Should I get PEP? Time window is running out

[ummmm20]

I am a man.  I had unprotected vaginal and oral sex with a potential prostitute around 40 hours ago in Georgia, USA.  I was completely blacked out when I met her and have vague recollections of the actual sex acts.  I have no idea if she was really a prostitute.  I base that off of her general appearance and demeanor the next morning.  She is a quite a bit older than me; she looked like a drug addict.  I did not give her any money, I know that for sure.  We had no talk about sexual history or stds.  The only thing I remember was her saying that an ex-bf of hers was a walking std.  She said it in a way that was looking down upon him.

About 6-12 hours after the sexual acts, I started to feel a burning sensation on the tip of my penis.  There has been no penile discharge, but maybe more frequent urination.  I went to see a doctor at a drive up medical clinic.  They took a urine sample and said that there was blood in my urine but no bacteria.  She put me on antibiotics, in case it turns out to be gonnorhea or clamydia or if it was a UTI.  The burning sensation has eased up a lot, it comes and goes.  And it doesn't sting when I pee really at all.

I have no cuts on my shaft, and one tiny, nearly unnoticeable lesion on the bottom side of my scrotum

I asked the doctor about 72 hour hiv preventive medicines, and she gave an answer that now leads me to believe that she had no idea what I was talking about.  

My PEP time window is running out.  Should I seek a second opinion asap?  My concerns are that I have little knowledge of the duration (although probably short considering my state), her std history, whether she was in fact a prostitute, and that I may have gotten a UTI which increases the risk of HIV.

Thanks in advance for your response.

[H. Hunter Handsfield, M.D.]

The warning "against starting and stopping" is only an issue if you start and stop a few times.  Starting and stopping causes absolutely no problem unless treatment is restarted yet again -- which you won't do.

Set up the appointment with an ID or HIV specialist.  This forum isn't a proper substitute for it, so that will end this thread.  I won't have any further advice.

[ummmm20]

I'm not going to start it.  My ER doc warned against starting and stopping.

I'm going to write "1 out of 2000" on my hand until I can get tested in 30 days.  Thanks for your help Doc.  I really appreciate it.

[H. Hunter Handsfield, M.D.]

Sorry, I can't help further.  If you remain in doubt, I would say you should start the PEP and then get on the phone make an appointment with your personal physician or an infectious disease specialist.  If you tell them the situation -- you have started PEP and need to set up care to follow up and decide whether to continue -- they'll understand the urgency and get you an appointment in the next few days.  It won't do any harm at all if you start PEP and then stop it after a few days.

[ummmm20]

I went to the ER.  I have the PEP prescription in hand, but now I'm having second thoughts.  The side effects make it seem like I won't be able to function the next 30 days.  The doctor made no recommendation either way, just said it was up to me.

I am in a bad state of mind here.  

[H. Hunter Handsfield, M.D.]

A hospital emergency department would be able to handle this on a walk-is basis, and on request might call in an ID/HIV specialist on the spot.

[ummmm20]

I called around to every local infectious disease clinic in my area (Kansas City).  No one is taking walkups or has available appointments today.  

It looks like I'm rolling the dice.  : /  

Thanks for your response.  

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  This is a second reply -- I initially misread your question.  Sorry for any confusion, if you saw the first reply before I deleted it.

There are no hard and fast rules about PEP.  If you knew your partner had HIV, or if you are confident she is at especially high risk -- e.g., an injection drug user or commercial sex worker -- then it might be recommended.  Other factors also might influence a decision -- for example, if your partner was African American, her risk of having HIV might be higher than for other racial or ethnic groups.  (This isn't a racist statement -- there are a number of complex reasons why HIV is more common in African Amercans.

For these reasons, a distant online expert cannot give you a definite answer about PEP.  Local doctors or health departments will be in a better position to judge the risk.  Therefore, you'll need to return to the clinic and have a more detailed conversation about it. Or even better, visit your local health department clinic, or find an HIV or infectious diseases expert.  (Either of these will be easy if you're in a major metropolitan area, especially Atlanta.)

If you decide against PEP, or can't find someone in time (72 hr after exposure) to prescribe it, you still should not be overly worried.  When a woman has HIV, the average transmission risk for each episode of unprotected vaginal sex is around once for every 2,000 exposures -- so even if your partner was infected, the odds are strongly in your favor.

Your penile symptoms don't concern me; they are not due to any infection from this exposure.  No STD can start to cause symptoms sooner than 2-3 days after exposure; with onset only a few hours later, your symptoms had to be due either to irritation or perhaps anxiety -- but not from any infection you caught.  (UTI is not an issue.  Healthy men rarely get UTI's, and certainly they are not caught sexually.)

I hope this has helped. Best wishes--  HHH, MD