Unprotected Receptive Vaginal Sex Risk

[Vataia]

Hi,

I hope everyone is well.

I have been feeling extremely stressed, anxious and numb. I got myself into a risky situation where I had unprotected sex with a person who I barely know. I met him at the gym and we exchanged numbers and immediately started flirting and planning when we’ll meet up to have sex. I recently went through a bad breakup so I wanted a rebound. I purposely drank a lot of alcohol before meeting him as I was depressed. He told me that he was in an open relationship and his partner (a woman) knows about his sexual endeavours.

We did some foreplay and when it was time to penetrate me I asked him to put on a condom. He tried to but he lost his erection when he did. He took it off and started playing with me again and before I knew it, his penis was inside me. He continued thrusting and because I was drunk I didn’t stop him. We switched positions and then he pulled his penis out and ejaculated on my stomach. I believe after ejaculation he inserted his penis inside again and continued to thrust. We were both nervous so the whole penetrative act lasted for a max of 5-10 minutes. After that happened, I immediately had a panic attack as I have always tried to protect myself and I promised myself that I will use protection. He also told me that he attends fetish parties and sleeps with transwomen.

I couldn’t stop beating myself over what happened. This happened last Sunday. I tried to ignore my intrusive thoughts on Monday but my panic started taking over so I went to the STI clinic on Tuesday (50 hours after the exposure) and was given PEP.

I started PEP 50 hours later just as a precaution. Even though I started it within 72 hours, I believe I should have started it at 24 hours as it will not be effective after 24-48.

I know I had a risk but how likely is that I will end up with HIV after this encounter? This was the only encounter I had. My initial test came back negative.

I have also read some moderators say that they have witnessed people turn positive after the completion of PEP. Will this happen to me?

Can someone also explain to me how PEP works and how effective it is.

[Jim Allen]

He told me that he was in an open relationship and his partner (a woman) knows about his sexual endeavours.

He also told me that he attends fetish parties and sleeps with transwomen.

Cool but of course totally irrelevant

I recently went through a bad breakup so I wanted a rebound

Sorry to hear that.  Did you use condoms or PrEP during the relationship? What is recent, was in within the last three months?

[Vataia]

Hi Jim,

Thank you for the response.

The breakup happened 2 months ago and I did not use protection throughout and I was not on PrEP. I did do a full sti screen including HIV 6 weeks post breakup and that’s when I had unprotected sex with this new man.

[Jim Allen]

Thanks for the reply.

PEP is highly effective when started within 72 hours, and although I would fully expect you to be fine, do test to confirm your HIV status.

Test six weeks after finishing PEP with a blood-draw (lab) HIV antibody test. The result at this time will rarely change, and retesting at three months post-PEP generally isn't needed.

Can someone also explain to me how PEP works

Well, in short, PEP works by interrupting the HIV lifecycle, thus preventing it from taking hold and being replicated.

PEP is a combination of three drugs from at least two different classes. Most common would be the NRTI class of drug inhibiting reverse transcriptase, the enzyme that copies HIV RNA into new viral DNA and the INIs class of drug designed to block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell. https://www.poz.com/basics/hiv-basics/hiv-life-cycle

So tenofovir & emtricitabine as a single pill + raltegravir or dolutegravir.

I immediately had a panic attack as I have always tried to protect myself and I promised myself that I will use protection.

The breakup happened 2 months ago and I did not use protection throughout and I was not on PrEP.

Again sorry to hear about the breakup.

For the future do keep in mind that even in a relationship condomless sex with your partner is obviously accepting the risk of acquiring HIV. In relationships, condomless sex is often based on trust or past test results; however, this does not prevent HIV. If in any future relationship, condomless sex does occur, you should consider testing more frequently.

Here's what you need to know to reduce your HIV risks:
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; testing is the only way to know.

Kind regards

Jim

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[Vataia]

Thank you for the prompt response, Jim.

I understand that PEP is effective when started within 72 hours but most websites and medical professionals state that ideally one should start it within 24 hours. Surely at 2-3 days the virus has had enough time to replicate within the body and PEP would be useless. It feels like a game of Russian roulette and I cannot live with this uncertainty. I had plans for the summer and I have met someone else who is more stable and now my life is put on hold. I am a week into PEP and then after PEP I have to wait another 6 weeks to get an answer. So I cannot resume my life until this course finishes and 6 weeks post PEP until I get an accurate test result.

The man I had unprotected sex with is waiting for his test results. He got tested on Tuesday, so 2 days after we had sex. I know that his test results will give me some reassurance but even they don’t mean anything.

Our penetration lasted 5-10 minutes and he did not ejaculate inside me but he did insert his penis inside me after ejaculation. I’m unsure how risky this is.

[Jim Allen]

The man I had unprotected sex with is waiting for his test results. He got tested on Tuesday, so 2 days after we had sex. I know that his test results will give me some reassurance but even they don’t mean anything.

Correct, it means nothing concerning your risk due to the window period and several other reasons.

It feels like a game of Russian roulette and I cannot live with this uncertainty.

It's not remotely like a game of Russian roulette. The odds that you have acquired HIV are overall tiny, and the outcome is fully expected to be negative with PEP. Russian roulette, on the other hand, is far more dramatic. Classic Russian roulette is a 33.3% chance that you would die.

I had plans for the summer and I have met someone else who is more stable and now my life is put on hold.

There is no reason to put your summer on hold. I genuinely don't get the drama, I've lived with HIV for 24 years, and a bit of HIV never stopped me, would be different if you had AIDS and were on your deathbed but you don't, and even if you did acquire HIV, it's not going to be with the same issues or challenges I had 24 years ago, and yet I lived my life uninterrupted.

You have a slight chance of acquiring HIV, no need to overthink this, you have the PEP, and you should see testing as just confirming your HIV-negative status, nothing more, no drama needed. If you do have sex with your summer friend, use a condom!

I am a week into PEP and then after PEP I have to wait another 6 weeks to get an answer. So I cannot resume my life until this course finishes and 6 weeks post PEP until I get an accurate test result.

All you need to do is take your pills once a day, this will take max 2-3 mins per day, and after finishing the meds, you test at the correct time. It's hardly a show-stopping interruption, and you can resume living your life whenever you want.

I understand that PEP is effective when started within 72 hours but most websites and medical professionals state that ideally one should start it within 24 hours. Surely at 2-3 days the virus has had enough time to replicate within the body and PEP would be useless.

After sexual exposure, it takes HIV nearly a week to fully take hold and be replicated permanently and hence PEP is taken to within 72 hours to stop that lifecycle. The sooner you start, the greater the odds of interrupting the lifecycle before it takes hold but before 72 hours is still effective. You started PEP within 50 hours and you should fully expect a non-reactive result when you do a test to confirm your negative HIV status.

I wish you well and hope you have a nice summer. There is nothing more I can help you with in this limited setting, but if you keep stressing about this, then prehaps talk to your healthcare provider about mental health support to help you cope.

Wish you all the best. Jim.

[Vataia]

Hi Jim,

Thank you so much for providing me clarity. I’m sorry for asking all of these questions but this is all very new to me. I don’t know much about PEP but I will stick with the regime due to the accident I had. If I had not taken PEP, would I still be at great risk for developing HIV?

Is there a chance that I could still develop HIV due to PEP failure? I cannot find information on how common that is.

A guy I slept with last year told me he was in the clear but gave me chlamydia. I slept with another guy only once and immediately gave him chlamydia after that exposure. Does HIV transmit in that way also? Just as easy as chlamydia after one exposure?

I am struggling to live my life and go about my daily tasks and work. I had a trip to a remote farm planned at the end of July but I have to delay it and go at the end of August because I need to be in the UK to do a HIV test and see if I am negative. I cannot go on the trip and risk not knowing my status and i’ll be with my partner and I don’t want to live with the anxiety of transmitting anything to him. We both planned on having unprotected sex and I really do trust him so that is also written off because of this 10 minute mistake. This mistake has cost me 2 months of my life and my plans. I don’t feel like myself at all.

So those that take PEP on the 71 hour mark still have a chance of not contracting the virus? How fast does the medication begin to work once swallowed?

You also mentioned that the test results of the guy I had sex with mean nothing due to the window period and several other reasons; may I ask what are the other reasons? If his results come back negative will that be a good indication of his status?

Thank you for also sharing your story and experience living with HIV. Your perseverance, dedication and optimism is truly admirable.

Do you also think it put me more at risk when he ejaculated outside of my body and then immediately inserted his penis inside me again?

This is all really overwhelming.

Thank you for your patience. 

[Jim Allen]

I’m sorry for asking all of these questions but this is all very new to me. I don’t know much about PEP but I will stick with the regime due to the accident I had. If I had not taken PEP, would I still be at great risk for developing HIV?

There was no accident. You had condomless intercourse, as HIV is difficult to pass on even when all conditions are perfect, you were never at great risk of getting HIV regardless of PEP.

Is there a chance that I could still develop HIV due to PEP failure?

Yes. If PEP was perfect there wouldn't be a need to test afterwards.

As previously mentioned, you started PEP within 50 hours and you should fully expect a non-reactive result when you do a test to confirm your negative HIV status.

A guy I slept with last year told me he was in the clear but gave me chlamydia. I slept with another guy only once and immediately gave him chlamydia after that exposure. Does HIV transmit in that way also? Just as easy as chlamydia after one exposure?

No. Chlamydia is a common bacterial infection that is extremely easy to pass on and how it infects is different.

Look, HIV can't pass through an intact condom, hence the recommendation to use them when discussing HIV prevention.

Now, condoms also somewhat reduce the risks of other STIs, However the levels of protection for various STIs, depends significantly on differences in how the diseases or infections are transmitted. Some infections (Not HIV) are transmitted primarily by skin-to-skin contact, viral shredding or skin-to-lesion contact etc., which may infect areas not covered by a condom, such as genital herpes, human papillomavirus [HPV], Chancroid (Haemophilus ducreyi) etc.

I am struggling to live my life and go about my daily tasks and work. I had a trip to a remote farm planned at the end of July but I have to delay it and go at the end of August because I need to be in the UK to do a HIV test and see if I am negative. I cannot go on the trip and risk not knowing my status and i’ll be with my partner and I don’t want to live with the anxiety of transmitting anything to him. We both planned on having unprotected sex and I really do trust him so that is also written off because of this 10 minute mistake. This mistake has cost me 2 months of my life and my plans. I don’t feel like myself at all.

I don't see why you need to be in the UK to get tested. Plenty of clinics around the globe and if not rapid testing test kits.

Giving what you have posted here so far about your history and the plans you have, you seem to have been taking plenty of risks. I'll say it again condoms & PrEP prevent HIV, trust has nothing to do with it.

HIV doesn't come from being untrustworthy and trust doesn't prevent HIV or count as safer sex.

So those that take PEP on the 71 hour mark still have a chance of not contracting the virus?

Already answered

How fast does the medication begin to work once swallowed?

Few hours and the levels of drugs within your tissue continues to increase over the next couple of days/weeks as you take it.

You also mentioned that the test results of the guy I had sex with mean nothing due to the window period and several other reasons; may I ask what are the other reasons? If his results come back negative will that be a good indication of his status?

window period is the main one. Lying, mistakes are the next and a few more reasons that are irrelevant.

[Jim Allen]

Summary.

You had condomless sex, it's a risk and you started PEP within 50 hours. There is nothing more you can do now except take the meds and test.

You should expect a nonreactive result when you test to confirm your HIV status.

If you want to avoid HIV start using condoms correctly and consistently, no exceptions and consider PrEP.

There is nothing more I can help you with in this limited setting, but if you keep stressing about this, then prehaps talk to your healthcare provider about mental health support to help you cope.

I truly wish you well but if you continue posting I'm going to consider it excessive and issue a 28 day timeout (ban) to help you move on with your life

[Vataia]

Hi Jim,

I will take all of your advice and information on board but I wanted to ask you one final thing. You need not ban me as I won’t excessively be posting after this question. I just want to know why this is on the BHIVA guidelines;

In a retrospective review where 649 people were prescribed PEP for sexual exposures, the mean time from exposure to first PEP medication dose was 38.5 h [33]. A total of 69% completed the 4–6 week follow-up visit, 44% completed the 3-month visit, and 24% completed a 6-month visit. There were a total of seven seroconversions among PEP users within the study period. The mean time from exposure to first PEP medication dose was 51.5 h for people who seroconverted.

Many thanks.

[Jim Allen]

PEP effectiveness has been asked and addressed already and I have nothing to do with what BHIVA publishes or not.

Long story short, you are not telling me anything we don't already know, I've been living with HIV for a long time and they don't keep me here because of my looks or charming personality.

I've already answered your questions and I'm tired of repeating myself so, 28 day ban for continued excessive posting over nothing

You had condomless intercourse and was prescribed PEP by the clinc to reduce the odds of you getting HIV.

Nothing you read will change the outcome now, so finish the PEP and test at the appropriate time, consider condoms and PrEP going forward.

[Vataia]

Good evening,

I hope you all have had a lovely Easter.


I have decided to reach out as I cannot seem to calm myself down over what happened.  I also cannot use logic to understand my level of risk. I suffer with severe OCD and intrusive thoughts and my experience has heightened my OCD symptoms.

Since my last post, I took time for myself and did not have much sex after my breakup.

However, I decided to go on a spiritual retreat in Spain at the end of March and after I left the retreat, I decided to indulge in pleasures - sex in particular.

I met a handsome and charming man and I had repeated unprotected sex for about 4/5 times over the course of 2 days without ejaculation. Although, on the 4th time, he inserted it after he had ejaculated a few hours prior.

I know it’s ironic that I have OCD and I still indulge in such risky behaviour but I want to highlight that I also have my own mental health struggles and it can be difficult in the moment. But I do acknowledge how stupid I have been.

I did speak to him about my concerns and he assured me that I shouldn’t worry about it and that he is fine. We still remain in touch but he hasn’t got tested. I don’t want to continue bombarding him with questions.

When I came back to London, I was still in the window to get PEP but I completed the questionnaire on the Dean Street Clinic and I also read the BHIVA guidelines and because his status is unknown and he is not in a high risk group, and considering that we had PIV sex, then I felt that I wouldn’t have been given PEP. I was also on PEP last year and it stressed me out to go through it again but now I regret not starting the course. I honestly don’t know what I should have done.

Of course I will get tested at the recommended time but I would like someone to evaluate my risk and tell me how high it is and whether I should have taken PEP.

The male is from Spain and I presume he is straight but I cannot be certain. I took all this into account and that is why I did not opt for PEP.

I do remember another man telling me he was ‘fine’ but gave me chlamydia. I always get worried about HIV and I feel like I am manifesting it in my life. It was supposed to be a spiritual month for me but I f**d up because it was all too tempting.

My apologies for this long post. Your help would be much appreciated. Many thanks for taking the time to read my post.

Take care and hope you have a lovely evening.

[Jim Allen]

Hiya,

You had condomless intercourse, it's the primary way HIV is passed on and the receptive partner is at greater risk than the insertive partner. 

That said the vast majority of people don't have HIV to pass on, however, for the sake of a risk assessment we presume they were living with untreated HIV.

Now, beyond that, nobody, Dean Street or BHIVA included can calculate your personal odds of acquiring HIV from these incidents presuming they were living with untreated HIV. It is simply not possible and several factors play a role, such as the presence of other STIs, stage of HIV infection/Viral load (this can dramatically increase the risk), tearing or not, etc, etc.

Test to confirm your HIV status six weeks after your last potential exposure with a blood draw (lab) HIV antibody test. A non-reactive result at that time would rarely change, and retesting at three months is generally unnecessary.

Next time consider condoms & PrEP.

[Vataia]

Hi Jim,

Many thanks for your response.

I also wanted to ask you whether it is worth doing a PCR test on day 10. I cannot afford to wait 6 weeks to test. Will the result be accurate?

Regarding PEP, I have been to the clinic before and they have not given me PEP as the man was not from a high risk country and that it was PIV sex. The only reason they gave me PEP last time was because the man I had sex with went to sex parties and slept with transwomen. I have HPV and they have monitored changes in the cells to my cervix.

Obviously I cannot do anything about it now. But I wonder why the Dean St and BHIVA/BASHH put these guidelines up when they should be viewing every partner as potentially positive. However, at the same time, if they prescribe PEP to every person who had unprotected sex/ONS then that would also not be sustainable.

I read many stories of women in the UK or US who have contracted HIV and if they based it on looking at statistics online then they would also assume they would not contract it - yet, they did.

I feel very worried, concerned, and regretful.

[Jim Allen]

Hiya,

Reading stories will not change anything, it will just add stress. Stop focusing on HIV and instead focus on living your life as usual and test when due.

I don't see the need for PCR testing and recommend you test six weeks after your last potential exposure with a blood draw (lab) HIV antibody test.

Finally, I do wish you well but there is nothing more I can do for you here. Talk to your healthcare provider about PrEP for the future and getting vaccinated against Hepatitis A & B.