7 days ago sex with condom with sex worker but,

[JamesN]

I had protected sex with a sex worker in the doggystyle position but I had an open herpes at the base of my penis on the top side that I was unaware of until I was finished, to be honest the sex lasted maybe a 40 seconds but I’m not sure her fluid didn’t make it to my lesion, added note the lesion is at my pubic line which I’m not sure but I think remained behind my briefs, anyways I went to the ER the next morning and was prescribed PEP, I started taking it at 26 hours post exposure...I’m unsure of the sex workers status as well as I’m very nervous that I’ve read a lot about herpes speeding up the hiv infection into overdrive so I’m worried the pep isn’t working

[CaveyUK]

You had protected sex so didn't have an HIV risk.

HIV is also a fragile virus that doesn't survive exposure to air, so any concerns about 'fluid' making it to any part of you that isn't covered by a condom is a red herring. HIV simply isn't transmitted that way.

We wouldn't recommend PEP based on the described event, but given you have started treatment I would strongly recommend finishing the course and then moving on with your life.

Regarding nervousness about the sex workers status, we see a lot of anxiety on here about this topic and I suspect much of it is fuelled by guilt. The reality is that the vast majority of sex workers are very aware of HIV and are regularly tested. The actual risk of HIV transmission is exactly the same whether your sex partner is a professional or a girl you met in a bar. The only way to be confident in protecting yourself from HIV infection is to wear a condom during vaginal or anal sex.

Finally, I will add the standard caveat here - as you are sexually active you should ensure you periodically (yearly) get screened for all STI's as most are far easier to catch than HIV.

[JamesN]

Thank you sir,the majority of the anxiety is the open herpes lesion at my pubic line, everything I’ve read says it’s a go for hiv as it can enter here more easily due to the already existing cd4 cells there and even speeds the process up

[CaveyUK]

Understood. However you said the lesions were on the public line and likely covered by your underwear, hence the view that the risk here didn't exist as any fluid exposed to air would be rendered non-infectious, and there wouldn't be a direct route to any open lesions anyway.

If your lesions were on your penis, and you had unprotected (condomless) sex then I would be far more concerned.

I suspect the health professionals you consulted after the event are erring on the side of caution by prescribing PEP, and therefore it is smart to continue that course, which should allay any further anxiety.

I'm not aware of any cases where PEP failed in the setting of an active Herpes infection, so I wouldn't spend any time unduly worrying about that either.

I'd also get a full STI screen - which you may be getting anyway as part of the PEP provision. If you haven't already, I would also get the 'Herpes' lesions looked at professionally, as many other completely benign rashes, spots and lesions can appear on the public area and be nothing to do with Herpes. As with all these things, it's better to know for sure

[Jim Allen]

James, I fully agree with what CaveyUK has posted.

This is so much a no risk for HIV you should stop posting about it.

Nothing you mentioned so far even warrants specifically testing for HIV as it is not how HIV is transmitted let alone PEP. With no disrespect to you but it’s an utter waste that a Doctor gave you PEP and just further stigmatises how HIV is transmitted.

Perhaps your doctor is one of the 12% that incorrect prescribes pep or perhaps you told them something different than you did here or they are giving it to you to curb your irrational fears - who knows. Does not change that what you posted is not a HIV concern. Finish the PEP course now as you started it and I have no idea what you told the doctor.

The protected intercourse was not a concern, HIV does not transmit through an intact Latex or polyurethane condom and if they break they shred leaving no doubt.

Having a pre-existing STI does not create a risk from a no risk situation, this is commonly misunderstood all it could do is increase the risk if you engage in activities that already was a risk HIV transmission. Example unprotected intercourse.

Understand and primary reason this is not a risk is simple because HIV is very fragile and difficult to transmit so much so that well nobody has been infected once it has been exposed outside the human body to air, either sexually or from day to day contact regardless of people touching their genitals, wounds, scrapes, cuts, herpes, objects, open wounds or sores as long as it was exposed outside the body to air first.

Once HIV has been exposed to the open environment outside the human body regardless of how you touch it, it is not a transmission concern going back to basics that HIV has an outer protein/receptors that are needed to remain infectious this is used to infect human cells and attach to the CD4 cell and they corrodes in contact with air, so leaving the virus no longer able infect human cells.

HIV firstly needs to be present for it to be a risk and in sufficient quantity for it to transmit, it also than needs an effective route, and it must also reach cells which are susceptible to infection. This are the 4 basic conditions needed for a theoretical risk and you met none of them and if even 1 of them is missing transmission can not occur.

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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P.S

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

In one Swiss emergency room, 22 percent of decisions about prescribing post-exposure prophylaxis against HIV did not follow guidelines.
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.

To be honest does not surprise me, here are the UK guidelines I'm more familiar with but same thing is seen in the UK https://www.bashh.org/documents/PEPSE%202015%20guideline%20final_NICE.pdf
People being prescribed medication when they had no risk, and just need a therapist to help them past their irrational fears in life. Also engagement with them and explaining safer sex and risk avoidance would be a good idea. Giving PEP unneeded just generates and reinforces further stigma and myths about transmission and fear where none is needed.

[JamesN]

Ok last post I suppose, no everything I told you guys is what I told the ER doc, except that after I finished and took the condom off I wheat to her bathroom and took liquid soap and wiped my penis and the herpe, hence how I found the herpe, the soap burned, but the web shows soap likely to help spread hiv if used to clean up directly after sex which sounds crazy to me but I’m in no way obviously an hiv expert

[CaveyUK]

Yes it's crazy. Soap doesn't spread HIV.