Shall I go thru PEP & Other quick questions

[FunExplorer]

Hello:

I have a situation here and would very much appreciate your insights as soon as possible.

About 30 hours ago I had sex with a lady while on trip in the USA (still on it).  Unfortunately the condom fell off and I did not realize this until later (I probably did not put it on right because we were drunk), so the sex was unprotected.  The lady is a CSW.  The reason I am concerned is my penis was exposed to her blood.  She thought her period was over but it was not completely (it was near end of her period – not a lot of blood in her but there was blood exposure).

She did tell me that she gets STD check monthly and she is disease free.  On one hand, I want to take her word for it, but I simply don’t know her well enough yet and not sure if we will speak again.

Shall I go thru PEP?  

I saw on this forum the infection probability for unprotected vaginal intercourse is 1 in 1000 or 2000.  Any data on how much incremental risk the exposure to blood created (assuming she is HIV positive)?  If it’s not available what’s your best guess? What’s your recommendation?

Also, I tried to get PEP drugs (Truvada and Isentress) at a local urgent care clinic.  The doctor there refused to do so because he claims these drugs could damage liver and must be used within 5 hours to be effective.  Can one 30 day treatment damage liver?  He claimed I would need a whole bunch of lab work for him to even consider giving me prescription (check my liver and STD status, which he claimed are required by his company, Concentra).  
Does this make sense?  Reason I asked is this seem to contradict what I heard before.

Many Thanks.  

[Edward W Hook, MD]

Welcome back to the Forum. The exposure you describe was low risk for HIV.  Although your partner was a CSW, most CSWs do not have HIV (or other STIs) and most unprotected exposures do not lead to infection.  Your partner told you she was checked regularly- I suspect she was telling the truth.  That blood was present during sex does not change this.  In fact, it is not uncommon that there are more virus particles in genital secretions than in blood. I would not recommend PEP for you in this situation.

As far as PEP is concerns, side effects do occur regularly.  there are a variety of side effects including liver damage which are possible but not common.  Many people however do experience some side effects, most commonly simply feeling run down, headaches or gastrointestinal upset.  PEP, when it is used, should be started within 72 hours of exposure and most scientists feel that the sooner the better.  As I said however, I would not recommend PEP in this situation.

I hope these comments are helpful.  EWH

[Edward W Hook, MD]

This is a repetitive question.  You are asking your original question again using different words.  I will not repeat it.  Hepatitis B is less common than HIV and hepatitis C is not transmitted through heterosexual research in any meaningful way.  EWH

[FunExplorer]

Hi Dr. Hook:

Thank you very much for your response.  

Given my genital was exposed to her blood (although a little) while I was inside her, what about the risk of Hepatitis C or B?

Is the transmission probability dependent on the amount of blood I was exposed to?  Is there any data on the probability of transmission of exposed to the blood of an infected person - such as during an intercourse?

Obviously I should get tested, but is there a newer test that has a shorter window or do I must wait 6 weeks?

Many thanks.