Aa
HIV Risk & PEP impacts.
Hi there.
Thank you for taking the time to read this. I think it's awesome that your resources are out there helping people.
I have a unique situation which I would like an opinion on.
Last night I may have had what was a high risk exposure with a Thai sex worker.
Before we went to bed to have sex, we had a shower together during which time she put my penis in her vagina. My penis was in her vagina for between 20 seconds.. i mistakenly thought ejaculation was the key factor in HIV transmission.
We then went to my bed and had protected sex. There was no condom split etc.
This was a one off incident.
Something about it played on my mind this morning and I decided to investigate online.
This led me to book an immediate appointment with the local hospital and the doctor there has put me on a course of PEP. I started medication 10 hours after exposure.
I have a few questions on this.
1. What is the risk of me becoming HIV+ from this incident bearing in mind my unprotected penis was exposed for a short time and after withdrawal would water from the shower have had any effect? Statistically what are my odds?
2. Will the PEP effectively stop me from developing HIV
3. How soon after exposure will I be able to confidently know I am in the clear and does PEP affect the timing of this process.
Many thanks in advance for your deliberation of my circumstances?
ARENAPUA
Thank you for taking the time to read this. I think it's awesome that your resources are out there helping people.
I have a unique situation which I would like an opinion on.
Last night I may have had what was a high risk exposure with a Thai sex worker.
Before we went to bed to have sex, we had a shower together during which time she put my penis in her vagina. My penis was in her vagina for between 20 seconds.. i mistakenly thought ejaculation was the key factor in HIV transmission.
We then went to my bed and had protected sex. There was no condom split etc.
This was a one off incident.
Something about it played on my mind this morning and I decided to investigate online.
This led me to book an immediate appointment with the local hospital and the doctor there has put me on a course of PEP. I started medication 10 hours after exposure.
I have a few questions on this.
1. What is the risk of me becoming HIV+ from this incident bearing in mind my unprotected penis was exposed for a short time and after withdrawal would water from the shower have had any effect? Statistically what are my odds?
2. Will the PEP effectively stop me from developing HIV
3. How soon after exposure will I be able to confidently know I am in the clear and does PEP affect the timing of this process.
Many thanks in advance for your deliberation of my circumstances?
ARENAPUA
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
I'm a little surprised the local physician considered this a sufficiently high risk exposure to recommend PEP. In general, HIV is a lot less common than it once was in Thai sex workers, owing to a very successful national educational campaign. Perhaps s/he reasoned the risk is higher because your CSW partner apparently is not a consistent condom user; or perhaps there is available information about a particularly high rate of HIV in sex workers locally. To your specific questions:
1) If a woman has HIV, one calculation (by CDC, the US national public health agency) suggests an average risk of one transmission for every 2,000 episodes of unprotected vaginal sex. If we guess a 10% chance your partner had HIV, that would put your risk at 1 in 20,000. Probably actually lower than that, given the brevity (20 seconds) of unprotected exposure. I doubt the shower, water exposure, etc make any difference one way or the other.
2) The effectiveness of PEP following vaginal sex can only be estimated; it's a nearly impossible topic for systematic research. Most experts believe it's around 90% effective.
3) When PEP does not work, it theoretically can delay the time to a positive blood test. Most experts recommend testing at 6 months to be confident that infection didn't occur. (This is one of the downsides of PEP. Without it, definitive testing can be done much earlier -- so one of the effects of PEP can be to prolong the anxious period until final testing.)
I hope these comments are helpful. Best wishes-- HHH, MD
I'm a little surprised the local physician considered this a sufficiently high risk exposure to recommend PEP. In general, HIV is a lot less common than it once was in Thai sex workers, owing to a very successful national educational campaign. Perhaps s/he reasoned the risk is higher because your CSW partner apparently is not a consistent condom user; or perhaps there is available information about a particularly high rate of HIV in sex workers locally. To your specific questions:
1) If a woman has HIV, one calculation (by CDC, the US national public health agency) suggests an average risk of one transmission for every 2,000 episodes of unprotected vaginal sex. If we guess a 10% chance your partner had HIV, that would put your risk at 1 in 20,000. Probably actually lower than that, given the brevity (20 seconds) of unprotected exposure. I doubt the shower, water exposure, etc make any difference one way or the other.
2) The effectiveness of PEP following vaginal sex can only be estimated; it's a nearly impossible topic for systematic research. Most experts believe it's around 90% effective.
3) When PEP does not work, it theoretically can delay the time to a positive blood test. Most experts recommend testing at 6 months to be confident that infection didn't occur. (This is one of the downsides of PEP. Without it, definitive testing can be done much earlier -- so one of the effects of PEP can be to prolong the anxious period until final testing.)
I hope these comments are helpful. Best wishes-- HHH, MD
Hi Doc
Thanks for your comments.
It was I who mentioned the PEP in the conversation and wanted to know about it.
He did mention the risk of exposure through pre-cum and that it was likely less of a risk than if I had continued with full unprotected sex.
He mentioned the risk of exposure was around 1/1000 and PEP reduces it by about 90%.
I just wonder whether my anxiety prompted him to suggest PEP.
As we parted he told me to relax as my risk is almost zero.
I've only taken one dosage of the PEP. Should I continue?
Thanks for your comments.
It was I who mentioned the PEP in the conversation and wanted to know about it.
He did mention the risk of exposure through pre-cum and that it was likely less of a risk than if I had continued with full unprotected sex.
He mentioned the risk of exposure was around 1/1000 and PEP reduces it by about 90%.
I just wonder whether my anxiety prompted him to suggest PEP.
As we parted he told me to relax as my risk is almost zero.
I've only taken one dosage of the PEP. Should I continue?
MEDICAL PROFESSIONAL
I wondered whether the PEP idea started with you and not the doctor. It sounds like he and I are in general agreement about the risk level; the difference between his and my transmission estimates (1 in 1,000 versus 2,000) is trivial.
No distant online forum can give specific medical advice and I will not make any suggestion as to whether or not you continue with PEP. This is something for you to discuss with the doctor who prescribed it. But if you're inclined to stop PEP, I would advise you not to do so until your doctor recommends it. The worst thing would be to take the drug intermittently.
No distant online forum can give specific medical advice and I will not make any suggestion as to whether or not you continue with PEP. This is something for you to discuss with the doctor who prescribed it. But if you're inclined to stop PEP, I would advise you not to do so until your doctor recommends it. The worst thing would be to take the drug intermittently.
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