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Is It PEP In Insertive Vaginal Sex With Partner Who's Unknown HIV Status?

Posted on Fri, 27 Oct 2023

Question: I'm 27 year old man from Saudi Arabia, married, circumcised, healthy, HIV negative, I had out-married sex with female partner in high country risk ( Thialand) , I met her in club then I had 1 exposure with her ( vaginal) I used condom but it was cut during 2 min Maximum I take off my penis without ejaculation then I saw the condom cut then I stopped , I ask her about hiv status and she said I don't have any diseases only flu symptom but l'm still not sure ,, after 13 h after exposure take the PEP and now I'm in 3rd day but still worry about my self and my wife, this one exposure was the first mistake in all my life and it will be last one , I'm family doctor also, so I read a lot of articles about hiv transmission and one of them ( said no need of PEP in insertive vaginal sex with partner who's unknown HIV status even if she he from high risk country ) so I want help , I just think all time

Answered by Dr. Sankaranantham Murugan (9 hours later)

Brief Answer:
You are free from HIV

Detailed Answer:
Hi,

You had started PEP within 13 hours after the
Exposure. Complete the course.as instructed.You will be free from HIV infection, even if she is a HIV positive individual. Not to worry. Follow the advice of your PEP provider.
Thanks
Dr S. Murugan

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

Follow up: Dr. Sankaranantham Murugan (8 hours later)

Sorry I have Qs

Is the HIV1-RNA Quantitive by PCR conclusive if i do it directly after pep finished or after 10 days ?

i just need to ensure , no matter the cost and all tests are available in my city

so I want nearst way to confirm

Answered by Dr. Sankaranantham Murugan (7 hours later)

Brief Answer:
As you are on PEP, transmission of HIV is unlikely

Detailed Answer:
Hi,
Welcome back.
RNA quantitative PCR is a prognostic test, not a diagnostic test. DNA PCR or qualitative ( not quantitative) RNA PCR are the diagnostic tests. HIV is caused by HIV 1 and HIV 2. The prevalence of HIV 2 is less than1% throughout the world except in certain countries. But these PCR tests are able to diagnose only HIV 1and not HIV 2. If you want to rule out HIV 2 also, then you have to ask for another separate HIV 2 qualitative RNA PCR. When you are on PEP, it may show a negative result.. But as you had started on PEP, it is better to wait till 6 months (Tests to be done on day 1 after 30 days, after 3 month and after 6 months), then we can declare that you are totally and conclusively free from HIV infection and you can resume your sexual live. Till then, either follow sexual abstinence or have protected sex.
Dr. Murugan

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

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

Excuse me Dr

Tomorrow it will be the 10th days after my exposure , I want to do STDs tests and HIV XXXXXXX and 4th generation tests , it will make me better if i do it

While I%E2%80%99m on PEP it%E2%80%99s ok to do theses tests ?

and until today I don%E2%80%99t have any symptoms

i just have mild testicular pain that I think related to my anxiety

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
During PEP, tests for HIV as per the protocol.

Detailed Answer:
Hi, Welcome back.
Your testicular pain is not related to HIV. But can occur with certain STIs.
You can go ahead with your tests.
Dr S. Murugan

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

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

Hello doctor

I just calm and stop reading about HIV transmssion

and I have good adherance to PEP medications and today is 12 days with no side effects and also no symptoms

all what I remember to make me relax is your words when you said you are free from HIV , not to worry

also when I think , my risk is very low 0.04 So it%E2%80%99s too hard to catch it from this brief exposure and also my she does%E2%80%99t have , and I took pep in perfect time

So I will wait until my pep finish then I will check after 2 days , and after 4 w , 6 w by 4th generations tests

Do you have dr any advise for me ?
thank you so much Dr ..

Follow up: Dr. Sankaranantham Murugan (4 hours later)

and also Dr I have Qs

Do u belevie the PEP will protect me if I take it correctly for 28 days ? , because I read some studies and said it not 100%25 and there is failure rate in some causes

and also Dr tell me , Can I do tests without fearing in my case ,, because I%E2%80%99m scare about my job and everything

also PEP protocol for tests show I can test after pep finished directly then 4 weeks (95%25) then 6 weeks (99%25) by 4th generation tests

and no one said abot RNA qualtitive test when Can I do it , because rule out of hiv 1 in nearest time will make my anxitiy decreased !

thank u dr so much

Answered by Dr. Sankaranantham Murugan (7 hours later)

Brief Answer:
You are free from HIV infection, not to worry.

Detailed Answer:
Hi,
Welcome back.
PEP has to be started as early as possible after the exposure and never after 72 hours. You had started PEP 13 hours after the exposure. So I am confident enough that you are free from HIV infection. There was no guidelines for molecular HIV test after the PEP. I can't say how for they are conclusive.
The exposure duration (brief exposure) has no much role in the transmission of HIV.
Dr S. Murugan

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Above answer was peer-reviewed by : Dr. Saisudha Kotla