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Risk assessment.

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paquiqua:
Hi! I stumbled on this forum after what I assumed is a high-risk exposure.

A little background from me first: 31-year-old male but I've only been sexually active for a little more than 3 years a half. In this three years I've only had anal sex (me being receptive) 5 times (there are two more times I don't really count because penetration was very slight). All of them with condom. Although I'm reluctant to oral sex as well, I have given oral sex in a few occasions (probably as many as I've had sex).

I've had a couple of problems during one time in which I gave oral sex: after I gave oral sex and went back to my room to wash my mouth, I noticed I started to bleed from my gums.

Another scary incident was a guy who I was kissing and who started bleeding on his lower lip and we realized this as he started to give me oral sex.

Both these incidents scared to death that that I might've contracted HIV or other STDs. I'd remained untested for those three and half years...until 6 days ago in which I had an unfortunate encounter.

I met a guy at a bar and we hit it off; very friendly, interesting, intelligent and knowledgable. He wanted to give me oral and I didn't object. Everything's fine. Then we went to another bar and had some more drinks. In a little while he got turned on and told me to go to a private part of the bar. He wanted me to give him oral and I said I didn't feel comfortable with it. I gave him oral with a condom. Then he wanted to penetrate me, I said I didn't want to and didn't feel comfortable doing that in a bar. We went back to the counter and had some more drinks. I wasn't drunk and even though he told me he couldn't drink more alcohol he wasn't drunk either, I mean, in a way that you'd act out of inertia.

After a while we went back to that private part and I gave him oral again with a condom; he wanted to penetrate me and I ultimately agreed to; he had me put him another condom and it wasn't going down well and then he realized it was upside down so he turned it over (a very dumb mistake, I know!  :-\ . Unfortunately your mind goes rather blank int these situations) and then proceeds to penetrate me. He was a little too rough on me and it felt a little rough...this was one of those fruit-flavored condoms but I'm not sure if they have some kind of added-on lubricant? Anyway, in less than two minutes, he takes his penis out and tells me the condom is broke: I was in absolute shock and could barely react; I just turned and watched him taking it off and right after releasing some pre-cum fluid but no visible ejaculation. I was so impressed I could barely think: the one thing I did was wipe my ass with a tissue. There was fecal matter in the tissue.

He told I shouldn't have to worry because it was less than two minutes, that he didn't ejaculate and that he's safe and knows how to protect himself. Afterwards we went to another bar and had a couple more beers. He could tell I was deeply worried and he gave me his number and again reassured me that I didn't need to worry about anything. I couldn't help not to trust him, despite his reassurances. When I got home, about 3 hours after the incident, I went to clean my behind properly.

I could barely sleep because all the thoughts in my head that I could've been infected from him. Hours later I went to the toilet for number 2 and I was over I noticed a red element which seemed like dried blood. That sent me over the edge! I started looking info on the internet like crazy and that's how I found this forum and about the PEP treatment. This took me hours. Finally, with all the necessary info, I headed to an ER.

I had to wait there for about 1 hour and a half and I could barely stay conscious; I just wanted to pass out due to the direness and despair of my situation. After I told them my story, weirdly enough the doctor told me that PEP was not recommended in my case but it could be offered, which sounds really weird to me. I think it may have to do with the fact that she thinks my partner is negative because he sounds so confident and told me I could get tested and that I don't have to worry...which seems very deceiving in retrospective considering HIV doesn't show after weeks in the system.

The doctor asked me if I was negative and I couldn't say the truth and said I was but that I hadn't been tested in two years.  :-[

She gave me PEP only for ONE day and then referred me to a clinic the next day for to get tested. I was so terrified to get tested I waited until very late to go to the clinic, I had no more PEP but didn't miss the single doses I was given. In the clinic I talked to a very nice and friendly female doctor and she gave me PEP for two more days. I had to get tested for HIV on Saturday.

My mind was in such a haze I even forgot to confirm the appointment for Saturday. Then on Saturday I went to the clinic and basically kind of begged them for PEP and an appointment. They gave me no PEP but they did give me the appointment. I talked to another doctor and when he asked me my status I had to tell him that I'd never been tested. He told me I needed to get tested in order to continue with PEP; otherwise the treatment would be detrimental.

After thinking it so much through and been filled with terrifying fear, I decide to take the plunge and get tested. The result is negative; I couldn't believe it for I thought I was so sure it'd come away positive. However, now I'm on PEP treatment for a month and today is my sixth day. One of the morning pills (not Truvada) I took about 4-5 hours later and I'm worrying that'll hinder the whole thing.

I also had to adjust the time for the night pills because the first one they gave me at the hospital was at 2am (the second one I also took at that time but after that about 4 hours earlier, so kind of at 11pm).

Btw, I'm in contact with the guy at the moment and he told me he could get tested no problem the first time I wrote him. Later, after I asked him if he could get tested so I didn't have to go through PEP he told me that he couldn't tell me at the moment when, so I'm assuming he's either positive or has no idea on his status. I don't know if it makes it better the fact that he told me he's only insertive and knows how to protect himself and what to do and what not; he keeps telling me I exaggerate and that I should calm down, that he didn't ejaculate inside me and that his penis was dry when he took it out.

Anyway, I had a crisis last night with the PEP. I swallowed both Isentress and Truvada at the same time; I had never had a problem with it (or so I think) but after I swallowed them I had the impression that maybe one of them was stuck in my esophagus. I absolutely freaked out and started drinking more water, even called two hospitals for advice and they told me to eat bread or yogurt; had the former so I ate pieces of bread to make the pill go down but it wouldn't. Drank more water; I was in absolute desperation. After that I decided to warm some milk and drank some...that calmed me down and later it seemed the sensation that a pill was still there was fading. However, it took me like an hour and a half for it to go away. Then I found some info on the internet about a condition called Globus something in which people have a feeling of having a lump or a pill stuck in their throat when in reality there's nothing there. Hopefully that was it because I'm freaking out a little that any delay in the doses can completely mess up the treatment...which leads me to another question: is warm milk a perfectly acceptable drink to make the pills go down easier? My doctor didn't say anything about it, so I'm going to assume it's ok?

So...this is where I stand at the moment. I'm hopeful in that the treatment will work (the doctor told me it's very very effective but like everything in life, nothing is certain  :( ) but I worry about that morning pill (Isentress) that I took a few hours late (the doctor told me that it was no problem but I still worry) and the Truvada + Isentress that, unless it was my imagination, took over an hour to go down my throat.

Also, I haven't been tested for other STDs (but will most likely in less than two weeks, when the doctor monitors my PEP treatment). In case I had STDs...would that affect the PEP treatment?

Thank you in advance for taking the time to read this long-winded post (which has actually kind of calmed me down)

Jeff G:
PEP is very effective if initiated within 72 hours so you should fully expect to test negative when you you confirm your HIV test at 12 weeks past PEP. The window period for testing is 6 weeks past any possible exposure or pep and again at 12 weeks to confirm it . Due to the window periods and peoples honesty or lack there of the only HIV test that matters is your own test taken at the appropriate time, never ask another person to test for you . 

You can read about testing here ... http://www.aidsmeds.com/articles/HIVtests_5029.shtml
You can read about PEP here ... http://www.aidsmeds.com/articles/Transmission_17146.shtml

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 .

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!

paquiqua:
Should I assume that since you didn't directly address any of my other questions that they have no relevance on the outcome of this treatment?

Thanks for the prompt reply!

Jeff G:
That is correct ... the meds are powerful and forgiving so just take them everyday around the same time within 3 hours either way and you will be fine .

paquiqua:
I've been experiencing night sweats (no fever, though) and some blandness in the stools when I go to the toilet...are these regular symptoms of PEP (Isentress + Truvada) or do they have to do with seroconversion? For some reason I'm also worried if the possibility of having an STD (don't know yet, have not been tested for other STDs) like hepatitis could really mess up the treatment.

Thanks again.

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