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Multiple exposures, pep, symptoms, window period

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Leon0505:
Hello Jim.
Thank you for your help and the info you provide. This forum is amazing.
So, i am Leon, 22 years old, a gay male from Europe. Last year, i met a lot guys via Grinder and these are my exposures:
Quite a lot oral exposures (people giving me oral) and insertive / receptive fingering. In some of this exposures when i was fingering the other person, i had open cuts on my fingers.
On 6th May I touch my lips on a dry penis for about 1 second, no precum, no cum. Also he gave me oral  On 16th May mutual masturbation with an unknown partner cumming exactly on my urethra and i used his cum as lube while i was masturbating.
On 28th May, a guy gave oral to me and i fingered him with an open wound in my finger. Later i found out that he was hiv positive so i went for pep in the first 24 hours. His doctor said that he's undetectable but he gave me pep to be sure. On 30th May a guy fingered me with precum in his finger and i noticed that the inside part of my anus started bleeding. Initially i had given 30 pills of pep, so after this incident, i took the 28-days course as i supposed to do. The only mistake that did happen is that i delayed the second dose for about 12 hours. And for some doses i took the pills +/- 2 hours earlier/later.
Around 10th May, i had 2  swollen lymph nodes under the right place of my jaw and around 25th May i got one swollen lymph node behind ear. This is quite large and it's a bean-size.
Yesterday, i had a 4th generation lab hiv test and it came back negative. Also, yesterday, a tourist from Uk of unknown status, gave me rough oral. During oral he bit me and my penis started bleeding a little. The blood from my penis was visible but it didn't not flow (i think). I want to add that i am uncircumcised and i was traumatized on the tip of my penis, in the foreskin. During the traumatization i felt pain but we didn't figure out what happened and he continued sucking me. I saw the red wound after i cummed. This guy is very active sexually. After the exposure i was anxious, and asked him about his hiv status and then he blocked me. I don't want to imagine why he did that😐
So i have some questions. Did my last hiv test that i did yesterday shows if i got infection from the exposures on 4th and 16th May? It's been 7-8 weeks, so it covers the 6 week period, but 29th i started Pep due to the exposure of 28th May. As far as i know pep extends the window period for the exposure that led to pep. But what about the previous exposures? Does the 28th May exposure and the starting of pep delay the window period for the previous exposures on 6th and 16th May? I am very confused about that.
Also, should i start pep again from the oral i received yesterday? I starting bleeding inside his mouth. I don't know his oral hygiene.
I can't wait again 6-8 weeks about testing, this thing is driving me crazy.
I know that you essentially state that receiving oral is not a risk, but how do we know that it's not even a minor one? In some old threads i saw some moderators told people that if they use condoms correctly for anal / vaginal penetration it's sure that they will be safe sexually about hiv, but then, some infections from giving oral sex appeared, and this advice gradually has changed. If the same happens for hiv receiving-oral exposures?
I tried to reduce my sexual partners after the exposure with pep and i did manage it, since 28th May, i only had one oral-receiving exposure, yesterday. I am planning to reduce my sexual partners even more.
Thank you for your time. Have a nice evening.

Jim Allen:

--- Quote ---Last year, i met a lot guys via Grinder and these are my exposures:
Quite a lot oral exposures (people giving me oral) and insertive / receptive fingering. In some of this exposures when i was fingering the other person, i had open cuts on my fingers.
--- End quote ---

Zero HIV exposure


--- Quote ---On 6th May I touch my lips on a dry penis for about 1 second, no precum, no cum. Also he gave me oral  On 16th May mutual masturbation with an unknown partner cumming exactly on my urethra and i used his cum as lube while i was masturbating.
On 28th May, a guy gave oral to me and i fingered him with an open wound in my finger.
--- End quote ---

Lips touching a penis isn't a concern, if you had given a blowjob even then it would only be a minute HIV risk, so much so that even testing outside of the yearly routine would not be warranted.

So, also not an HIV risk


--- Quote ---His doctor said that he's undetectable but he gave me pep to be sure
--- End quote ---

Gosh I will write a separate post later tonight on why this is the most stupid thing I've heard all year .


--- Quote ---On 30th May a guy fingered me with precum in his finger and i noticed that the inside part of my anus started bleeding.
--- End quote ---

Again no HIV risk


--- Quote ---Also, yesterday, a tourist from Uk of unknown status, gave me rough oral. During oral he bit me and my penis started bleeding a little. The blood from my penis was visible but it didn't not flow (i think). I want to add that i am uncircumcised and i was traumatized on the tip of my penis, in the foreskin. During the traumatization i felt pain but we didn't figure out what happened and he continued sucking me. I saw the red wound after i cummed.
--- End quote ---


Same again


--- Quote ---This guy is very active sexually.

--- End quote ---

Irrelevant to you and define very? It's a moral judgement and doesn't change your lack of HIV risk from the activities mentioned


--- Quote ---After the exposure i was anxious, and asked him about his hiv status and then he blocked me. I don't want to imagine why he did that😐

--- End quote ---

The reason is totally irrelevant but prehaps because you are asking a silly question.

Just presume whoever you are sleeping with is living with untreated HIV and reduce your risks. Again what you mentioned so far isn't an HIV risk regardless of the person's HIV status.


--- Quote ---I know that you essentially state that receiving oral is not a risk, but how do we know that it's not even a minor one?
--- End quote ---

--- Quote --- In some old threads i saw some moderators told people that if they use condoms correctly for anal / vaginal penetration it's sure that they will be safe sexually about hiv, but then, some infections from giving oral sex appeared, and this advice gradually has changed.
--- End quote ---


Lacks all the biological and environmental conditions required for HIV to transmit to the person being sucked. The vectors for acquiring HIV are well known and haven't increased in over four decades they have gotten less after fears from the early years were dismissed once science caught up after the mid-90s.

The advice to use condoms for vaginal and anal intercourse is solid, nowadays, PrEP can also provide an additional layer of prevention.

Giving a blowjob, possible but not plausible. This route has always been known; it's theoretically possible, but there are barriers and buts. I tend to air on the side of caution with any assessment and give context around any theoretical risks that it's a minute risk that doesn't warrant testing outside of the yearly routine. However, I understand why other sexual educators or healthcare providers might communicate this effectively as not an HIV risk.

However, I'm not going to debate decades-old threads with you, it would be pointless, and often the details are different. I can give you an assessment, and that's about it.

Jim Allen:

--- Quote ---His doctor said that he's undetectable but he gave me pep to be sure
--- End quote ---

Why would his doctor share this with you, it's his health data and none of your business. Also, if he is successfully treating HIV, even if you had engaged in condomless intercourse, there would be no HIV risk and no need for PEP.
https://forums.poz.com/index.php?topic=71864.0

Now I disagree with prescribing PEP for anxiety or mental health reasons, I know it's done, but I don't believe it resolves the issue, educates the person and ultimately, all it does is just further stigmatize HIV and people living with HIV. Of course, it could be that something was said to the doctor that wasn't mentioned here.

Anyhow what you mentioned here so far isn't an HIV risk.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse correctly and consistently, with no exceptions. Consider talking to your healthcare provider about PrEP as an additional layer of protection against HIV

Keep in mind that some sexual practices described as safe in terms of acquiring HIV still pose a risk for other easier acquired STIs. So please do get tested at least yearly for STIs, including but not limited to HIV, and more frequently if condomless 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.

Kind regards

Jim

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Leon0505:
Hello Jim. Thank you about your responses, and sorry about the amount of questions but the whole situation it was a little bit complicated.  Thank you again for your help, i really appreciate that.


--- Quote ---"Why would his doctor share this with you, it's his health data and none of your business."
--- End quote ---
The guy that i had the encounter, suggest me to go together to his doctor to tell me that there is no risk. That's why his doctor said about his status.


--- Quote ---"Now I disagree with prescribing PEP for anxiety or mental health reasons"
"Of course, it could be that something was said to the doctor that wasn't mentioned here."
--- End quote ---

Well, it was Friday evening so i didn't went to his doctor initially, but in the emergency room in a hospital. The doctor here was a young man that he may didn't know much about hiv and he gave me pep for one day and told me the next day to go there again. Next day, again in the emergency room, doctors told me that we continue the pep course, until Monday, when i go to the "official" doctor and he'll decide. Then i went to the doctor in this hospital and he told me that because the previous doctors in the emergency room prescribed me pep he'll continue it too, unless if we come into contact with the guy's doctor. Then i informed the guy and he told me that we can go to his doctor, in another hospital. When his doctor heard that i was given pep by 3 different doctors in previous hospital, he decided to continue it till the end. 
I think that if i had gone initially to his doctor, he wouldn't prescribe me pep, but i always choose to follow the doctors' instructions.

What about Pep and previous exposures? Before starting pep we get tested, to see if we already are hiv positive, but if we are in the "window period"? Does pep affect the window period of the exposures that happened 1-2 weeks before starting pep?
If the swollen lymph nodes were due to the exposures of 6th / 16th May, will the test i got yesterday (lab 4th gen / 7-8 weeks after exposure) will show reliable results? Or the pep will prolong the window period even for those exposures?

Thank you Jim.

Jim Allen:

--- Quote ---What about Pep and previous exposures? Before starting pep we get tested, to see if we already are hiv positive, but if we are in the "window period"?
--- End quote ---

What previous exposures?

So far nothing you mentioned was an exposure, and certainly no PEP or testing is needed outside of standard yearly screening.

I'm unwilling to pretend what you posted is an HIV issue.


--- Quote ---Well, it was Friday evening so i didn't went to his doctor initially, but in the emergency room in a hospital. The doctor here was a young man that he may didn't know much about hiv and he gave me pep for one day and told me the next day to go there again. Next day, again in the emergency room, doctors told me that we continue the pep course, until Monday, when i go to the "official" doctor and he'll decide. Then i went to the doctor in this hospital and he told me that because the previous doctors in the emergency room prescribed me pep he'll continue it too, unless if we come into contact with the guy's doctor. Then i informed the guy and he told me that we can go to his doctor, in another hospital. When his doctor heard that i was given pep by 3 different doctors in previous hospital, he decided to continue it till the end.
I think that if i had gone initially to his doctor, he wouldn't prescribe me pep, but i always choose to follow the doctors' instructions.


--- End quote ---

Absolutely crazy that doctors aren't up-to-date on HIV basics and that PEP was issued, although, understand that generally part of this could also be down to patient fear and people do lie about their real exposures so I'm not surprised.

Decisions About PEP in the ER Are Not Always by the Book
https://www.poz.com/article/decisions-pep-er-always-book

For 12 percent of these visits, the hospital staff prescribed PEP to people who were not considered at risk for HIV. Ten percent of the visits involved people who were at risk for HIV but did not wind up receiving PEP.

Knowledge of HIV PEP among healthcare workers in Ireland, 2016: room for improvement
https://www.lenus.ie/bitstream/handle/10147/621064/ART9.html?sequence=1

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