Aa
HIV Exposure with CSW and PEP
Hello Doctor,
I am very worried about an HIV exposure. I recently made a drunken mistake and had unprotected vaginal intercourse with a Korean CSW in Los Angeles. We met via her profile at a paid website that reviews providers. During our session, we both got caught up in the moment and failed to use protection.
I typically am very careful and always use protection. However, the alcohol got the better of me. Hopefully, the cost of learning this lesson will not be my health and my life.
The next day, I managed to get her on the phone again to ask her about her HIV status. There is a language barrier as she speaks almost no English, but I think I got my point across. After some confusion and rudimentary translation on my part, I think she said that everything is ok and that she got tested in Korea a month ago, just before coming to the US. She made it seem like it wasn't something to worry about because she was Korean. This somewhat cavalier attitude only made me worry more about her past safety, even though it sounds like an isolated incident for her as well.
After a sleepless night of worry, I went to an emergency room and obtained PEP for this exposure. I am discovering that the side effects are bearable but more than I expected.
Here are my questions to you:
1) What is your risk assessment of HIV infection this situation? How does her country of origin or being a foreign CSW affect the probability?
2) Would you have recommended PEP in this same situation?
3) How soon should I get tested?
4) Would it be worth it to pay her to take an at-home HIV test? If negative, I assume it would be safe to go off the PEP?
Thank you much for your time.
Best,
Lesson Learned
I am very worried about an HIV exposure. I recently made a drunken mistake and had unprotected vaginal intercourse with a Korean CSW in Los Angeles. We met via her profile at a paid website that reviews providers. During our session, we both got caught up in the moment and failed to use protection.
I typically am very careful and always use protection. However, the alcohol got the better of me. Hopefully, the cost of learning this lesson will not be my health and my life.
The next day, I managed to get her on the phone again to ask her about her HIV status. There is a language barrier as she speaks almost no English, but I think I got my point across. After some confusion and rudimentary translation on my part, I think she said that everything is ok and that she got tested in Korea a month ago, just before coming to the US. She made it seem like it wasn't something to worry about because she was Korean. This somewhat cavalier attitude only made me worry more about her past safety, even though it sounds like an isolated incident for her as well.
After a sleepless night of worry, I went to an emergency room and obtained PEP for this exposure. I am discovering that the side effects are bearable but more than I expected.
Here are my questions to you:
1) What is your risk assessment of HIV infection this situation? How does her country of origin or being a foreign CSW affect the probability?
2) Would you have recommended PEP in this same situation?
3) How soon should I get tested?
4) Would it be worth it to pay her to take an at-home HIV test? If negative, I assume it would be safe to go off the PEP?
Thank you much for your time.
Best,
Lesson Learned
Thank you for your thoughts, Dr. Handsfield. I appreciate your answer as well as the information I've gleaned from your past posts these past couple days. Much of this information is new to me.
As you might have suspected, the ER doctor who prescribed me the PEP was hesitant to do so. But because I was in a panic and agreed to make an appointment with an HIV specialist, he complied with my request. He did not consider Korean immigrants or CSW's to be a high risk group, but thought I should confirm his assessment with a specialist.
In regards to the PEP prescription, I have an appointment with an HIV specialist to see if I should continue per the ER doctor's request.
Thank you again for your perspective.
Best,
LL
As you might have suspected, the ER doctor who prescribed me the PEP was hesitant to do so. But because I was in a panic and agreed to make an appointment with an HIV specialist, he complied with my request. He did not consider Korean immigrants or CSW's to be a high risk group, but thought I should confirm his assessment with a specialist.
In regards to the PEP prescription, I have an appointment with an HIV specialist to see if I should continue per the ER doctor's request.
Thank you again for your perspective.
Best,
LL
MEDICAL PROFESSIONAL
Welcome to the HIV forum. Your question is like many others and the replies are the same.
First, heterosexually transmitted HIV is extremely rare after single sexual exposures. Most HIV transmissions occur in couples who have repeated sex for many years, typically with the infected person being unaware s/he has HIV.
Second, it is unlikely your partner had HIV -- and especially unlikely given what she said after you called her up. Most people don't lie about it when asked directly. Her "cavalier" attitude should be reassuring, not a cause for worry.
Third, even if she had HIV, the average chance of female to male HIV transmission for unprotected vaginal sex is once for every 2,000 exposures. That's equivalent to having sex with HIV infected women once daily for 5 years and maybe never catching it. HIV is not all that easy to transmit!
I'm surprised you were prescribed PEP. I would not it for you, even if you asked for it. However, perhaps there are local data that support a more aggressive approach in this particular community. For example, if it were known that CSWs in the area -- or mabye Korean immigrants in particular -- have particularly high HIV rates, perhaps PEP is warranted. But I am doubtful.
Now to your specific questions:
1) See above. As I recall, HIV rates are low in Korea -- like in Japan, where they are very low.
2) This sort of exposure does not fit into usual criteria for PEP.
3) Have an HIV antibody test in 6-8 weeks. You can expect it to be negative.
4) I'm not going to go against the advice from the doctor who prescribed PEP. If your partner has a negative HIV test, please talk to the doc about continuing or stopping PEP. My recommendation would be you don't need it in that case, but this should be between you and the doc who prescribed it.
Bottom line: There is little if any HIV risk here. But discuss continuing PEP with the doc who prescribed it.
Regards--- HHH, MD
First, heterosexually transmitted HIV is extremely rare after single sexual exposures. Most HIV transmissions occur in couples who have repeated sex for many years, typically with the infected person being unaware s/he has HIV.
Second, it is unlikely your partner had HIV -- and especially unlikely given what she said after you called her up. Most people don't lie about it when asked directly. Her "cavalier" attitude should be reassuring, not a cause for worry.
Third, even if she had HIV, the average chance of female to male HIV transmission for unprotected vaginal sex is once for every 2,000 exposures. That's equivalent to having sex with HIV infected women once daily for 5 years and maybe never catching it. HIV is not all that easy to transmit!
I'm surprised you were prescribed PEP. I would not it for you, even if you asked for it. However, perhaps there are local data that support a more aggressive approach in this particular community. For example, if it were known that CSWs in the area -- or mabye Korean immigrants in particular -- have particularly high HIV rates, perhaps PEP is warranted. But I am doubtful.
Now to your specific questions:
1) See above. As I recall, HIV rates are low in Korea -- like in Japan, where they are very low.
2) This sort of exposure does not fit into usual criteria for PEP.
3) Have an HIV antibody test in 6-8 weeks. You can expect it to be negative.
4) I'm not going to go against the advice from the doctor who prescribed PEP. If your partner has a negative HIV test, please talk to the doc about continuing or stopping PEP. My recommendation would be you don't need it in that case, but this should be between you and the doc who prescribed it.
Bottom line: There is little if any HIV risk here. But discuss continuing PEP with the doc who prescribed it.
Regards--- HHH, MD
You are reading content posted in the HIV - Prevention Forum
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?
Can you get HIV from casual contact, like hugging?
Frequency of HIV testing depends on your risk.
Post-exposure prophylaxis (PEP) may help prevent HIV infection.
