POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: kpatel on November 27, 2011, 11:46:36 pm
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Hey Everyone, just today found this site and am surely happy I did. Never thought i'd be posting a question pertaining to HIV but I guess that's just one of the things about life, anythings possible. Just a little background, i'm a 28 yr old male from New York and am a physician, however due to the limited exposure to HIV we had in medical school this topic is way out of my ball park, and my specialty has very little to do with infectious diseases thus my scope of knowledge is limited. I just got out of a 6 year monogamous relationship last January and have had very limited sexual encounters since then except for last weekend. I was at a bachelor party in vegas, drank way too much, more than i'm used to. I met a girl at a bar, have no idea who she is, just remember her saying something about having a previous job as a stripper (although I didn't pay her for the encounter we had). Within 30 minutes of talking to her we were in a cab heading towards my hotel at which point she performed unprotected fellatio on me in the cab, and another noteworthy point is that I am not circumscribed and although there was no bleeding i think stretching the foreskin over the head caused some irritation/tenderness/possible micro tears..I do not recall much of what happend next, except I remember putting on a condom correctly, recall it being on for most of the intercourse but blacked out completely during the last part and don't remember taking it off, if it ripped or anything, just remember saying goodbye to her and walking her to the exit. I know the chances are very low if they even exist, however as I returned home I visited my doctor and on my request about 60 hrs later he gave me PEP which I am now currently taking. I am very very worried and concerned, i think most of the reason being that I blacked out and do not recall the latter portion of our intercourse and if the condom was intact. Sorry for the long explanation I guess my questions are:
1. When a condom is used correctly which I know I put it on correctly and it was on for atleast part of the intercourse, what are the chances of it slipping or breaking.
2. I know PEP isn't fully warranted in my case, nor do I like the fact that i'm taking 11 pills/day, however do you guys believe there is even a slight risk/justification for me to continue use of PEP (i'm nearing the first week of taking it)
3. Do you think I should be concerned about getting the 3 month/6month Elisa, or should I just continue with my normal yearly physical.
Thanks a lot for reading this long post, really appreciate your time and efforts.
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Have to call this one as I see it. BS....
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? What is BS? I'm explaining everything exactly how it happened...
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You are taking 11 pills for what and why?
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PEP.. My physician prescribed me Crixivan, Ritonavir and Epivir. The crixivan i take 2 pills 3x/day, the Epivir I take 1 pill 2x/day and the Ritonavir I take 1 pill 3x/day...I don't think the PEP was necessarily warranted in my case, however I think I panicked and bc my physican is my colleague he prescribed it..
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Your colleague prescribed you nPEP for a no risk issue? Just amazing. Being a physician, did you happen to look up the side effect and health risks?
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Yea.. that's why i'm primarily double guessing my choice of taking it now.. I think the main issue was I didn't remember the latter portion of the intercourse, and whether the condom was intact/ripped when we finished. I've never drank to the point where I don't recall certain things, thus I think I panicked and felt 28 days of prophylaxis if it would mean making the chances very very minimal would be worth it. I know there are several side effects and I think this is one of the reasons i'm asking you guys, i've taken it for 6 days now, but am wondering if I should stop, I know my collegue will go along with what I want, thus I want a more expert opinion..
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The guidelines for prescribing nPEP is; unprotected penetrative anal or vaginal sex with a KNOWN HIV positive partner.
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In terms of risk stratification, because I can't recall if the intercourse ended with an intact condom, how would you rate the risk and in terms of testing does this warrant following possible HIV exposure guidelines or should I follow my normal yearly physical?
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No not at all and in the future it would most advantageous that you remember excessive alcohol consumption and sex don't mix. Sex lasts for minutes but HIV lasts a life time.
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Thanks for the replies... My final question was going to be if (since a dose is scheduled soon) I should continue the use of PEP, however based on your last response, i'm gonna take that as a no.. Do you think it would be wise to continue the PEP till tommorow and then discuss this with an infectious disease specialist, or do you feel based on the information provided, I should drop this and move on...
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My recommendation see a physican that is knowledgeable in HIV. As for stopping, if it were left up to me I would tell you to continue to take it and then you'll get a sample of what people with HIV are going through daily.
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You're response is a bit contradictory. On a previous comment you stated "no not at all", but now you're recommending seeing a physician who is knowledgeable about HIV...I would assume if you truly believe there was no risk, you would have stated that there is really no reason to see another physician. As for the PEP, i've treated patients with HIV/AIDS and have seen the side effects of the medications as well as the effects of the disease, so I don't know if taking PEP would necessarily teach me something new..
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You're response is a bit contradictory. On a previous comment you stated "no not at all", but now you're recommending seeing a physician who is knowledgeable about HIV...I would assume if you truly believe there was no risk, you would have stated that there is really no reason to see another physician. As for the PEP, i've treated patients with HIV/AIDS and have seen the side effects of the medications as well as the effects of the disease, so I don't know if taking PEP would necessarily teach me something new..
Liability issues. You see it but you don't know a damn thing about it. What really suprises me is that there has never been a time in your life that HIV and AIDS wasn't around and you want to claim ignorance. Have you evered wondered why your malpractice insurance is so high?
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I honestly came on this forum to get a little bit of guidance and support, something that goes a long way to ease someones anxiety, but in all honesty what I've gotten are sarcastic and snide remarks. To reply to your comment, if you're concerned about liability issues, this means that you're not 100% confident in you're response, because if you were, there would be no liability issue. If you have a hair of a doubt, say it, instead of covering it up behind your sarcastic remarks. Secondly, as I mentioned in my original post, I have NOT been around HIV/AIDS all my life, there was limited exposure in my training, and the patients I treated were patients in the hospital who were already on HIV therapy, I am not an infectious disease specialist, so when it comes to the minute details of how this virus is spread, I come to a forum such as this to fill in the gaps. If someone else would like to give input I would appreciate it, otherwise I think it would go a long way to change your attitude, as people come on this site for sympathy, compassion, guidance and support, none of which were even remotely provided by your responses..
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What, you are offended by what we have to go through with inept doctors and you have the audacity to bitch and moan when given the facts? No one here are doctors, we can't diagnose or give you anymore advice than we are qualified to do, anymore than that would be practicing medicine without a license.
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Doctors or not, i'm assuming you're human... and bottom line, it wouldn't hurt you to start acting like it... Didn't come here to argue, so this is gonna be my last post.
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There was no argument. To have an argument you have to have two parties that are both knowledgeable in the discussion.
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Patel,
To be honest, I also have to question much of what you've written about yourself. What doctor says he's not "circumscribed" when the word is "circumcised"?
And this PEP combo you've allegedly been put on - nobody in the western world uses Crixivan these days and certainly not for PEP. The current PEP guidelines uses a two pill, once-a-day combo.
You certainly do not need PEP over this situation. One doesn't take PEP on the basis of whatiffs when the patient was the insertive partner.
To answer your specific questions...
1. A correctly used condom rarely breaks or slips.
2. You do not need PEP. Hiv is a fragile, difficult to transmit virus and more so from a woman to a man. Getting a blowjob is not a risk and I really doubt that the woman would have allowed you to remove the condom and if it broke, she would have said something. Stop whatiffing about your condom use. You used one, you were protected.
3. Anyone who is sexually active should be having a full sexual health check-up at least once a year. The window for hiv testing is three months, not six. Test over this if you want, but don't be surprised by your negative results.
And remember, what happens in Vegas is supposed to stay in Vegas.
Ann
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Thanks for your reply. I believe I misspelled circumcised and spell check corrected it to circumscribed. I'm not sure as to why I was given Crixivan either, I believe my colleague used uptodate to find PEP treatments, however I haven't been able to find the regimen I'm on anywhere. I'm still having difficulty being at ease due to this incident and I agree I think even in my inebriated state I would have realized it was broken, or the person I was with would have, since I had enough sense to put it on to begin with.
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Alright so just wanted to get some quick input for something that I just recently noticed. Since my last post, I had discussed the usage of PEP with an ID doctor (who lives in Brooklyn and has seen and worked with thousands of HIV patients) and is someone I worked with in the past who knows me very well recommended that I continue with the PEP and I just finished the course a few days ago, however, was switched to Truvada, Prezista and Norvir (I know most of you will disagree with continuing PEP). Nothing has changed from my initial post in terms of the exposure (or what I recall), however, about a week ago I noticed there was some mild itching in my penile area with some irritation near the urethra. Upon closer examination, it appears I have candida (and I've tested for gonorrhea and chlamydia which were both negative 2 days after my exposure and I recently retested with the results pending) and although it's rare in males, I guess not be circumcised probably contributed to me developing it. My questions for you guys are 1. Have you ever heard of a link between HAART and candida (we know the link between antibiotics, just haven't heard of anything with antivirals). Secondly, have you guys ever seen/heard of a male developing a yeast infection post recent infection (I never have, but then again I haven't seen hundreds of HIV patients) Thanks for your input
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Have a god day.
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Patel,
To be honest, I also have to question much of what you've written about yourself. What doctor says he's not "circumscribed" when the word is "circumcised"?
And this PEP combo you've allegedly been put on - nobody in the western world uses Crixivan these days and certainly not for PEP. The current PEP guidelines uses a two pill, once-a-day combo.
You certainly do not need PEP over this situation. One doesn't take PEP on the basis of whatiffs when the patient was the insertive partner.
To answer your specific questions...
1. A correctly used condom rarely breaks or slips.
2. You do not need PEP. Hiv is a fragile, difficult to transmit virus and more so from a woman to a man. Getting a blowjob is not a risk and I really doubt that the woman would have allowed you to remove the condom and if it broke, she would have said something. Stop whatiffing about your condom use. You used one, you were protected.
3. Anyone who is sexually active should be having a full sexual health check-up at least once a year. The window for hiv testing is three months, not six. Test over this if you want, but don't be surprised by your negative results.
And remember, what happens in Vegas is supposed to stay in Vegas.
Ann
You continue to come up with more "what ifs," but they don't change the evaluation of your situation which you have received several times. Nothing you are adding now has changed that. You'll ultimately get tested and collect the negative test result we expect for you. There's really nothing more we can do for you at this point.