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Hi Doctor, I Had Protected Sex With A CSW On

Posted on Tue, 17 Dec 2019

Question: Hi Doctor,

I had protected sex with a CSW on November 13. Everything was fine but at the end when I was behind her and while I was pulling out I found out that the condom got stuck in her vagina and my penis was not covered. The CSW was having her period as well but I did not find or observe any vaginal fluids or blood on my penis.

When I asked her about this, she said that the condom was stuck just outside the vagina and most likely while pulling out got stuck there and I probably was not exposed to her fluids while pulling out and I never felt I was inside her unprotected. However, I freaked out after this incident and went directly to hospital emergency room and took my first dose of PEP ( Truvada +Tivicay) within 3 hours of exposure. I have been taking it for a week now and will continue to take it for another 3 weeks.

Please find my timeline below:
1. November 13, 10 PM: Exposure event
2. November 14, 1 AM: First dose of PEP ( Truvada + Tivicay)
3. November 14, 7 PM: Second dose
4. November 15, 7 PM: Third dose
5. November 16, 7 PM: Fourth dose
6 November 17, 7 PM: Fifth dose
7. November 18, 7 PM: Sixth dose
8. November 19, 7 PM: Seventh dose
9. November 20, 7 PM: Eighth dose

I will continue to take PEP till December 13 when my prescription ends. I have also asked the CSW to test and she said she will take a rapid test soon. and will let me know the result. I am super scared. Does PEP really work in case I was exposed and I am not sure if I even was exposed while I was pulling out. Also in case she has a negative result, what should I do? Have you seen PEP fail when taken that early after an exposure. I have not had any symptoms so far and I was thinking of getting an RNA PCR test soon to confirm my status.

Please help.

Answered by Dr. Sankaranantham Murugan (17 hours later)

Brief Answer:
Your risk for HIV infection is remote

Detailed Answer:
Hi,
Welcome to Ask A Doctor.
Thanks for posting your query.
Only after the completion of your act condom slipped. So your risk is low. Tiruvada is a combination of two drugs. Nowadays they recommend only 3 drug combination for PEP. Any having started complete the course.
You will be unlikely to get infected. Not to worry.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sankaranantham Murugan (34 minutes later)

Hi Doctor,

I am on Truvada + Tivicay and I have been taking both since November 13 and my regimen will complete on December 13. I read online that combination of Truvada + either Isentress or Tivicay is considered for PEP.

I have been taking Truvada + Tivicay since November 13 and took first dose within 3 hours of exposure. Is this combination of PEP in case of the worst case scenario that I was exposed to HIV? Does PEP work?

Answered by Dr. Sankaranantham Murugan (15 hours later)

Brief Answer:
You are absolutely safe.

Detailed Answer:
Hi,
Welcome back.
You are safe.
Your regimen is highly effective and complete the course. Even if we considered some HIV entry it will be totally cleared. Nothing to worry at all as you had started the PEP so early after exposure.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Sankaranantham Murugan (43 hours later)

Hi Doctor,

I went for an RNA PCR test approximately 8 days and 12 hours later and I am waiting for the results. If the results come out negative or target not detected, should I assume that I did not get HIV.

I have been taking PEP since 3 hours after the exposure event. Can the PEP possibly reduce HIV to undetectable in 8 days and it may be a false negative? I will complete the course regardless of what I get in the RNA PCR test but I went for the test. Please let me know how should I test afterwards to make sure that I did not get HIV. Will an antibody + PCO test 30 days post PEP be good enough to rule out HIV?

I will update you as I get my test results.

Answered by Dr. Sankaranantham Murugan (2 hours later)

Brief Answer:
A nonreactive HIV test 6 months after the exposure for PEP is necessary

Detailed Answer:
Hi,
Welcome back.
Qualitative RNA PCR can rule out HIV 1 only. If you want to rule out HIV 2 also you have to take up a separate test for HIV 2 SPECIFIC.HIV 2 incidence is less that 0.5% only.

Even though PCR can pick up the the HIV infection as early as 7 days, It can be considered conclusive after 3-4 weeks after the exposure.
As you are taking PEP it could delay even more.
As per PEP guidelines, one can declared free from HIV only after a nonreactive HIV antibody test 6 months after the exposure.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (2 days later)

Hi Doctor. I got the RNA PCR blood results and it came as negative. I had taken this Friday, November 22 at around 10:30 AM. This was after 8 days and 12 hours of the exposure incident on November 13.

I have also uploaded my results so that you can view. Can we rule out HIV-1 because of this?

I will continue to take PEP drugs as directed and will test again 3-4 weeks after PEP finishes.

Answered by Dr. Sankaranantham Murugan (3 hours later)

Brief Answer:
Complete the course of PEP. You will be safe

Detailed Answer:
Hi,
Welcome back.
Noted your HIV PCR report.
Continue the PEP and complete the course.
Repeat the HIV test as per PEP guidelines.
Dr S Murugan.

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Above answer was peer-reviewed by : Dr. Prasad