Condom Failure and PEP Effectiveness

[ikarous13]

Hi everyone,

As a young gay man, I always practice safe sex. However, an unusual encounter on July 5th has me a bit worried.

I met a man from the Internet who claimed to be HIV negative. His profile specified "safe sex only" and he even brought his own condom. As I always do, I checked to make sure that he was actually wearing the condom before he began topping me.

During the encounter, he withdrew and readjusted several times. I couldn't see his penis because of my position, but I assumed he was still wearing the condom. However, when he came and withdrew, the condom was gone. It had slipped off and gotten, er, 'lost' inside me. The guy came inside me. A lot.

He  seemed neither particularly surprised nor worried by the condom failure, which makes me wonder if he didn't do something to the condom while re-adjusting. We used plenty of lube, and the condom seemed to fit well. I have a hard time believing that he didn't notice it had slipped off.

In any case, I acted quickly. I flushed out as much of the semen as I could and got myself to an urgent care clinic. They had never even heard of PEP, so I had to educate them and thus they were much slower to act than I would have wished. Nevertheless, I took my first dose of Truvada and Kaletra approximately six hours after the exposure. I adhered completely to the PEP regimen for 28 days, never missing a dose of either medication by more than a few hours.

What's got me worried is that while on PEP, I developed a strange rash on my trunk. I have little red circles that don't itch. They've been present for three or four weeks now and haven't gone away. I don't know what the ARS rash looks like (or if it's even possible to experience the ARS while on antiretroviral medications) but still, I'm a little scared.

I'm going in for my first test on 8/30, which is four weeks post-PEP. If anybody can provide me with information of any sort, I'd be grateful.

[Ann]

ikarous,

You started PEP in a very timely fashion and this means you are extremely unlikely to have been infected, even if this guy is positive and just doesn't know it yet.

Show your rash to a doctor. It sounds more like a fungal infection called ringworm more than anything (ringworm doesn't always itch) and ringworm is a very common fungal infection, particularly during hot summers. Anyone can get ringworm, hiv positive or hiv negative. Show your doctor and get treatment for it. (And no, you're not going to get an ARS rash while on PEP, so forget about that.)

You really should wait until six weeks post PEP. A four week negative would be good, but a six week negative is much better and is highly unlikely to change when you confirm at the three month post-PEP point.

I fully expect you to test hiv negative.

Ann

PS - by the way, for future reference, if by "flushing" you meant douching, you really shouldn't do that in a case like this. Douching, unless done with a VERY gentle flow, can force the virus into the tiny capillaries or any breaks in the lining of your rectum. As you took PEP and started it in a very timely fashion, this should be a moot point; just don't do it again. 

[ikarous13]

Thanks Ann.

The possibility of a fungal infection actually occured to me not long after I posted. I picked up some over the counter antifungal agents designed to treat ringworm and the marks are already fading. Much adieu over nothing, as it happens.

I did some research on my own regarding modern PEP regimens. It is indeed highly effective in preventing transmission. What I wanted to add to this thread for future readers is that in the unlikely event that PEP doesn't prevent infection, it will likely protect your immune system from much of the damage that occurs during initial infection, which can make your prognosis longterm that much better!

As an aside to those of you who are on a three drug cocktail: I admire you. Those side effects were rough.

[Ann]

Ikarous,

Good luck. Let us know how it turns out for you - I'm expecting you to test negative and you should also be optimistic.

Ann

PS - not all of today's combos are bad side-effect wise. The Kaletra you took is notorious for causing diarrhea and nausea, but Kaletra isn't used all that much these days.

[ikarous13]

Hi Ann,

I just wanted to let you know that I tested negative at six weeks post-PEP. I'll test again at the three month mark to be absolutely sure, but from what I understand, a six week result is very unlikely to change.

Thanks for earlier your help and assurance; it was much appreciated.

[Ann]

ikarous,

Happy, if not unexpected news. With a six week negative under your belt, I fully expect you to continue to test positive when you confirm at the three month point.

In future, get into the habit of periodically reaching down to check there is still a condom on your top, particularly if he keeps fiddling with it like this guy did. I do this (because I want my virus to stop with me). If you feel you need to hide the fact that you're checking up on him, disguise it by giving him a caress at the same time. It works - and it will keep you safe(r) from guys who might want to remove the condom. 

You can relax now, just make sure you confirm at three months.

Ann