POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: worriedsdguy on May 14, 2009, 11:21:39 pm
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I'm really worried. I had protected anal sex with a guy that now I think is probably hiv+. I'm the insertive partner and I wear a condom.
However, about a week before the sex, I had some herpes lesion on my penis but it almost healed by the time we had sex. However, the lesion is at the bottom of the penis and thus is not covered by the condom and have had contact with the rectal fluid of the guy.
I read that the rectal fluid has more viral load than even blood and now I'm really worried. Immediately after the sex, I noticed that the (almost healed) herpes lesion turns red again, indicating probably lots of immune cells at the site. And it is sensitive to touch.
About two days after the encounter, I started to develop low grade fever. Sometimes as high as 99.9 under the arm, usually in the afternoon, accompanied by a chilling sensation when it comes.
It's been only a week since the encounter and the fever is still here. No other symptoms so far.
So experts here, please please help me out. What are my risks? Can the acute syndrome happen so fast (two days after?)
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Worried,
No, symptoms, if they happen at all (and they don't always), don't come on that fast. It normally takes two to three weeks.
I also have herpes, and it sounds to me like rather than the lesion not being healed, that you're getting a fresh outbreak. Fever can sometimes accompany outbreaks.
You're worrying unnecessarily about hiv in this instance. For there to have been a risk to you, the lesion would have had to actually been inside of the other person, and it wasn't.
I would like to point out that you probably gave the guy herpes. Even if there is no open lesion, when an outbreak is just coming on, you will be shedding the herpes virus from the area. You need to abstain from having sex when you have lesion that is not covered by a condom. You can also talk to your doctor about taking acyclovir as a herpes prophylactic. This means you take it every day and it will prevent you from having outbreaks, thus preventing you transmitting your herpes to others. Believe me, having herpes on your anal area is NO fun.
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 all three condom and lube links in my signature line so you can use condoms with confidence.
ALTHOUGH YOU DO NOT NEED TO TEST OVER THIS SPECIFIC INCIDENT, 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.
Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple.
Ann
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Thanks Ann!
I guess I need to clarify a bit. By saying "Immediately after the sex, I noticed that the (almost healed) herpes lesion turns red again, indicating probably lots of immune cells at the site. And it is sensitive to touch. " I meant that a few miniutes after the sex... the leision was healed before that, not red, not sensitive so I thought I recovered from the outbreak. Maybe the rubbing during the sex makes it that way.
I read (from the acyclovir manufacture's site) the macrophage at the base of the herpes leision will make HIV transmission easier. Does that put me at additional risk for HIV transmission?
I'm restraining from having sex when I had an outbreak, but the leision got healed up and the scab falls off so I thought I'm OK. Does that still make me vulnerable for HIV transmission and make the other persion vulnerable for HSV?
Really appreciate all your expert help!
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worried,
As I already told you, as the lesion was not actually inside the other person, you weren't at risk for hiv. If you were starting another outbreak, yes, you did put the other person at risk for herpes.
If you continue to worry about this, then go test. You should be testing regularly anyway. If this is the only incident you're worried about, don't be surprised by your negative result.
Ann
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Thanks Ann for the replies for my previous question.
I just felt really dumb now!!!
It happened yesterday, I was the passive one during anal sex but I insisted the other guy put on a condom; however, to my dismay, at some point during the act, he deliberately removed the condom and reinserted me. He didn't ejaculate inside me but I don't know how long he has inserted me w/o the condom, maybe for 1-2 min.
And when asked, he refused to answer my questions regarding why he would do that and wouldn't answer my question regarding his HIV status (earlier he said he's negative)
Now I'm getting really really freaked out and I'm at actual risk for HIV exposure.
I went to the ER last night and got a course of PEP ordered and the first dose taken for about 10 hours after the incident.
The doctor gave me a single dose of Nevirapine 200mg, then prescribed Truvada (200mg emtricitabine/ 300mg tenofovir) TWICE daily!
This is the part I'm confused, I read online and it seems that the dosage for Truvada is ONCE daily. Today is a holiday so I can't talk to any specialist. Should I stick with TWICE daily or should I do it ONCE daily? I searched and read some horror stories about the side effects of Truvada on liver and kidneys...
And BTW, can Truvada alone be considered an effective PEP regimen?
Lots of thanks for your expert opinions and I just felt dumb maybe I shouldn't have sex at all!!!!!
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What was the reason you started PEP?
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Thanks Rod for replying!!!
This is what happened yesterday, it is entirely a separate incident:
It happened yesterday, I was the passive one during anal sex but I insisted the other guy put on a condom; however, to my dismay, at some point during the act, he deliberately removed the condom and reinserted me. He didn't ejaculate inside me but I don't know how long he has inserted me w/o the condom, maybe for 1-2 min.
And when asked, he refused to answer my questions regarding why he would do that and wouldn't answer my question regarding his HIV status (earlier he said he's negative)
So I was at the receiving end of anal sex w/o a condom!!! I think I'm at great risk here, right? I just couldn't understand why the other person would take off the condom in the middle on purpose!
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Worried,
In the US, the preferred PEP treatments are the following combos:
NNRTI*-based
Efavirenz plus (lamivudine or emtricitabine)
Efavirenz plus (zidovudine or tenofovir)
or
Protease inhibitor
Lopinavir/ritonavir (co-formulated as
(PI)-based
Kaletra) plus (lamivudine or emtricitabine)
plus zidovudine
(source (http://aidsinfo.nih.gov/contentfiles/NonOccupationalExposureGL.pdf))
In the UK, the preferred PEP treatment is
TRUVADA (tenofovir + lamivudine) (1 tablet daily) + KALETRA tablets (Lopinavir 200mg/ritonavir 50mg) (1 tablet twice daily)
(source (http://www.cmshn.nhs.uk/document_uploads/Resources/Microsoft%20Word%20-%20PEPSE%20guidelines%20version%2013%200.pdf))
I really don't think you should be taking Truvada twice daily, and the recommendations say you should probably be combining the Truvada with Kaletra or Sustiva. You need to get another opinion on what you're taking. Kaletra is twice daily dosing, while Sustiva is once a day. You can read about the drugs in our drug lessons (http://www.aidsmeds.com/list.shtml) section.
As this person didn't cum inside you, your risk is less than if he had cum inside, but it's not no risk.
Ann
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Thanks Ann for the info!
I'm at day 28 of my PEP after an exposure of an (unintended, that guy simply removed the condom half way w/o letting me know!) unprotected anal (I'm the bottom, and ironically, first time after a long time, being top otherwise and never had a scare...)
The ER visits happened after 10 hours, thinking about my options and asking the guy his status and when did he remove the condom. He insisted he's negative and only removed it the last min (he didn't cum in me). Finally made the decision to go to the ER. The first place I went, an urgent care center, refused to treat me, had to drive to the hospital ER, wasted another hour or so.
Finally saw a doctor at 1AM in the morning, had to educate him about PEP with the printout I googled earlier. Was given a single dose one hour later, nevirapine and Truvada at the time. But was given incorrect dosage on Truvada (was told to take one pill TWO times a day!).
Fiinally got to see a AIDS specialist 48 hours post exposure (Memorial day holiday, my worst one!), the receptionist wouldn't give me an appointment intially, but after I showed my insurance card, she did give me an appointment and I saw the doctor 10 min later (Damn, money talks, see how much they billed my insurance.)
Was put on exactly the same course Ann recommended, Truvada (1 pill, once a day) +Kaletra (two pills twice a day). And hadn't miss a dose since then.
Now I'm super worried, I had episodes of severe night sweat for a few nightes at about two weeks post exposure. Now my lymp nodes are enlarged starting at around the same time and they are not sore (ARS lymphadenopathy?!)
Had weekly blood test to monitor my liver and kidney functions (feared about the side effects of those potent drugs!) So far so good. Had diarrhea now and then and other than that no major side effects. (Hope it's the drugs, not the virus causing my diarrhea!!!)
Tomorrow another appointment with the ID doctor, to discuss my blood differential results. Plan to do the viral load next week.
Hope everything will turn out fine! Hope I could learn the lesson from the scare and move on! Those 28 sleepless nights! Please please no viral loads....
p.s. Just got my insurance bills, ER visits: $983, ID doctor appointments 3*$350 each time. Lab work, $1500!!! Two drugs Truvada $1800 + Kaletra $890.
PEP is not cheap nor easy. Now just hope it will work. BTW, given my symptoms, should I consider lengthening my PEP treatment for another month? I started it pretty late (11 hours post exposure) and according to this paper, longer PEP might make sense [1,2].
Please people, be responsible, safe sex everytime. And be extra cautious, if your partener is not trustworthy!
[1] Effectiveness of Postinoculation (R)-9-(2-Phosphonylmethoxypropyl) Adenine Treatment for Prevention of Persistent Simian Immunodeficiency Virus SIVmne Infection Depends
Critically on Timing of Initiation and Duration of Treatment, CHE-CHUNG TSAI,* PETER EMAU, KATHRYN E. FOLLIS, THOMAS W. BECK, RAOUL E. BENVENISTE,2 NORBERT BISCHOFBERGER, JEFFREY D. LIFSON, AND WILLIAM R. MORTON, JOURNAL OF VIROLOGY, 0022-538X/98/$04.0010 May 1998, p. 4265–4273
[2] Post-exposure prophylaxis for SIV revisited: Animal model for HIV
prevention, Peter Emau*, Yonghou Jiang, Michael B Agy, Baoping Tian, Girma Bekele and
Che-Chung Tsai, AIDS Research and Therapy 2006, 3:29 doi:10.1186/1742-6405-3-29
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PEP is for 28 days. Period. So no, you should not be thinking of extending it.
Your symptoms are not HIV specific. If they persist you should discuss them with your doctor. I daresay stress is playing some part in them as stress always lowers the immune system.
You had a single incident in which you were partially unprotected. The odds are in your favor that you're going to test negative. Meantime you need to make a real effort to get productively busy about other things in your life. It will make the waiting time a lot easier. And you can do it so don't tell us you're too worried to think about other things. That won't fly here.
Good luck.
lly y
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Thanks Andy!
Negative anti-body at 4 weeks. Duno if PEP will extend the window period, the paper I referenced seem to suggest so from the Monkey models. Had a viral load done at the same time, will know results in 2 weeks.
Will probably do another viral load and antibody test in 2 weeks post-PEP.
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Worried,
You need to test at three months past your last dose of PEP for a conclusive result.
You do NOT need expensive PCR tests. If they're testing with DNA PCR, the more you test, the more likely you are to end up with a false positive result and you don't want one of those. (false positive results are why the DNA PCR is not approved for diagnostics) RNA PCR tests can also sometimes return false positives.
The vast majority of people who have actually been infected will seroconvert and test positive on the antibody tests by six weeks, with the average time to seroconversion being only 22 days. The same applies to the post-PEP period. A negative antibody result at six weeks needs to be confirmed at the three month point, but is unlikely to change.
If you want to test again at the six week post-PEP point, use an antibody test. That's all you need.
Ann