Hiv testing and post-exposure HIV prophylaxis

[bankbar]

hi Doc,

I had sex with Russian pro twice during the same night in Bangkok. First time, the condom had stayed on till the end and I had taken it out safely myself but during second intercourse her vagina was a bit dry and hence, because of the pressure I believe the condom broke. I did not realize this during the intercourse which lasted for almost 5-7 minutes. I had ejaculated inside her and when I took out the penis it was mostly dry. I immediately washed my penis with soap and shampoo 5-6 times to avoid any infection. She assured me that she does not have any problem as she uses condom every time but I am little bit hesitant to believe her. Its been 12 hours since then and I don't feel anything awkward till now.

I am leaving Bangkok in a couple of days. Please advise if I should go for a HIV test in Bangkok and start taking post-exposure HIV prophylaxis medicine to minimize chances of spreading the infection. I live and work in a Middle-eastern country where I don't want to go for testing as it has very strict deportation laws regarding HIV positive people.

What is the best time window to detect and minimize the chances of spreading the HIV infection and should I take the PEP medicine immediately even if the initial results test negative or should I wait longer?

[Edward W Hook, MD]

Welcome to our Forum. To summarize your problem, you had sex with a Russian CSW twice and, on the second exposure the condom broke. thus your real risk is from a single exposure to this person who is at modest risk for HIV.  That she said she always used condoms may well be true and if that is the case, it is likely that she does not have HIV.  If she does not always use condoms, her risk of being HIV infected is still probably less than 10%.  Then, the risk associated with a single episode of unprotected intercourse is about 1 infection in 1,000 sex acts.  Thus, on a statistical basis, it is unlikely that you acquired HIV from this exposure.  

I do not recommend PEP in this situation but some of our clients opt to take it anyway.  To be effective PEP should be taken no later than 72 hours after exposure and the sooner the better.  In the U.S.PEP cost over $1000 for the medications.  In addition, many people who start PEP do not finish it because of site effect (GI disturbance, rash, etc).  If you take PEP you should do so under a doctor’s supervision.

Hope these comments are helpful to you.  EWH

[pimboa]

i had a needlestick injury 5 weeks ago.t was superficial from a needle , i had tried to take blood from a positive pt bt faid.but there was a smal drop of blood n the syringe b4 i prickd myself.I didnt take PEP.I now have small lymph nodes,less than cm n my neck ,post ,one side.what wud u suggest??i regret not taking Pep.whatz yo suggestion?

[Edward W Hook, MD]

I am not aware of any reliable home urine tests for HIV. Such tests are not approved for use in North America.  EWH

[bankbar]

Hi Doc,

I wanted to know how reliable are the HIV home urine tests? I got them from this website [http://www.std-home-test.com]. I have done the testing today [28 day mark] after my condom break incident and the result was negative. I am planning to go for an anti-body test in a couple of days but wanted to know if the home tests are reliable?

Also, I have a boil on my penis [near the base] with white liquid [pus] and if I try to touch it or it rubs against my trousers, I feel little pain. I am also feeling dryness in my throat couple of days back. Is it normal??

Thanks

[Edward W Hook, MD]

Any negative result is good news, just not definitive.  We know that about 50% of persons who acquire HIV have positive tests at 2 weeks.  As to exactly what proportion have positive p24 antigens, tougher to say.. eWH

[bankbar]

Hi Doc,

I have taken a HIV I & II Anti-body and P24 Antigen test at the 10 day mark and the results were negative. I also did a rapid test but the results are still awaited. I had very mild fever around the 9 day mark for a couple of days. Today is the 15th day from my potential exposure.

Please advise. Is the P24 Antigen test at the 10 day mark a good indication??

Thanks

[Edward W Hook, MD]

If you take PEP, you need to wait until about 12 weeks following completion of PEP to have definitive results.  EWH

[bankbar]

Thanks for the reply Doc.

So when should I go for testing to be sure.

I will try to start the PEP course while in Bangkok just to be on the safe side.

Regards