Risk Assessment and PEP Question - Fresh Sperm on Foreskin and Glans

[renesk]

Dear staff at Poz, as I have been receiving mixed answers from different experts, I would really appreciate if you could help me with risk assessment of the situation described below.

Exposure:
I am not circumcised, and after receiving vigorous oral sex for a minute or so, my sexual partner ejaculated, and a copious amount of his cum ended right on the glans of my penis. For about a minute or two I myself masturbated with his cum covering my glans, until I came. I then immediately went and washed myself with cold water and hand soap.

PEP:
I went to the ER and started PEP with Truvada and Kaletra 22 hours after the exposure described above. For 3 days and a half I took both drugs, but I stopped taking Kaletra for 36 hours as I did not have the funds to get it. During those 36 hours, I continued to take Truvada as prescribed. The doctor said it was ok to reintroduce Kaletra once I got it. I have been taking both drugs since, but was 5 hours late once with my Truvada.

The partner:
I don't really know him, but he claims that he tested negative 1.5 months ago, but he had other encounters with men before me since. He said it is too soon to get tested but that he will get tested again to determine his status.

My questions:

1. How high is the risk I exposed myself too? If my sexual partner tested negative 1.5 months ago and had other encounters in the meantime, he might be in the midst of seroconverting which would make him super infective. Given the nature of my exposure and the fact that I am not circumcised, how high are my risk levels?

2. The fact that I temporarily had to discontinue Kaletra, and only took Truvada, for 36 hours, will it dramatically decrease the effectiveness of my PEP?

Please reply to me, as I feel I have deteriorated mentally so badly that I am starting to have panic attacks several times a day and I'm also feeling depressed, and finding it hard to go to work or go about my daily life.

Thank You,
Rensk

[Andy Velez]

Rensk, I would never have thought it necessary for you to begin PEP in the first place. Having semen on your foreskin is not a risk for HIV transmission. HIV is a very fragile virus and is not passed in that manner. In fact the only confirmed risks for the sexual transmission of HIV are unprotected vaginal and anal intercourse. As long as condoms are used properly everytime for those activities you will be well protected.

In this situation the time for testing is counted from when you complete PEP. If you continue doing PEP then you can initially test at 6 weeks after the completion of PEP and then for a conclusive result at 3 months after completing PEP. If you continue it and get tested it's basically just for your peace of mind because there was no real risk.

I don't expect anything other than negative results for you because I don't see PEP as having been warranted to begin with.

[Ann]

Ren,

1. YOU DID NOT HAVE A RISK even if this guy had a viral load in the millions. You do NOT need PEP.

2. Truvada on its own is an effective PEP regimen. You don't need any of these drugs, and you can drop both the Truvada and the Kaletra.

You didn't have a risk, you don't need PEP, and you don't need to test over this specific incident.

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.

ALTHOUGH YOU DO NOT NEED TO TEST FOR HIV OVER GETTING CUM ON YOUR DICK , 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

[renesk]

Dear Andy and Ann,
Thank you very much for your replies. I very much appreciate the time and effort that you put into this forum. I would love to contribute financially but I'm unfortunately completely broke after having to dish out more than $1,000 for PEP.

I don't mean to question your conclusions, but there is a lot of conflicting information out there on the Internet.

For example, a website puts masturbation using the sperm of another man, as a moderate-high risk activity for risk transmission.
Also, I have called my local HIV information hotline in Toronto, Canada, and after describing them my situation they told me that my risk is substantially higher than oral sex, but not as high as unprotected anal/vaginal. They told me is somewhere in between, which freaked me out!!!

Also, I was reading that for uncircumcised man, dendritic cells found on the underside of the foreskin are an excellent portal for HIV.

Given that I have inadvertantly masturbated with my sexual partner's fresh sperm covering my glans and therefore likely sliding under my foreskin for about two minutes, after receiving vigourous oral sex, wouldn't this have created a situation in which active HIV viruses could have found their way into my system?

Also, why would the ER prescribe me with PEP if they thought there were no risk?

I don't want to waste your time, but mutual masturbation and fluid exposure of mucuous membranes seems to be such a grey area that it is hard to get consistent answers.

Everybody seems to agree about the risks of penetrative anal/vaginal/oral sex, but for the rest it seems that each person has their own opinion.

The depressing thing is that I went out of my way to refrain from any potentially unsafe activities with this guy, yet accidentally his frigging sperm landed right on my penis out of all places!

I will try to continue my PEP regimen, but it's making me feel miserable, and I might have to quit my job because of it. I really hope your assessment of my risk is right as all of this contradicting information is crazy making.

If you have a chance and the time, it would be really helpful to break down a little more why you believe there was no risk, given my description of the act.

Thank you very much for all the work you are doing! People like you DO make a difference and I wish would get the recognition that they deserved!
If I ever reach above the poverty threshhold, I will definitely be your supporter!

[Andy Velez]

If you re-read what I said previously you will see exactly why you were not at risk.

You need to stop surfing the net for so-called information. I can guarantee that you will find too much there to feed your worst fears and all to no good purpose. You were not at risk. It's unfortunate you wasted that money on PEP but it's totally unnecessary for you to take it.

Get on with your life. HIV is not your problem.