POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: rougelarmes on August 24, 2012, 06:58:46 am
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Hey guys, I just wanted to start off by saying thanks for all the awesome work all of you do here. This forum has been incredibly informative, patient, and kind. Anyway, here is my story: I went to a bathhouse and I went into a guys room. I asked him if he is clean and he said yes. I let him jack me off, and it lead to him giving me a blowjob. He offered to bottom and I figured as long as I wore a condom it shouldn't be a problem. I put my condom on, made sure the tip had no air in it, and I slowly penetrated him. The condom was lubricated, but as we didn't have additional lube I didn't add any extra. I would say I was inside him for 4 minutes before I felt the condom snap. I know what topping feels like with a condom versus without one, so I detected the change immediately. I pulled out as soon as I felt the condom break, and it appeared it broke from the head all the down to the base, so it left my urethra completely exposed. I would say I was inside of him unprotected for no more than a minute, and that's tops. Realistically I would say 30 seconds. I freaked out and asked him if he is HIV positive and he said he is. That's when I really started panicking and he told me that he has an undetectable viral load and that since I was the top that I likely wouldn't get it. That's when I asked him what meds he is on, and he was able to recite the meds back to me, but as I was very anxious and upset at the time I can't recall what they were. I told him that even though I was the top, I am still at risk. I washed my penis off in the showers with soap at the bathhouse, and called a taxi. I had the taxis drop me off at the nearest ER room, and I requested to be put on PEP. I would say I took my first dose at 3-4 hours post exposure. They prescribed me Truvada to take once a day. That day in the ER room I took it at 10:00am, but the next day I didn't take it until noon. Would taking Truvada two hours late the next day have a negative impact on the effectiveness of my PEP treatment? Also, I have been reading online that Truvada is recommended to be prescribed with a protease inhibitor, like Kaletra. I am only taking Truvada, so am I on an inferior PEP treatment? I have been taking Truvada for about a week now (it was 7 days ago this all happened) and I'm worried that not having Kaletra (or another med) attached to my regimen is at my disadvantage, and I'm also worried that taking Truvada two hours late on the second day hurt my chances of having a successful PEP. Also, I've been having painful, itchy sensations in my penis. I'm sure I acquired either gonorrhea or chlamydia from this person, but I'm waiting for my test results to come back for those two. I'm sure I have it though, as my penis has never felt this way before. My questions are as follows:
1. What are the chances I acquired HIV from my brief unprotected insertive anal sex with this confirmed HIV + man?
2. If this man had anal gonorrhea or chlamydia, does that increase my chances of acquiring HIV from him? I'm certain I have either gonorrhea or chlamydia.
3. If I did acquire HIV, what are the chances of a solo Truvada PEP regimen initiated 3-4 hours post exposure halting the infection? Please take my 2 hour late dose on the second day into consideration.
4. I was in Las Vegas when this happened, and I was drinking moderately prior to beginning my PEP and for two days after. Would alcohol interfere negatively with my PEP effectiveness?
5. What is your final opinion on my situation? :-\
Also, I regularly use protection and get tested, and I know for a fact that prior to this encounter I was clear of all STDs including HIV.
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rouge,
1. You're more likely to win three multi-million dollar lotteries in a row than you are to end up hiv positive following being inside the ass of a positive man with an undetectable viral load for a minute or so. Seriously. You don't need PEP.
2. Yes, it slightly increases your risk. Make that two multi-million dollar lotteries instead of three. As the insertive partner, you're highly unlikely to end up poz following a condom break even if the guy didn't know he was poz and therefore wasn't on meds.
I've yet to see the insertive partner test positive following a condom break and I don't expect you to be the first, PEP or no PEP.
3. The initiation of PEP has a 72 hour window period (36 is better). You started in a very timely manner. Truvada on its own is an effective, valid PEP regimen. Trust me, you don't want - or need - to add Kaletra. It will more likely than not give you a month of the shits for no good reason (because your risk is so low).
You need to know that taking PEP for the usual 28 days will make your testing window period longer by one month.
The earliest you should test is at six weeks post-PEP. A six week post-PEP negative is highly unlikely to change, but must be confirmed at the three month point.
4. No, alcohol isn't going to affect it. Neither will taking it a few hours late. The important thing is that it is taken once a day at roughly the same time every day. Fit it into a daily routine like brushing your teeth.
5. I fully expect you to test hiv negative, PEP or no PEP. I've been answering questions in this forum since 2001 and I've yet to see the insertive partner end up poz following a condom break. I very much doubt that you'll be the first.
Get that possibly gonorrhea/chlamydia seen to, pronto. If left untreated, these easily transmitted bacterial infections can cause other, possibly chronic, problems.
Ann
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Thank you sweetheart.
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You're welcome, darling.
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I just recieved my gonorrhea, chlamydia, and syphilis test results and they both came back negative. I must admit I am surprised. I know anxiety can create the illusion of symptoms, but I genuinely feel pain and itchiness around the head of my penis, and pain in my general groin area. I got tested four days post exposure. Is that too soon for a reliable test result?
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rouge,
It's recommended that most other STIs are tested for around ten days to two weeks following a possible exposure, so yes, an infection may have been missed when testing only four days later. You'd be wise to re-test.
The anal area can be a harbour for yeast (that we ALL have living in our intestinal tract, poz or neg). Genital yeast infections can cause the pain and itching you describe, so get checked out for that as well.
Syphilis shares a three month testing window period for a conclusive negative result.
Do you do (what I call) the "stroke test" when you put a condom on? You said there wasn't any trapped air, but if you didn't give it a firm stroke from tip to bottom after you rolled it down all the way, there may have been air that wasn't apparent. (Um yeah, there's a pun in there somewhere.)
If you're doing the stroke test in the dark, while keeping a grip of the base with one hand, use the fingers of the other hand to make sure the tip is sucked tight against the head and not standing up and away from the head. Get used to what air in the tip feels like when you've got the opportunity in lit conditions.
If you've got air, roll it back up and try again. You should also be pinching the tip of the condom while rolling it down.
It sounds like it could possibly have been a lack of lube - use your spit if there's nothing else water-based available (do NOT use hand-lotions or anything that may contain oil). I cannot stress enough how important lube is when using condoms, particularly where anal is concerned.
Correctly used condoms rarely break, so please make sure you read through the condom and lube links in my signature line so you can use them correctly and with confidence. Also always make sure they've been stored correctly (not near heat sources or in a hot car) and make sure they're in date.
Ann
edited to add yeast info
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Hey Ann, I have feel really bad to say this, but I was late on my dosage yesterday. I try to take truvada every day around the same time frame, 12:00pm to 3:00pm, I was extremely late on my dosage. I took it at 1:00am. I plan on continuing with my typical dosing patter today, of taking it between 12:00pm to 3:00pm. How much would this late dose affect my the chances of my PEP being effective?
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Rouge,
A one-off late dose isn't going to matter. Just don't make a habit of it.
I still fully expect you to test negative. You're going to be ok, ok?
Ann
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Thank you sweetie. Are forum members allowed to private message moderators?
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Rouge,
In a word, no. Not about hiv transmission or testing concerns anyway. As it says in the Welcome Thread (http://forums.poz.com/index.php?topic=220.0) that you should have read before posting:
Do NOT use Private Messages to question other members about any transmission, testing or symptom issues. These issues must be discussed in the public forum. Misuse of the PM function in this manner will result in your PM privileges being removed without warning.
Ann
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Ann, I found something while searching through the forums and I thought I should show it to you. Your statement that you have yet to see an insertive partner test positive following a condom break is very reassuring, however, there is a member of this forum who claims just that happened to them. Here is the link:
http://forums.poz.com/index.php?topic=14632.msg182568#msg182568
I almost wish I didn't find this, because all it does it provoke my anxiety. I have an appointment to see a counselor on the 13th, but in the meantime I don't know what to do to console myself. I find myself researching about HIV obsessively.
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You would do yourself a big favor if you stopped surfing the net. All it does is feed your worst fears. And to no good purpose.
Only a test taken at the proper time can give you the answer you want. And despite your finding something that feeds your fears, the great likelihood is that you are going to test negative.
We're not going to get into an ongoing discussion of this. Your situation has been evaluated and there's really nothing more to add at this point. Going to a therapist is a very good idea.
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I went to psychotherapy, and it was nice to talk about what I was going through with someone. He didn't really soothe my worries though, he just listened, he didn't give much feedback. I don't know what I was expecting, but I felt a little disappointed. They prescribed me zoloft to help with the anxiety. Today is the my last day of PEP, and I have been completely adherent to it besides day 16, when I took my Truvada about 11 hours late. I would feel so much better about my situation if I had just remembered to take it on time. I can't help but feel like my last chance of avoiding infection was ruined, and it's all my fault. The six week mark for me is October 28. I have a long road ahead of me. I'm trying to stay busy with work and I've just recently started going back to the gym. I really hope i'll come out of this negative, oh man. Thank you Ann and Andy for talking with me about this, I appreciate your feedback.
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Rouge,
Like I told you the other week, one late dose isn't going to make a single bit of difference. You're not going to become infected following a condom break when the receptive partner is on meds with an undetectable viral load anyway, PEP or no PEP.
I didn't respond to your earlier question (reply #10) because I was offline for a week with a busted computer. I'll respond now.
I have to say I very much doubt that guy's story. If you read all of his posts, you'll find that he also had a girlfriend and where there's one girlfriend, there's probably more. A lot of men don't think they're going to end up with hiv from a woman and therefore don't bother with condoms. "She's on the Pill so I don't have to worry". Get the picture? I also find that men who so adamantly claim to be "total tops" protest too much and just don't like to admit to being the bottom now and then. Surely you've heard of the type - "straight acting" and all that malarkey.
Even if his story is true, then he for sure didn't have a condom break with someone who was on meds and undetectable. It would be likely that his bottom was VERY recently infected and had a viral load in the MILLIONS.
I still stand by my statement however. I have NEVER seen a guy in THIS forum (Am I Infected) who was the insertive partner when a condom broke end up hiv positive.
You're going to come out of this ok and you're just going to have to trust me - and the science of hiv transmission - on this.
Ann
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I trust you Ann. I'm going to keep myself busy and productive in the next six weeks and let you know how everything goes.
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I finished my PEP treatment on the 16th, and I just left my follow up appointment. My doctor ordered an HIV test today, 3 months post exposure, and 6 months post exposure. When I get my results from the HIV test I took today, will they have any meaning? There is a lot of conflicting evidence on the internet about whether PEP delays seroconversion. These articles particularly shed the most light on the situation:
http://www.thebody.com/Forums/AIDS/SafeSex/Q165017.html
http://www.thebody.com/Forums/AIDS/SafeSex/Q214563.html?ic=2003
Is there a definitive answer to whether PEP delays seroconversion? Yes, no, sometimes?
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Yes, reason that you need to test 3 months post your last dose on nPEP.
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Rouge,
Honestly? The jury is still out and I don't think we'll ever know for sure. We advise adding the month on PEP to the testing window because of how hiv and how PEP both work.
PEP works exactly the same as it does in a confirmed positive person. It stops the virus replicating during various times in its life-cycle (http://www.aidsmeds.com/articles/hiv_life_cycle_5014.shtml). When a person has very recently been infected and PEP is initiated within three days (72 hours), the virus can be stopped in its tracks, before it gains access to the various reservoirs in the body where it can hide from the meds. The fact that hiv hides in reservoirs is one of the reasons why a cure for hiv is so elusive.
The theory is that if hiv gets into the reservoirs before PEP is initiated, once PEP is stopped it can come out of hiding and start replicating in the blood again, because the meds are no longer in the blood. This means the process of antibody production starts within a week or so, when there is enough virus in the blood to trigger this response from the body's immune system. That's why we count the window period from the last day of PEP.
The biggest question mark over this process is that we don't know for sure whether or not hiv that may be hiding in the body's reservoirs can trigger antibody production. I'm not sure if we'll ever be able to answer this question.
However, in your case, one, you started PEP in a VERY timely manner. Hiv would not have had time to get into your body's reservoirs. Two, you were never likely to end up positive in the first place, as I have repeatedly told you.
Sweetie, you're going to be ok. OK?
Ann
edited for clarity
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I got lab results today and it came back non-reactive. The test was administered 34 days post exposure. It felt amazing to see non-reactive on the monitor, but I know I have to get retested again at 6 weeks post pep and 3 months post pep. I hope my status doesn't change, please. I'm so scared. This whole ordeal has caused so much anguish for me. I'm on zoloft, I'm seeing a therapist, and despite all of this I feel like I will sooner or later hook up with someone again. I don't trust myself. It's obviously not good enough that I ask for people's statuses and use protection, because the condom can still break. I just want to be celibate until I meet someone who I can be in a committed relationship with, but the temptation to hook up is strong. Logically my desire to remain HIV negative would prevent me from participating in risky behavior, but here I am on this message board. I told my therapist that I don't trust myself to stay celibate, and it scares me. What's wrong with me?
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I got lab results today and it came back non-reactive. The test was administered 34 days post exposure. It felt amazing to see non-reactive on the monitor, but I know I have to get retested again at 6 weeks post pep and 3 months post pep. I hope my status doesn't change, please. I'm so scared. This whole ordeal has caused so much anguish for me. I'm on zoloft, I'm seeing a therapist, and despite all of this I feel like I will sooner or later hook up with someone again. I don't trust myself. It's obviously not good enough that I ask for people's statuses and use protection, because the condom can still break. I just want to be celibate until I meet someone who I can be in a committed relationship with, but the temptation to hook up is strong. Logically my desire to remain HIV negative would prevent me from participating in risky behavior, but here I am on this message board. I told my therapist that I don't trust myself to stay celibate, and it scares me. What's wrong with me?
Thing is, celibacy is not necessary to remain HIV free. You know that.
Moreover, it seems that you are putting all of your fears into an HIV basket. That can't be healthy. There are so many things out there as scary and more scary than HIV. Do you have time to focus on all of them? How the heck would you get out of bed?
HIV is not a disease I would wish on someone. But there are far, far worse things out there. I wouldn't wish those on someone, either.
I hope that your therapy can find you the peace you need to attain the happiness you deserve,
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You're absolutely right. There are far more terrible things than HIV. I don't mean to overstate the seriousness of an HIV infection. I didn't mean to be insensitive, I'm sorry.
The only reason I'm so preoccupied with HIV right now is because I'm in a window period for testing. I'm in limbo, I don't know what what my status is for sure. The only reason I'm attempting celibacy is because I don't think I am mature enough to be having sex. This isn't the first time I've had an HIV scare, but it is the most significant. The demographic that I fall into is also the most impacted by HIV in America too. I'm a young gay male. I like to think I'm very educated on HIV too, I knew about PEP. Despite all this I still put myself into risky situations. I don't understand--why?
I know celibacy is not realistic in the long term but at this point it's all I can think of to keep myself sane. This whole thing has been so burdening and stressful, yet entirely avoidable.
My therapist is overbooked and can only see me once every month, if at that. I am extremely grateful for having this resource at all, but I honestly feel an over eagerness to prescribe from my psychiatrist. I was hoping for more intensive psychotherapy, but I get the vibe that the resources are spread too thin for that kind of individual attention. I know they want to help me though.
I don't know... I don't mean to ramble, but I get more solace here than anywhere right now.
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Rouge,
A correctly used condom rarely breaks. Go back and re-read my condom instructions in reply #5. Practice in the privacy of your own home - maybe while watching some porn. That would help you associate condoms with sexiness, rather than utility. Get comfortable and confident with condom usage.
Attempting to remain celibate is a mighty tall order - and it's why Abstinence Only education has failed so spectacularly. We're programmed to have sex. It's hard-wired into our brains and reinforced with hormones. Get some condom confidence under your belt, make sure you use them, and don't beat yourself up over your sexuality or your desire to have sex. It's normal, it's natural, and it's human. Don't deny your humanity.
By the way, asking a person their hiv status doesn't really work as a preventative measure, unless the guy admits to being hiv positive. Many people who claim to be hiv negative don't accurately know their hiv status. Wrap it up regardless of what you're told about a person's hiv status.
You're going to come out of this ok. Seriously.
Ann