.htm
Maybe you failed to read the post, I can't get a P24 antigen test here in the States. I have looked everywhere (and I mean everywhere) so I went with the Ultrasensitive RNA at two weeks. Dr. Sean is not only patient, but considerate of people's feelings when they are going through an extremely tough time.
MEDICAL PROFESSIONAL
Lord in Heaven!....Dr Sean has the patience of a saint...how many times does he have to spell it out for you??...now stop this and get a grip please..I'm repeating below what Dr Sean has said already and you need to read it again and then follwo the instructions! Goodness me! Mervyn
"I can understand where he is coming from with this although I would recommend that people have an ultra-sensitive PCR RNA test done after 7 days post completing PEP. The whole point about PEP is that is designed to subdue or prevent viral replication. If PEP fails then you can argue that PCR ; antibody ; and or p24 antigen testing will be positive. However the data on this is incomplete as yet. Therefore my logic is to do a PCR RNA test at 7 days after completing PEP followed by a 4th generation combined HIV 1 and 2 antibody test and p24 antigen at 14 days after completion and then to stick to the guidelines which say to test 4 months after completing PEP. In my experience, chances of an antibody test yielding a positive after the first two tests detailed above yielding a negative are zero"
"I can understand where he is coming from with this although I would recommend that people have an ultra-sensitive PCR RNA test done after 7 days post completing PEP. The whole point about PEP is that is designed to subdue or prevent viral replication. If PEP fails then you can argue that PCR ; antibody ; and or p24 antigen testing will be positive. However the data on this is incomplete as yet. Therefore my logic is to do a PCR RNA test at 7 days after completing PEP followed by a 4th generation combined HIV 1 and 2 antibody test and p24 antigen at 14 days after completion and then to stick to the guidelines which say to test 4 months after completing PEP. In my experience, chances of an antibody test yielding a positive after the first two tests detailed above yielding a negative are zero"
I finished PEP two weeks ago and today (couldnt find anyone who offered DUO test - looked all over the net) took an Ultrasensitive RNA test (down to 20 copies) and an antibody test. If these are negative, is it biologically possible to still test positive later (no other encounters)? Or can I finally get on with my life?
Thanks
Thanks
MEDICAL PROFESSIONAL
"Any comment on the cut? "
No - its fine - irrelevant.
No - its fine - irrelevant.
Any comment on the cut?
Well, I finished my last dose of PEP and will be testing in two weeks. One thing that has been nagging me. i had trimmed up my pubes with a beard trimmer about 13 hours before the encounter and nicked myself about 1.5 inch from the base on my penis shaft. It bled but I took a shower and all bleeding stopped. Before we engaged in frottage, we had protected anal (didnt mentione before as it was protected) for a couple of minutes but the condom did not cover the nick. I am sure this nick came into contact with his rectal secretions. Would this increase my risk? I believe it was superficial (couldnt even tell 3 days later) and didnt bleed after my shower.
MEDICAL PROFESSIONAL
Hi again,
Yes, there is a lack of p24 testing in the US, although it is FDA approved since June of 2010 - see here
http://www.medscape.com/viewarticle/723965
You can access it via private labs but I'm afraid I can't tell you which ones.
I think though a PCR will give you all the information you need and I suspect will be negative.
best wishes and good luck, Sean
Yes, there is a lack of p24 testing in the US, although it is FDA approved since June of 2010 - see here
http://www.medscape.com/viewarticle/723965
You can access it via private labs but I'm afraid I can't tell you which ones.
I think though a PCR will give you all the information you need and I suspect will be negative.
best wishes and good luck, Sean
I really appreciate your detailed explanation. The internet makes it difficult to get answers with so much conflicting information. One last question. There seems to be a lack of P24 antigen testing here in the states (my doctor doesnt prescribe to it and none of the testing sites), so should I just wait two weeks (post PEP) and get an ultrasensitive RNA and antibody test?
Quick update. Although I had discharge, Gonorrhea and Chlamydia came up negative. My doctor said NGU/NSU caused by bacteria. Not sure if this has an impact to anything.
One last thing. I got a shot and two pills for the std last wednesday. Today, when I milked my penis, I noticed a very small amount of discharge. how long should it take before I dont notice anything anymore. I am hoping I dont have a resistant strain.
Couple of clarifications. Won't know until Monday if it was Gonorrhea, Chlamydia or NGU. I was given Truvada only; not sure why I was not prescribed Kaletra with it. I am in the U.S. right now for work which is why I am guessing the doctor wants to to the DNA test; apparently the P24 antigen isnt standard over here.
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