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HIV PEP
Hi, I am 29 years old and male and I'm in good health other than the issue I will explain. I had unprotected vaginal sex in Bangkok 2.5 weeks ago with a Thai girl (she was a student and 23 years old). I went to hospital 30 hours later, they put me on PEP medication (Crixivan 400mg, Lamivudine 150mg, AZT 300mg). I have a dull but pronounced aching in my testicles (and sometimes penis), it comes and goes but can be almost painful at times. I have no other STD effects such as burning on urination, itching or discharge) but a patch on my "helmet" is a bit redder than the rest. A week before any of this happened I masturbated and there was some blood in my semen, I checked online and it looked like this was not a problem. I had not ejaculated since the Thai episode happened and when I did yesterday there was reddish brown jelly like clumps in my semen which I hope are related to the blood and not ejaculating for so long rather than an STD. I am abroad and cant get good medical help so I would like some kind of advice please. I am hoping that the risk is low, after the incident in Bangkok happened I met with the girl again and asked her to have a HIV test which she did and was negative. But I am still worried because I have read that there is a minimum of a 4 week period in which HIV cannot be detected and if she has contracted it during this time then there is a higher risk of it spreading. I really dont have any information on HIV which I why I am contacting you as well, I dont know where else to turn as the English NHS wont discuss anything with me because I'm abroad. I have heard I should have a test 6 weeks after I initially had sex which I will have, how accurate is this test and what is the likelyhood of a HIV infection occuring afterwards if I do test negative? Do you have any stats for HIV in Thai students having HIV and the infection rates? Sorry for all the questions but I'm obviously very worried about this all.
Thank you so much.
Thank you so much.
MEDICAL PROFESSIONAL
Aching testicles can be a manifestation of a complication of untreated gonorrhea or chalmydia but this typically occurs after the infection has been present for some time (weeks, not days). When this is due to STD however it does not come and go but get's progressively worse over time. The symptoms you describe woul dnot bring STD to mind for me. EWH
Thank you Doctor, that is very reassuring and has helped greatly. I still have the query about my aching testicles, hopefully you can answer that as it is not HIV related as such. Do you know if aching testicles is a side effect of another STD or do you think it is related to either the blood in my sperm and not ejaculating for a few weeks, or the side effect of this kind of the PEP medication? Many thanks
MEDICAL PROFESSIONAL
You have posted on the wrong site and I cannot move your question over. Questions about HIV belong on the HIV prevention site or the International HIV site. I will do my best to answer your questions with this reply but, if you have additional questions or follow-up they must be on one of the other sites. Sorry
Your risk from the exposure is very, very low. You already know that your partner had a negative HIV test at the time you had sex with her. Your concern that she might have been in the process of converting her HIV test and had a negative blood test at that time is statistically very, very unlikely. Scientists trying to find people who are in the process of converting their blood test have a very, very hard time doing this. Even if she were a commercial sex worker, the likelihood that she was in the process of developing HIV in miniscule. To add still more perspective, if she were in the process of developing HIV at the time of your exposure, your risk of becoming infected is still somewhere between 1 in 1000 and 1 in 100. Putting these two numbers together, your risk of getting HIV from this exposure is probably somewhere in the neighborhood of 1 in a million to 1 in 100,000. This is not high risk and is not a level of risk where most providers would recommend PEP.
As for the blood and blood clots in your ejaculate, this is not related to infection or to HIV. This happens on occasion, sometimes because of trauma and sometimes for reasons that are not apparent (i.e. they are random events). Either way, blood and blood clots in ejacualte tend to be transient and are not related to HIV or other STD.
Bottom line, your risk is lower than low. I would not have recommended PEP. Given your level of concern, I suspect you will want to be tested again for HIV. If you choose to stop the PEP, do so 12 weeks after stopping PEP (normally we would say an 8 week value work be definitive but you have now taken anti-HIV medications which can, on rare occasions, slow antibody development). If you choose to continue it, then get your follow-up test 12 weeks after you complete your course of PEP.
Hope these comments help. Your risk is far lower than just ""low". It is close to, if not, zero. EWH
Your risk from the exposure is very, very low. You already know that your partner had a negative HIV test at the time you had sex with her. Your concern that she might have been in the process of converting her HIV test and had a negative blood test at that time is statistically very, very unlikely. Scientists trying to find people who are in the process of converting their blood test have a very, very hard time doing this. Even if she were a commercial sex worker, the likelihood that she was in the process of developing HIV in miniscule. To add still more perspective, if she were in the process of developing HIV at the time of your exposure, your risk of becoming infected is still somewhere between 1 in 1000 and 1 in 100. Putting these two numbers together, your risk of getting HIV from this exposure is probably somewhere in the neighborhood of 1 in a million to 1 in 100,000. This is not high risk and is not a level of risk where most providers would recommend PEP.
As for the blood and blood clots in your ejaculate, this is not related to infection or to HIV. This happens on occasion, sometimes because of trauma and sometimes for reasons that are not apparent (i.e. they are random events). Either way, blood and blood clots in ejacualte tend to be transient and are not related to HIV or other STD.
Bottom line, your risk is lower than low. I would not have recommended PEP. Given your level of concern, I suspect you will want to be tested again for HIV. If you choose to stop the PEP, do so 12 weeks after stopping PEP (normally we would say an 8 week value work be definitive but you have now taken anti-HIV medications which can, on rare occasions, slow antibody development). If you choose to continue it, then get your follow-up test 12 weeks after you complete your course of PEP.
Hope these comments help. Your risk is far lower than just ""low". It is close to, if not, zero. EWH
Sorry this was meant to go in the HIV - international section. Can you move it over please? Sorry.
You are reading content posted in the STDs Forum
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