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Avatar universal

Possible exposure to HIV

I'm an uncircumsized heterosexual man without any history of STDs. Two days ago I had insertive vaginal sex with a female sex worker. Unfortunately the condom broke. I only realized this after I pulled out. I don't know when it broke, but the period of maximum friction and stretching of the condom was a few minutes before I pulled out, meaning that I probably had unprotected sex for several minutes. When the sex worker saw that the condom broke she acted nonchalantly - "oh, you'll be fine". The fact that she wasn't scared scared me. How normal is unprotected sex for her? I washed my penis with soap in the bathroom right after this. Didn't see any cuts on it. But there WAS an abnormal-for-me amount of friction during sex, which is why the condom broke, so I thought "what if there are micro-cuts invisible to me there which could provide an entry point for infection?" It goes without saying that I felt like an utter idiot.

I later texted her, asking if she had been tested. She replied that she gets tested every month and that everything is fine. I don't know whether to believe this.

I didn't sleep at all the following night, was nauseous for many hours. Had upset stomach. All probably from anxiety. Read a lot about this on the Internet. Learned about PEP.

The next day I went to an emergency room. They gave me a 4-day PEP package (Truvada and Insentress). I started taking them about 18 hours after the encounter. After a day and a half the only side effect I have is decreased appetite. But I've read about much worse side effects online, some of them permanent. The more of these meds I take, the higher the risk from them.

My question is "should I continue taking the meds?" What is the cost-benefit analysis in my situation? Insertive vaginal sex is low-risk, but there was all that friction, and sex workers are a high-risk group. Would you recommend that I continue?  
4 Responses
Avatar universal
Oh, and I do know that PEP should be taken for 28 days. I was told to make an appointment at the hospital to get a prescription before my 4-day pack ends.
There are unknown variables, chiefly whether she is negative, so you will have to make a judgement call  whether to continue the PEP.
If she tests monthly and always uses a condom then that is favorable since she would be using the condom to protect herself from her clients. Condoms don't break often so if nothing broke since her last test then that makes her safe, although there is a window period from exposure until when you can test (which varies depending on the type of test used) so you have to account for that too.
Any condom break is very evident like yours so she would know if another had broken recently.
"The fact that she wasn't scared scared me. " That quote is open to interpretations, but the optimistic view would be she knows she is negative, so again it is indeterminate.
Good luck with this, and you can test with a duo 28 days after you stop taking the PEP.
Did she supply the condom?
Yes, the condom was hers.

We tried a somewhat unusual position: her lying on her stomach and me on top. There was more friction and, I think, more stretching of the condom than usual. I've never had a condom break on me before, so there was no inner voice telling me "stop, this is unsafe".
I'm thinking maybe I should offer her money to show me her test results or to go for an STD test with me.

It's easy to alter documents on a computer, and I guess she has an interest in me not thinking that she infected me. So maybe asking her to go do a test with me in person is better.

For some reason this didn't occur to me before. I mean, she does things for money, why wouldn't she do this if I offer her enough?

If this succeeds, the only uncertainty will be the window period that you mentioned. Should I disregard that window period risk and stop PEP if she tests negative now?
I don't know if she has unprotected sex with clients. One time, maybe a year ago, she seemed to misinterpret my body language to mean that I wanted to start before the condom was on, and she seemed game for it before I pushed her away.

I had bladder cancer 10 years ago, so when I come, nothing comes out. Obviously she knows this. I guess that would make unprotected sex with me safer for a woman? I don't know this for sure though. Maybe that's why she was unphased by the condom breaking 2 days ago?
If she tested conclusively (proper window period for the type of test) negative and says she didn't have a condom break afterward then you are safe. However you still have to trust her word that happened.

AnxiousNoMore, thank you for answering my questions.
She agreed to meet me tomorrow in front of a walk-in clinic that does "rapid HIV" tests among other things. These are supposed to take 15 minutes. How do I find out if the window period is proper for this kind of test?  
Ask the clinic if it is a duo, but I imagine it is. Good luck.
Avatar universal
She did meet me in front of a clinic on 9/26, 4 days after the unprotected encounter. We went in together, she took the test. We asked for the result in writing. Some time later, as we were sitting in the waiting room, an employee of the clinic gave us the result paper. It said that the rapid HIV (1+2) test was negative.

I was relieved of course. Stopped taking PEP meds.

15 days after the encounter I got the common cold. I think. Of course I've read about acute HIV symptoms, and I'm a worrier by nature, so this made me wish I went through with the full course of PEP meds. There's been no rash, just regular cold symptoms: sore throat, fatigue, malaise, nasal congestion, coughing, etc.

I will get an HIV test after 28 days, then after 3 months. The rational (I think) part of my mind tells me "she tested negative, stop thinking about this". Other parts tell me "I chose the test after a 5-minute search online, I don't know anything about HIV tests, what if this was some cheapo half-fake marketing-gimmick test that no one takes seriously", etc. They advertised results in 15 minutes, but it actually took about an hour.
You can ask the clinic what kind of test they used and the window period is 28 days for a duo, longer for other tests and 3 months for any test. If she gives you the date of her last unprotected other than your condom break, then you can calculate if she was past the window.
Symptoms prove nothing because you interact with others who have colds and are careless, so they are to be expected at any time. Googling will only make you more anxious so it is best to stop trying to get an answer there because only a test can provide that.

Oh, and when I asked if the test was a duo, I got total incomprehension. Which isn't surprising. I don't expect doctors to answer the phones at these places. The website doesn't say if it's a duo.
I didn't ask her if she had unprotected sex recently. First, it's tricky to trust the words of someone I barely know. Second, she was offended by the fact that I wanted her to get tested, that I'd suspect her of having HIV. I was glad she showed up, so I didn't want to alianate her further with more questions.

I just spoke on the phone with the test center that we used. They told me that the rapid test that she took is less accurate than the culture test. The culture test takes longer to process. The rapid test involves a finger prick. For the culture test they take blood from a vein. When I asked by how much it was less accurate, they said they didn't know.

Do you know how accurate finger-prick non-culture rapid tests are?

When I asked about the window period, at first they didn't know what I was talking about, then they said that they recommend to take these tests a month after exposure.

How large do you think my chance of having been infected is? Obviously, it's not 0. Taking everything into consideration, do you think it's above 1%, above 0.1%?

By the way, thank you very much for answering my questions. This is stressful, and it helps to talk to someone who knows what they're talking about.
Avatar universal
I've read about the chances associated with a single unprotected act. But taking everything into consideration, including my cold-type symptoms, her negative result, the nature of the test she took, etc., how likely is it?

If you were in this situation, would you worry at all? We have a non-zero chance of getting killed by lightening every day, yet most never think about it. Should that be my attitude right now, or is it more serious than that?
Statistics are useful for when you want to predict results on large populations of people and you are just one so it is not going to be useful to study odds - especially since she might be negative.
Googling will provide nothing of use and is guaranteed to only increase your anxiety so I strongly recommend you stay away from it because only a test will provide answers. The only thing you can do is find ways to kill time until Friday when you can test.

The fact she tested negative and used a condom are the only info you have and are exactly what you want, so I would focus on the positive aspects of each of them whenever your anxiety gets to a high level.
Avatar universal
Sorry to bother you with another question:

The unprotected encounter was on 9/22. I took PEP from 9/23 through 9/25. You said above that I should get tested 28 days after I stop PEP. So it's not 28 days after possible exposure, but 28 days after my last PEP dose? Or did I misunderstand you?
28 days post PEP is when you should test. I didn't review your circumstances today so didn't realize you were on it.

Try to relax until then because nothing is pointing toward you or her having HIV. It isn't very likely for a male to get it this way, so lots of doctors wouldn't even prescribe the PEP - although none of this is conclusive so you should still do your test.
Thank you for saying that. I stopped PEP early, after only 3 days, after she tested negative.
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