Rash while taking Prep, sign of PEP failure?

[nervousandscared]

Hello,

I recently had condomless anal sex (more like dipping) ( i was the bottom) with a partner of an unknown status. He came and dipped one more time after that, allowing semen to touch my mucousal tissue. I did not have any cuts or abrasions, and I washed myself in the shower with soap and water immediately after.

Immediately after I took 2 of my Truvada pills (I am normally on Prep, but have not taken it for a month or more)... and then went to the emergency room, recieving PEP 5 hours after.

I am on Prezista, Truvada, and Norvir. Which I have taken regularly since the incident. So far very few side effects, with stomach pain, aches and fatigue only lasting the first day I started the pills. However, yesterday 1 week and 2 days after the risk, I developed a single small blotch of rash.

rash is listed as one of the common side (1 out of 10 people) effects of Prezista and Norvir (and even truvada)... But I cant help but look at the list of ARS symptoms which include rash with a fever, swollen lymph nodes, etc.

My only symptom is a small rash, red, clustered, very small, just below my belly botton. It started as an itch which I kept scratching, and then pretty soon after that day or the following i look down and its red and rash like. It could just be an infection caused from the PEP which effects the immune system. It could also easily be a side-effect of the medication. The rash doesnt itch I dont think, and it hasnt gone away in a full day.

But nonetheless, I am panicking. Trying to get the partner I slept with to go get tested.

I think part of my fear is inspired by the fact that he had a rash covering his legs. He explained it was a heat rash, and that his doctors were helping him with it. He also had scaly rashes on his feat which he said were irritation from the heat and his tight shoes. His last negative test was in January. He has a husband, and uses condoms with partners outside the relationship.

Perhaps he had a rash that was contagious? Or my rash is from the medication? or any other reason, heat etc?

While I'm on PEP, would ARS rash be rare? Would seroconversion be lessened or prevented? Is this rash a sign or PEP failure? Normally ARS symptoms begin 1 to 4 weeks after exposure, which its only been 1 week and 3 days when this rash blotch developed.

PEP is normally highly effective, so Im worried this rash is a sign of early PEP failure.
I've been taking PEP daily since the incident, not always with food though.... but I've been pretty good at taking it at the same time! So I hope a potential infection didnt occur because of my not taking it with food. I'm going to take it properly from now on.

I will be meeting an HIV Specialist tomorrow, and I'm hoping the guy will get tested this week as soon as possible.

[Ptrk3]

No, the rash you are experiencing is not the result of any PrEP and/or PEP failure.  A so-called "symptom" of HIV infection would not occur so quickly after exposure.

Both PrEP and PEP are extremely effective in stopping the spread of the HIV, so it is virtually impossible that you have been infected because of the incident you describe in your post.

Relax and continue to work with your healthcare provider.

[nervousandscared]

More re spots are developing on my body and they are not itchy.
I'm panicking at this point it's been 13 days since my exposure. I have no fever. No aches. No swollen noses. The guy will have his results in 2 days.

I'm praying that this is my body réacting to the medication and not the early stage of ars.

I'm going to doctor today but she probably won't be able to get me a definitive à answer. I just want to know that prep can protect me..

[Jim Allen]

PEP is highly effective when taken correctly and within 48-72 hours post exposure.
The guys results mean nothing at all to you, even if you were to witness the test and test results all it means is he was negative conclusively 3 months ago, as he could be in the window period. Also if he is HIV positive he could be successfully on treatment.

End of the day the only result that ever matters is your own and your own behaviours and if they are risks for HIV transmission.

Your rash could be from anything and nothing, hence see your doctor treat the rash.
Test at 6 weeks and 13 weeks post finishing PEP for a conclusive result, in the meantime calm down, treat your rash and live your life as normal.  Stressing and worrying about it is not going to change the outcome it will only make you sick in the meantime.

All in All you had very little risk considering it was a single incident to start with, and you started PEP within the time-frame and PEP its highly effective.

Here's what you need to know in order to avoid hiv infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

More information on HIV Basics, PEP, TaSP and Transmission can be found through the links in my signature to our POZ pages, this includes information on HIV Testing

Kind regards

Jim

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[nervousandscared]

Good news! The guy tested negative from a test he did 12 days after the unprotected sex act.

Considering that 95% of infections are caught within the first 4 weeks, there is a large chance that he is negative.

He took the antibody and p-24 antigen test, 4th generation. blood test. not rapid.

I have a swollen nymph node on the right side of my neck, and possibly the right side of my genitals. No fever. This could be me imagining and fearing "symptoms" again. The "rash" that I described earlier was examined by 3 different doctors and they told me it was not at all typical of ARS rash. It was just little red pimples or spots that have already mostly faded.

I know that the only sure way to know is to test 4 weeks, 6 weeks, and 3 months after PEP. But I just want to chill out about all this.

The liklihood that my recently-negative partner had sex, unprotected sex, with someone who was HIV positive, and that it transmited to him, and then to me in one exposure is very very rare. It would mean all of that must have occured between June 20th and July 6th.... 16 days (2 weeks and 2 days)... And given that he told me he is monogamous with his husband and practices safe sex otherwise is also nice to know.

The liklihood that he's in a rare 5% bracket of people who test positive later is unlikely.
The liklihood that he had sex, unprotected sex, with someone who also had HIV, and managed to pass it to him in that 16 day period before me and him had sex, is also unlikely.
The likelihood that one sexual act with him would pass it to me is unlikely. 1 in 70. or 1 in 3 if his viral load was super high (multiplies normal risk by x20) which would be unlikely because it takes 4 to 6 weeks for viral load to climb high right? and a test during high viral load / seroconversion period would test positive no?

The likelihood that this virus if it existed, would survive 2 truvada pills right after, plus a blast of PEP 5 hours after potential exposure (28 day treatment that I've never missed a dose) is highly unlikely as well. more than 82% unlikely.

And additionally, it is unlikely that these so called "symptoms" I keep imagining are even remotely similar to ARS "symptoms" and not other coincidental things. I dont have a heavy flu like seroconversion illness at all.

It seems to me that the odds are in my favor. But I wont be 100% sure until testing. The lymph node thing made me think about all this again obsessively, so I'm just gunna stop overthinking.

Anyways. I'm trying to stay reasonable about all this I think Im just guilty and afraid. But I should let myself relax and just do the test 4 to 6 weeks after i finish PEP.

[Jim Allen]

You are way overthinking this.

His test will not be conclusive so until it is focus on your own results and presume he is HIV positive.  Also unless you witnessed the draw and the results being given by the lab yourself you can't verify the result (We had a few of them over the years)

Simply test when your test is due and that is the only way to know for sure what your status is.

Jim

[nervousandscared]

I'm very worried!

Had a very traumatic night 3 days ago, when after performing anal sex with a condom and oral sex without a condom and swallowed his ejacualate.

On Grindr a person informed me that the guy I slept with was hiv positive, and doesn't know if he Is on treatment or detectable or recently infected.
The guy denied it when I called him but didn't send me his last results (claims to haven had a last test in may) he has since stopped responding completely and hasn't not gone on Grindr since.

The situation was very traumatic. I started a course of PEP 4 hours  after the oral Sex.

The risks of oral sex with a hiv positive, recently infected, potentially high viral load Is still "lower" than anal sex, but my head is spinning from all the contradictory information I've been reading. It seems different sites have different opinions.

Unfortunately I have not found any studies about hiv postive high viral load oral sex being lower risk than anal. But the statistics seem to say that it is 1 in 2500 or 1 in 10,000, with and "hiv postive source"....

More information on my recent prevention tools are as follows. On august 2nd at 12:30 midnight I finished taking my last pill of truvada, that I had been taking daily for 30 days. The unprotected oral with hiv positive source was 6 days after on august 8th at 12:40am midnight. I know that this would be incorrect prep use, but I have read studies that say that prep stays at protective layers even after stopping the pills. For those who take 2 pills a week the protection is 74%. For those who just finished prep for 30 days there are 6 days of protection at 90 or 95% or 85%? It appears that prep stays effective and at decreasing levels after the last dose.

Lastly, my pep regiment includes truvada and tivicay. I started it 4 hours after. First dose was without food. Will this effect absorption? Are these 2 drugs effective against infection?
Will the prep protect me? Or would it have decreased too much?
Is the oral sex pose a low risk of infection? Will my pep/prep fail?

I'm trying to stay calm and see myself as protected. Doctors have said mixed results, but one was saying how oral sex is low, aa nurse said she has seen people infected this way.

[Jim Allen]

 

Stop it.

You had no real world risk at all, the mouth lacks biologically the cells to infect so unless you had gaping wounds in your mouth you had no reason to panic or test let alone take PEP over this incident.


The guy stop responding because you are simply being paranoid and a pain.

Stop reading outdated rubbish online and out of context that simply does not apply to you, seek professional face to face counseling or mental health support if you can not move on with your life in a normal or at least constructive manner. It is not healthy to have such reactions reach time you have intercourse.

Please do not post about this again or out of kindness I will give you a ban to help you move on.

Jim 

[nervousandscared]

thank you 

I fully expect a negative result at testing 4 weeks post exposure,
And at 4 weeks post PEP,
And at 3 months post PEP.

I'll only come back to post my results, as I'm going to be not panicking these next two months.

Thank you!

[Jim Allen]

Why would you panic, you had no real risk.
I wish you well but I am giving you a time out.

Jim