POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: benoitlucent on April 14, 2013, 07:59:43 pm
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Hello everyone,
I have a question I'd like to ask you. I engaged in protected vaginal intercourse with a CSW here in a spa in Malaysia. Unfortunately towards the end of the act, my condom broke - I must have had intercourse for about a minute or two before realising. Upon realisation, I immediately stopped intercourse and freaked out. Upon asking the CSW - she assured me that she's HIV negative and that she get's checked every six months in order to maintain employment. Needless to say I was exposed at low risk I understand. In fear of transmission and anxiety I got in touch with a ID specialist here, and was prescribed a 30 day course of PEP [Tenvir-Em (300mg) & Strocrin (efavirenz - 600mg)] - (14 hours post risk) and was told to take Tenvir-Em in the AM and Strocrin in the PM before sleep. I have been following through on this regiment quite stringently but have a few questions that I feel have caused worry in me for the last few days:
1. I am uncircumcised - and assuming my condom had broken and I was having intercourse unprotected for nearly a minute ++ - does this seriously increase my risk of HIV transmission?
2. Is taking PEP this way - Tenvir-EM in the AM and Strocrin in the PM an effective, and internationally recognized method of PEP, and is it effective in inhibiting HIV seroconversion?
3. And this is where I have most concern - I keep my PEP meds in my laptop bag in the front pocket. It says on the meds that they should not be exposed to direct sunlight or moisture - which I havent. But what I am worried about is the fact that I am sure that at time the meds in my bag have been in the boot of my car for a maybe 1-2 hours at a temperature higher than 30 degrees. On the PEP meds it says that these medications need to be stored below 30 degrees - my question is that if these meds have been exposed a few times to higher temperatures - would it mean that these tablets are rendered useless as effective PEP? I'm at my 2 weeks mark now, and plan to go back to the ID specialist and request a change of tablets or refill.
Thank you
Awaiting your kind feedback.
Sincerely,
Benoit Lucent.
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You did the right thing by getting tested and the meds you are on for PEP are very effective when taken within 72 hours post exposure .
I wouldn't think you ruined your batch of meds from the two hour exposure in your car but if you still need information , call your pharmacist and ask them , Im sure they are better informed on that aspect than I am .
As for as risk and being uncircumcised , I prefer to look at it as a risk is a risk and I try not to assign percentages because it can encourage people to bend the rules and definition of what safe is . The bottom line is you are doing everything right and you should feel optimistic about testing negative when you test again .
Since you have chosen to take PEP you will need to wait 6 weeks post PEP to test and again at 3 months to confirm your results .
I'm wishing you the best of luck .
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Thanks so much for your feedback Jeff :-)
Is it true that the likelihood of myself testing positive after a condom break, with someone of an unknown status, and using PEP, on the basis of this 1-time encounter is relatively low?
Have you, or Ann, or Andy seen an insertive partner like myself ever test positive given my circumstances and PEP? I'm getting really worried.
Thanks again,
Sincerely,
Benoit Lucent
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In the ten years I have been doing risk assessment on this forum, I have never seen an insertive partner test positive after a condom break, with or without PEP.
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Ben,
I've been doing risk assessments on this forum for twelve years and like JK, I have never seen the insertive partner test positive following a condom break, with or without PEP. You really don't need PEP over this brief possible exposure.
Stocrin isn't a popular PEP drug - not because it's not effective, it's VERY effective - but because of the side-effects associated with this drug.
These side-effects can include nightmares and other sleep-problems, anxiety, depression and mood-swings, as well as feeling dizzy or drunk.
These side-effect often fade after a month or so, but you're only going to be taking it a for a month - if you chose to continue taking a med you really don't need.
The other drug you're taking is two drugs in one pill (tenofovir + emtricitabine) and it also goes by the name Truvada. You can take it at night with the Stocrin - most people do.
You can also dump the Stocrin and take only the Truvada. Truvada is an approved PEP regimen on its own, particularly for very low risks like your own.
You can read more about the meds you're taking by clicking on the appropriate links on our Treatments (http://www.aidsmeds.com/list.shtml) page.
If you chose to continue taking meds you don't need, it will extend your window period by one month (the length of time you take the meds).
The earliest you should test for hiv is six weeks following your last dose of PEP. A negative result at this point is highly unlikely to change, but must be confirmed at the three month post-PEP point.
You are far more likely to end up with some other STI following this condom break than you are to end up with hiv, so make sure you get a complete sexual health check up.
Here's what you need to know in order to avoid hiv infection:
You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.
To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.
Have a look through the condom and lube links in my signature line so you can use condoms with confidence. A correctly used condom rarely breaks, so make sure you read the information to avoid condom breaks in future.
Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.
If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.
Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.
Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!
Ann
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Dear Jeff, Ann, and JK,
Thank you so much for the comprehensive advice alongside counsel. May you be blessed for all you do for so many people who come to you with their concerns. You truly all are heroes. In conclusion, I would prefer to no longer dwell upon my anxieties any further from hereon in, however would like to just reiterate one of my queries to Ann & JK before getting myself busy till appropriate testing time.
In reference to possible exposures to temperatures above 30 degrees, would the PEP medication I have become ineffective? I called up my prescribing Infectious Disease Specialist this AM - and asked him about this - and explained that I had for the last 2 weeks carried my PEP meds in my Laptop bag (meds were in their respective manufacturer bottles) and at times, not so often - perhaps once or twice I would leave my laptop bag inside the boot of my car - where temperatures may have exceeded 30 degrees for a 1-2 hours. The ID specialist said that as the medication was inside the laptop bag, and furthermore inside their original bottle - the temperature change wouldn't have been drastic as such. In conclusion he told me that my worry is primarily a hypothetical worry, more than a practical one however to be more careful about PEP storage - but overall he said they wouldn't be compromised. Do you feel that my doctor is correct in his assessment? or is it warranted I go and swap the remaining tablets for new tablets?
Thank you once again guys,
Sincerely,
Benoit Lucent.
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Ben,
You don't need new meds. People who live in hot countries don't keep their meds in the refrigerator and they have no problem. Don't worry about it.
I fully expect you to test hiv negative - with or without PEP.
Ann
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Dear Ann, Andy, JK, and Rapidrod...
Please forgive me but I feel that the waiting game through PEP and testing is finally starting to break through my confidence. Today is officially the first day I've started to genuinely feel worried inside. I pursued a 7 day subscription just to better understand the level of risk I am encountering for the moment.
1. I am scared to death thinking about the possibility of my PEP medication having been some how damaged in higher temperatures when it was inside my bag inside my car. Even the medication was in the bag and inside the respective bottle - i'm sure the temperatures could have gone up to 35-40degrees. What if the medication's potency is rendered useless? hence the efficacy of my regime is compromised? Am I over-reacting here? or could this be possible guys?
2. I called the spa wherein the CSW works, and spoke to the manager - and he told me that the girls working at the hotel spa all go for regular health checks every 3-6 months and practice safe sex regularly. He told me that this particular girl is HIV negative, but then again for the sake of business - anybody could lie to a customer in fear of me tracing her back to this spa in the event I'm positive? When the condom break took place - I remember she told me she was worried about her own health as well, but more so she told me she's sure she doesn't have any STI or HIV.
3. I don't know whether i am experiencing ARS symptoms or anxiety? As of the last few days, I feel at times I may have a slight fever - but when I check my temperature is normal. But I have a sensation of heat inside of me from time to time throughout the day. Further to this, I feel at times a small itch here or there - every 1 or 2 hours. I was told by Rapidrod on MedHelp that ARS symptoms come altogether - but I don't have some symptoms - but have some that are similar. If this were ARS, would the momentary itch at one spot, feeling of heat inside, and the ARS rash on my tummy area, etc be accompanied by fever or flu for sure? because I don't have any fever, or swelling in my lymph nodes, or a lumpy throat, or anything - but I have been certainly VERY anxious these last 2-3 days. Could Anxiety cause this?
4. Another thing that's worried me is that I was told by a Doctor here that Truvada & Stocrin is considered the more lower scale of PEP, and isn't all that effective when it comes to substantial risk exposures. Is this true? Because I know for a fact that there was an option for more expensive PEP than this concoction given to me - but the my ID specialist said that Truvada & Stocrin are strong enough to manage my exposure.
Seeking your advice guys :-(
Sincerely,
Benoit Lucent.
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Benoit, it's time to step back for a moment and consider again what actually happened originally. Until your condom broke you protected during intercourse. The period of time during which you were unprotected was short. It was a single and brief incident. As the insertive partner you were at significantly less risk than is the receptive partner. Given all of those factors the strong likelihood is that you are going to test negative, even if you hadn't done PEP.
So while I appreciate you're being worried, you really need to let go of focusing on micro-examining every bit related to the incident and PEP.
What I am suggesting may sound impossible to you but it isn't. You need to make a real effort to focus on other matters in your life while waiting to test. By doing that the waiting time can be much easier than you may imagine is possible at this moment. Don't bother saying I'm too worried to do that, because that response will not fly here. Just do it.
And ultimately I believe it is very likely you are going to come out of this incident ok. As others have said, I too have never known of a broken condom incident to result in testing positive.
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Andy, I will do my level best to NOT focus on my anxieties around this, however could you please at least shed some light upon my queries about PEP being damaged via higher temperatures, and furthermore about whether Truvada & Stocrin truly are considered a very mild PEP regime? Is it true that this combo is ineffective in comparison to the more recent anti-viral drugs prescribed for PEP?
In regards to ARS symptoms - is a faint red rash in the tummy area, alongside a momentary itch from time to time without fever or scratchy throat considered ARS possibly? I feel hot flashes inside from time to time as well.
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Benoit , we already covered the issue of how you store your meds and by your own admission your doctor reassured you it wasn't a problem also . If you cant except our advice then we are doing you a disservice by enabling you to obsess over this incident and that ultimately is bad for you . If you keep coming back asking for calcification on issues that's been addressed we will have no other option but to give you a time out for your own good .
We do not discuss symptoms because they are NOT specific to HIV .
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Hello Guys,
I would like to better understand whether Truvada & Strocrin is a strong enough regiment for effective PEP? Or is it considered ineffective compared to more expensive forms of Anti-Viral drugs?
Ann mentioned Strocrin isn't a very common PEP drug, but is that because of the side effects alone? Or does the combo of Truvada (Tenvir-EM) & Strocrin (Efivarenz) in itself not prove to be an effective PEP therapy to substantial risk exposures?
Sincerely,
Benoit.
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Ben,
I've been doing risk assessments on this forum for twelve years and like JK, I have never seen the insertive partner test positive following a condom break, with or without PEP. You really don't need PEP over this brief possible exposure.
Stocrin isn't a popular PEP drug - not because it's not effective, it's VERY effective - but because of the side-effects associated with this drug.
These side-effects can include nightmares and other sleep-problems, anxiety, depression and mood-swings, as well as feeling dizzy or drunk.
These side-effect often fade after a month or so, but you're only going to be taking it a for a month - if you chose to continue taking a med you really don't need.
The other drug you're taking is two drugs in one pill (tenofovir + emtricitabine) and it also goes by the name Truvada. You can take it at night with the Stocrin - most people do.
You can also dump the Stocrin and take only the Truvada. Truvada is an approved PEP regimen on its own, particularly for very low risks like your own.
You can read more about the meds you're taking by clicking on the appropriate links on our Treatments (http://www.aidsmeds.com/list.shtml) page.
If you chose to continue taking meds you don't need, it will extend your window period by one month (the length of time you take the meds).
The earliest you should test for hiv is six weeks following your last dose of PEP. A negative result at this point is highly unlikely to change, but must be confirmed at the three month post-PEP point.
You are far more likely to end up with some other STI following this condom break than you are to end up with hiv, so make sure you get a complete sexual health check up.
Here's what you need to know in order to avoid hiv infection:
You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.
To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.
Have a look through the condom and lube links in my signature line so you can use condoms with confidence. A correctly used condom rarely breaks, so make sure you read the information to avoid condom breaks in future.
Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.
If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.
Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.
Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!
Ann
All of your new questions have been answered by Ann in this quote above , the only thing you can do at this point is wait and test . The drugs you are on are more than adequate .
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Guys! Please help :-(
I have oral thrush - whitish tongue and small dots at the back of my tongue :( I can't believe it! I'm on my last week of PEP after a condom breakage incident 3 weeks ago. I'm on the verge of breaking down in tears after having seen my tongue this morning - It's definitely a series of dots at the back of my tongue! and I am going nuts - I am sero-converting :(. According to the internet - PEP doesn't cause oral thrush as a side effect, and neither does anxiety! HIV seroconversion is the only thing that seems to account for this - I've never have thrush on my tongue before, and now this all of a sudden!
Sincerely,
Benoit Lucent
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Hi Benoit . I'm sorry you are feeling ill but there really isn't a thing more we could add to what we have already advised . If you are sick you need to go see your doctor . Best of luck .
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Sigh. Please guys. I am going absolutely crazy with "what ifs" in my mind playing over and over again. Can I ask you guys one question please. I can't swallow pills, so for the PEP I chew & break the tablets in my mouth and then swallow the medication. According to my doctor - this wouldn't reduce the efficacy of PEP, but what do you guys think? Would chewing and then swallowing the bits render PEP treatment ineffective?
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It doesn't matter how you take the pills , they will be just as effective .
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Ill go ahead and say it. If those white dots don't hurt like hell - then it's not thrush.
You are doing two things here - diagnosing yourself and doing so with HIV as your default conclusion.
In fact, if you have indeed acquired HIV despite your extremely low risk and taking pep, then you are indeed a scientific anomoly.
In short - I highly doubt you have HIV or will indeed seroconvery while on the drugs specifically am designed to interrupt the viral integration and replication processes.
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Thank you JK & Jeff,
There's something else that's really scaring me though. I would assume that the vast majority of people who've come to the "Am I Infected" forum are circumcised, and obviously a condom break with them is a low risk. I understand that you haven't seen an insertive partner test positive following a condom breakage - but given that I am uncircumcised, is it still appropriate to consider me at the same level of low risk as circumcised insertive heterosexuals?
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As for as risk and being uncircumcised , I prefer to look at it as a risk is a risk and I try not to assign percentages because it can encourage people to bend the rules and definition of what safe is . The bottom line is you are doing everything right and you should feel optimistic about testing negative when you test again .
I'm wishing you the best of luck .
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JK, can I ask what my chances are of coming out positive after this possible exposure?
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Well, you'd be the first person in the ten years I have been answering questions on this forum to seroconvert after a condom break in an insertive, heterosexual encounter. Assign the risk quotient as you will.
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Thank you for the vote of confidence JK, could I ask how effective PEP (Truvada + Stocrin) would be, 14 hours post this exposure?
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Thank you for the vote of confidence JK, could I ask how effective PEP (Truvada + Stocrin) would be, 14 hours post this exposure?
Very. PEP is most effective when started within 23 hours of the event.
Yet even without PEP, I have yet to see an insertive partner seroconvert after a condom break. It is obviously an extremely remote risk - a risk, of course, no denying that. But there have been thousands, perhaps tens of thousands of people through these forums. I would be flabbergasted if you were to be the first.
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Thank you JK. I went to my Infectious Disease Specialist last week and vented my fears, and he said that the chances of me proving positive after an exposure like this, whilst completing a PEP course were even lower than 1%. Would you agree with this?
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Ben,
You're not going to seroconvert three weeks into PEP, while still taking PEP.
As you've already been told, you are not in the least likely to end up hiv positive following this condom break, PEP or no PEP.
You need to get busy with other things in your life while you wait for the appropriate time to test. There's nothing more we can add.
Ann
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Thank you Ann :)
Given I am on PEP that started approximately 14 hours post exposure, does this increase my chances of coming out of this episode ok even more so?
Sincerely,
Ben.
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Ben,
As you've already been told, you are not in the least likely to end up hiv positive following this condom break, PEP or no PEP.
You need to get busy with other things in your life while you wait for the appropriate time to test. There's nothing more we can add.
Ann
I'm getting a little tired of repeating myself.
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I'm sorry to have bothered you all so much Ann. I will try to focus on other things in my life till the appropriate time of testing. I understood what you meant by PEP or no PEP - but what I wanted to understand was that, now that I have almost completed a course of PEP, would this lower my already low risk?
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JK,
Would me having secured PEP, 14 hours post exposure (Truvada & Stocrin) and taking it everyday, better my chances of coming out of this condom breakage incident ok?
Thanks,
Benoit Lucent
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JK,
Would me having secured PEP, 14 hours post exposure (Truvada & Stocrin) and taking it everyday, better my chances of coming out of this condom breakage incident ok?
Thanks,
Benoit Lucent
Of course it would. I just don't think a month-long drug regimen that might have intense side effects is necessarily worth the expense or the drawn out mental anguish.
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JK,
I really hope that the PEP keeps me HIV negative. This is the first time I've had a condom break in my life. It is driving me insane inside re-thinking every moment.
Thanks,
Benoit.
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Dear JK,
Do you think I'm over-reacting with this exposure? I guess I just need some confidence in my situation. With the type of exposure I've had alongside PEP, do you think that the odds of me ending up HIV negative are overwhelmingly high?
Thanks,
Benoit Lucent
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Dear JK,
Do you think I'm over-reacting with this exposure? I guess I just need some confidence in my situation. With the type of exposure I've had alongside PEP, do you think that the odds of me ending up HIV negative are overwhelmingly high?
Thanks,
Benoit Lucent
Yeah, honestly I do think you are overreacting. Which, given the mis/disinformation out there, is totally understandable. But since I thought that, even without PEP, you wouldn't be the first in ten years on this forum to seroconvert with your situation, adding PEP into the mix cinches the deal.
I honestly didn't think the risk warranted PEP, and only for the sake of routine warranted testing in three months. But it's all your decision.
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JK,
Thank you so much! I just need to talk to someone so badly :-( My parents, siblings, and friends - no one knows my anxiety and mental anguish at this stage. I tried talking to the doctor, and he did reassure me, but I can't sleep, I can't eat, I can't enjoy anything at this point.
Sincerely,
Benoit Lucent.
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Guys,
I posted a paid-subscription question on MedHelp for Dr. Edward Hook. He said he hadn't heard about the Tenvir-EM (Truvada) & Stocrin (Efivarenz) combo before. Have you guys heard about Truvada & Stocrin as a PEP regime? I am worried that this PEP regime given to me wasn't strong or recognised enough to begin with?
Ann, Jeff, JK? Have you come across this PEP combo before? Thanks
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Hi Ben , you have already been told by Ann that that the pep combo you are on would be more than enough .
I'm going to ask you to please read your whole thread again and if you have any other questions , read it yet again . All of the questions you are asking have been answered before and we have been generous with calming your fears to no avail .
If you come back again asking for information that you have already received from us you will be given a time out , so consider this your only and last warning .
I thank you for your understanding and cooperation .
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Ben,
As Jeff noted, I've already addressed your Stocrin question:
Stocrin isn't a popular PEP drug - not because it's not effective, it's VERY effective - but because of the side-effects associated with this drug.
These side-effects can include nightmares and other sleep-problems, anxiety, depression and mood-swings, as well as feeling dizzy or drunk.
These side-effect often fade after a month or so, but you're only going to be taking it a for a month - if you chose to continue taking a med you really don't need.
The other drug you're taking is two drugs in one pill (tenofovir + emtricitabine) and it also goes by the name Truvada. You can take it at night with the Stocrin - most people do.
You can also dump the Stocrin and take only the Truvada. Truvada is an approved PEP regimen on its own, particularly for very low risks like your own.
You need to realise that it is VERY possible that the Stocrin is adding to your sense of anxiety. It's well-known for its anxiety-producing side-effect.
However, Stocrin will not prevent you from reading your entire thread again until what we've already told you sinks in. We have nothing new to add.
The bottom line here is that you are HIGHLY UNLIKELY to end up hiv positive over this insertive condom break, PEP OR NO PEP!
We're not here to hold your hand while you take unnecessary meds over a very low risk situation. Keep coming back with more of the same questions and you WILL be given that time out Jeff warned you about. Taking out a subscription here does not exempt you from our rules governing the mis-use of this forum.
Please consider yourself warned for the very last time!!!
Ann
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Dear Ann,
I understand. I will discontinue my incessant questions from hereon in. This is my last post, may I ask if my already low risk exposure would be brought even lower with the PEP regiment I'm on? Furthermore, have you seen an insertive condom break on PEP end up positive?
Further to your answers here, I shall no longer post any more questions on this thread. Please forgive me for being a pain.
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Ben,
AS I'VE ALREADY TOLD YOU, I HAVE NEVER SEEN THE INSERTIVE PARTNER FOLLOWING A CONDOM BREAK END UP HIV POSITIVE, PEP OR NO PEP!!!!!
Are you so daft that you can't figure out that PEP lowers the risk of infection regardless of your risk level?
I give up on you. Despite being warned by TWO moderators that if you kept asking questions we've already given you the answer to, you'd be given a time out. Yet you come back and do it again.
Guess what? I'm giving you that time out you've been warned about. Do not attempt to create a new account to get around your time out because if you do, you will be permanently banned.
Ann