Questions on transmission

[Ahmed1985]

Hello.

Thank you for all that you do here.

I know that generally hiv is not transmitted outside the body and not through cuts. But I wanted to ask about my specific situation.

I had nose surgery a few months ago, it has mostly healed I think. I worry about that being a route of transmission because yesterday I gave this guy a handjob (I know no risk) but he ejaculated on my face. Some of his semen went in to my mouth, nose and eyes. I wanted to ask whether this was a risk. My worry is that the tissues of my nose may be sensitive or not fully healed after a few months. I also have dry skin and my nose bleeds every now and then, so I assume I have cuts inside my nostrils.

Is this a risk? If not, can you please tell me why?

There have been cases if im not wrong of blood splashing on the face and infection occurring, is this different?

Does the volume of fluid matter? Does the amount of time a fluid is outside of the body matter?

Thank you again.

[Jim Allen]

Hiya,

It's not an uncommon question about ejaculation on the face, cuts or on the skin, anyhow, what you posted isn't an HIV risk; it lacks direct route and exposure. You already answered the question yourself.

There have been cases if im not wrong of blood splashing on the face and infection occurring, is this different?

In short, no. You are talking about occupational blood exposure to the face. This would be theoretical with a larger volume of blood, and this would be the eyes with realistically only a rare suspected case remaining.

Outside of occupational situations, like jerking some guy off and getting a bit of cum or even blood on your face is hardly comparable and never has and doesn't result in acquiring HIV.

There are plenty of other easier-to-transmit STIs you could get this way, anyhow, please don't post about this again. Move on with your life. 

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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[Ahmed1985]

Hi Jim and team,

Please accept my apologies, I was not sure whether I should start a new topic or continue this one.

My question is about PEP usage. I had an exposure where I had vaginal sex where I was the insertive partner. We had used a condom but it broke. I went to emergency and got pep a few hours later. The doctor prescribed Truvada for 30 days and I took one pill that same night. The next day I read online that pep is a combination of medications so I visited a sexual health clinic where they told me to take Tivicay in addition to Truvada for 28 days. They seemed concerned that only Truvada was prescribed. So essentially I started Truvada about 6 hours after exposure and then Truvada and Tivicay together the next day at around the same time.

Now I have continued to have protected sex a few times after that. The problem is that on more then one occasion I was drunk and cannot recall if the condom broke or I did something I cannot remember. I read that more risks after taking pep may cause it to fail. So my questions are:

If I had another risk I cant remember one week after starting pep, should I go back and ask for pep continuation for another week? So that means 28+7 days. Shall I treat this as a new incident and double the dose or anything else? I ask because I soon travel to a conservative country for a work assignment and I will no longer have access to hiv prevention and the topic is unfortunately taboo. I have a few days to sort this out and I wanted your guidance please.

Also I have been advised to test at 3 weeks after exposure and then 6 weeks after exposure. I understand your guidelines are different? Thank you.

[Jim Allen]

You had a potential HIV exposure and started Truvada (TDF + FTC) six hours after the event and Tivicay (DTG) within 30 hours.

PEP is highly effective, so confirm your HIV status test six weeks after finishing PEP 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.

Also, get an STI screening for far easier to acquire STIs. Talk to your healthcare provider about the HPV and Hepatitis A&B vaccine. 

if I had another risk I cant remember one week after starting pep, should I go back and ask for pep continuation for another week?

No need. It would have been a slightly different answer if the exposure was at the end of the PEP course.

  The problem is that on more then one occasion I was drunk and cannot recall if the condom broke or I did something I cannot remember. I read that more risks after taking pep may cause it to fail. So my questions are:

If I had another risk I cant remember one week after starting pep

Serious lapse in common sense and consideration.

As for drinking, this level of drinking is seriously harmful to your mental & physical health. Don't underestimate the impact alcohol has and I urge you to give some serious thought to the topic and to talk to your healthcare provider.

double the dose or anything else?

No, don't double the dose!

[Ahmed1985]

Hi Jim,

Today I noticed what looked like sores or tears in the skin on my penis. My last activity was protected vaginal intercourse two days ago. Is this a concern if these are herpes, syphilis sore or tears in the skin on the penis that were not covered by the condom or the condom riding slightly up? I saw no obvious breakage of the condom and it did not completely slip off. As mentioned before I just finished pep, should I extend? Thanks.

[Jim Allen]

It's not an HIV concern.

[Jim Allen]

Some tips on correct condom usage:

Use approved condoms and check for a certification mark (e.g. FDA, C.E., ISO or Kitemark) because the condom complies with safety standards. Check the expiry date and make sure the condom is still within date.

Use lubricant condom-safe water-based lubricants to make condoms more comfortable and reduce breakage risk. – but avoid oil-based lubricants as they can weaken or break condoms.

As for putting the condom on correctly:

Incorrectly done, the risk of breakage can increase. Place the condom on top of the erect penis and pinch the teat at the end of the condom before you start to roll it down the penis. By doing this, you'll squeeze out any air bubbles and ensure there is room for the semen (cum). Roll the condom down to the base of the penis.

If it's on correctly, it will roll downwards easily. If you've started putting it on the wrong way, take it off, and even if you or your partner has not ejaculated (cum), there can still be semen or (pre-cum), so it's important to try again with a new condom. (More to do with risks from other STI's/pregnancy than anything else)

Finally, never "test" the condom before or after intercourse. It's not needed at all and could damage the condom, as it's not designed as a reusable (re-stressed) product, and "testing" the condom could lead you to mistakenly think that the condom was damaged during sex when in fact, you caused the damage after the intercourse by trying to "test" it.

Instead, use condoms correctly and consistently. If they don't break during intercourse, there is no reason to stress or test for HIV outside of standard yearly screening.

[Ahmed1985]

Thank you Jim. Regarding your helpful reply on correct condom usage, I did not check the condoms I or my partners used for certification or expiry. I think most of them were of the Skyn brand which are made from polyisoprene. I also did not check the type of lubricant used. I took my last and final dose of pep (due to condom breakage which I mentioned in previous posts) about 7 hours ago so I can still get more to extend the course if needed. Should I take any action or be concerned now? These couple of encounters occurred during the 28 day pep course and as far as I observed there was no condom breakage. Thanks.   

[Jim Allen]

Should I take any action or be concerned now?

No.

It's not an HIV concern.

I can still get more to extend the course if needed.

Don't.

I did not check the condoms I or my partners used for certification or expiry. I think most of them were of the Skyn brand which are made from polyisoprene. I also did not check the type of lubricant used.

That's fine as the condom didn't break. The incorrect lubricant and expired condoms etc. are all issues that can increase the odds of a condom breaking during intercourse.

However, HIV can't be transmitted through an intact latex, polyisoprene or polyurethane condom. Unless a condom obviously fails during intercourse, there is no reason to be stressing about HIV or PEP or testing for HIV outside the standard yearly HIV screening.

When used correctly condoms also offer some level of STI protection, however, the levels of protection condoms offer for various STIs depend 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.


You have now finished PEP. So to confirm your HIV status test six weeks after finishing PEP 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.

Also, get an STI screening for far easier to acquire STIs. Let them have a look at the sores or whatever it is you have on your penis and treat it, also talk to your healthcare provider about the HPV and Hepatitis B vaccine.

[Ahmed1985]

Thanks Jim.

When you say condoms when used correctly offer some level of protection I assume you are talking about STIs besides HIV. So as you mention me not checking the condom for certification and lube used is not a concern for HIV stress etc. as it did not obviously break. I will test at the 6 week post today mark and not take any more prep or stress.

[Jim Allen]

HIV can't be transmitted through an intact latex, polyisoprene or polyurethane condom. Unless a condom obviously fails during intercourse, there is no reason to be stressing about HIV or PEP or testing for HIV outside the standard yearly HIV screening.

When used correctly condoms also offer some level of STI protection, however, the levels of protection condoms offer for various STIs depend significantly on differences in how the diseases or infections are transmitted. Some infections (Not HIV) are transmitted primarily by skin in-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.

Read it again as a whole, start to finish and you will have your answer.

[Jim Allen]

I will test at the 6 week post today mark and not take any more prep or stress.

Great.

I'll also repeat this : Also, get an STI screening for far easier to acquire STIs. Let them have a look at the sores or whatever it is you have on your penis and treat it, also talk to your healthcare provider about the HPV and Hepatitis B vaccine.

If you do have an STIs, odds are you have passed them onto others, so talk to your clinic about partner notification should you indeed have a positive STI result

[Ahmed1985]

Hi Jim,

Thanks very much for your advice and care. I have had both the hep B and HPV vaccines in the past.

I went to the doctor to do the STI tests as you mentioned. They also had a look at my penis and they feel it is just minor cuts from dryness and friction.

Before going to the doctor I reviewed all the information provided in this thread so I dont miss any talking points. While reviewing, some questions came to mind so I hope it is okay to ask in this forum since it is related and for continuity.

1) I had mentioned previously that I was drunk (thankfully the drinking is under better control now) and may have had additional exposures while on PEP and could not recall actions or condom status. This was around a week into PEP (5-8 days), you mentioned that extending PEP wasn’t necessary. Can I please understand why? I would not assume PEP was acting and PrEP during such a short duration.So do you think I was protected for these additional exposures?

2) Relating to the above you also mentioned that the advice would be slightly different if it was towards the end of PEP. I’ve seen some answers on this forum where at the 25 day PEP mark and an exposure during that time, the advice was to not extend PEP as it was acting as PrEP. So I was wondering how the advice would change with an exposure at the end of PEP that you mentioned.

3) I’ve seen on replies in the forum that PrEP should be considered. I think it would be good for me so I had some questions. I spoke to the doctor and they mentioned that PrEP can be:
a) taken everyday
b) taken one week before sex and one week after
c) the 2-1-1 method
How long after sex or an exposure does PrEP need to be taken for? There seems to be conflicting answers, with 2-1-1 it is two days, the doctor said one week, and online it says to continue PrEP for 28 days. I’m trying to understand the best solution to be because of cost and plus I dont want to be taking it everyday if I dont really need to.Will taking PrEP have an impact on testing timeline? In my case if PEP was acting as PrEP at some point after an exposure that I didnt recall and given that in all cases there is a minimum number of days that it needs to be taken for (although conflicting as stated above), should it not be safer to continue for a few days after that exposure?

4) How do I transition from PEP (it’s done now as mentioned) to PrEP?

5) All this got me thinking, in my case where there was many sex encounters during PEP for 28 days, and I could not remember some encounters, is there any case, example or instance where Truvada alone  would be recommended as an extension beyond the 28 days PEP  or Truvada and Tivicay would be recommended beyond the 28 days PEP that I took?

6) If someone is on PrEP and the condom breaks, is the advice to start PEP?

Thanks so much Jim- Please do be patient with me and try to break all of this down as I’m really confused now.


 

[Jim Allen]

1) You were 5 days into PEP when you had a new potential exposure. The levels of drugs in your tissue were either sufficient to prevent the infection or not. Extending the end date of the 28-day course would make no difference to the outcome.

2) There is no change in advice. If you had real exposure in the last few days, extending by an additional few days would be an option to ensure the drug levels remain sufficient.

3) In pill form, you can consider daily continuous PEP or 2-1-1.

https://i-base.info/guides/prep/on-demand
https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing

4) So two trains of thought.

1) Start PrEP the day after completing PEP
2) Wait 6 weeks to test and rule out an HIV infection before starting PrEP. Currently, I urge caution, waiting and testing first.

5) I feel this has been asked and answered already. Truvada and Tivicay is PEP you don't need it, not for a few extra days, and not for 28 extra days either. Truvada alone is PrEP I have also answered your PrEP questions.

6) Generally no but it can be considered.

I’m really confused now.

Nothing to be confused about.

You had a potential exposure and took PEP. You have now finished PEP, get tested at the appropriate time and start using condoms correctly and consistently, consider daily PrEP or 2-1-1 in the future as an additional layer of HIV prevention going forward.

Now, enough questions, no more, it's simple and there is nothing more to say.