Risk assessment

[Vernod]

Hi

I had posted here a few days ago only to have the moderators remove the post and day I am posting excessively. I only made one follow up post to a very real problem.

I had unprotected vaginal sex with a csw of Moroccan descent in India. I started truvada pep within 24 hours and added kaletra within 36 hours. I also got a rash on my penis about 24 hours after the incident. It started with small red bumps and bumps became white on top within 12 hours. There was a bad odor. By the 3rd day when I showered, the bumps came off when rubbing and the skin peeled away. I was only able to show it to a doctor after this and he wasn't sure if hetpes or fungal.

My questions;
1. Does pep really work?  If I got herpes from this, then the chances of hiv are high from what I've read here. My only hope seems to be pep.
2. Is this rash too early for herpes or fungal?  Trying to figure out what it could be.
3. What are my odds for hiv. I am not circumcised and the sec was rough.
4. Would pep be recommended for this exposure?

[Midnight_Sun]

Quite frankly. If you are on PEP, that means you under the care of a doctor. You need to take this information to him/her and take their advice.

[Vernod]

Thanks Vance. But given her negative test do you think I can stop the pep and the go for a test later?

[Vance2335]

Can not take any test while on PEP

[Vernod]

Update.

The csw tested negative hiv duo 9 days after the incident. But since yesterday I have developed a fever (feeling really hot but 99.8 constantly), weakness, back ache, etc.  what test can I take since I'm on pep to rule out ars?  Would her negative mean I'm not infected (I know the possibility of window period but made her get a PCR RNA as well and will get results in 2 days time). If it's negative should I stop PEP?

[nursegirl6572]

"Thanks!  Will continue with the pep even though there's no proof it work "

Huh?

Not sure where you're getting your info, but it's not accurate.  There have been numerous studies, and while there is not a lot of DEFINITIVE proof, the numbers indicate that nPEP when started within the 72 hr time frame, has been over 80% effective in preventing HIV infections.  The earlier it's started, the more effective it is.

[Vernod]

Thanks!  Will continue with the pep even though there's no proof it work . Have read about failed pep while being the insertive partner and quite frankly am very worried at my stupidit . I wish D . Handsfield was back on this forum to help assess risk and provide advice!

[fullquestion]

A heterosexual risk contact is still a risk. It doesnt matter if the chances to get infected are 1% or 100%, u should take the pep.

[Vernod]

Thanks for the replies. But still very confused. This definitely seems like high risk. And surely the risk has to be higher than that as most HIV transmission in developing countries is from heterosexual sex. I'm just trying to figure out whether its worth staying on pep and waiting for 12 weeks for a definitive test or stop if pep was not warranted and get the test at 4 weeks. Its a very tough call because if pep helps even a little I might as well maximize my chances. On the other hand if the risk is too low for pep no point subjecting the body to this.

[Midnight_Sun]

Just to clarify my colleague's advice of infection of 1 in 2000, that's ONLY if your partner was HIV positive. The true odds of a heterosexual transmission of HIV through vaginal sex, through a one-time, unprotected, unknown status partner is 1 in a 1,000,000. Of course that may be slightly lower due to your uncircumcision, however, it's not enough to be worried. You have better odds of being struck by lightening, dying in a car accident or being shot to death than to have contracted HIV through the exposure you describe. HIV is extremely rare in heterosexuals and is normally only contracted by long term heterosexual male partners of HIV+ females. If I was you, I would get tested for Chlamydia and Gonnorhea on or about day 7, and herpes and syphilis at 3 months. You can, for peace of mind, through in an HIV test for peace of mind. However, I wouldn't worry.

[Jcc1970]

PEP would be a good recommendation.  Unprotected sex has put you at risk.  Being uncircumcised does increase your risk some.  However, the odds of a single exposure leading to infection are about 1-2000.  

The odds your partner was infected are also not likely.  Have a 4th gen DUO test done at 28 days post for a conclusive result.  If this test is not available to you have a 3rd gen antibody test 7-8 weeks post for a pretty accurate result.  However, in your case I would recommend follow up testing at 3 months for conclusive results.