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Author Topic: Best time to test following exposure  (Read 678 times)

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Offline lee97

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Best time to test following exposure
« on: December 18, 2021, 01:21:17 pm »
Hello and thanks in advance for your help. A little over 4 weeks ago I received oral sex from a stranger of unknown status. It was for less than a minute and I didn't ejaculate but the other person did ejaculate on my penis including the penis head. Edit: for what it's worth the other person claims to be HIV negative and on PREP. Not sure I believe that as when I asked a 2nd time they just said they were recently tested and didn't mention PREP.

Anyway I went to the hospital within 48 hours but was refused PEP, even though they said it was low risk (not zero risk). They did baseline blood test and I had a follow up full STD test (including veinous blood drawn to test for HIV) a few days ago, 29 days post exposure. I am waiting for the results. But since then I read that I should really have tested after 6 weeks or 3 months for HIV.

When should I really test? I have a postal kit (blood drawn from finger to send back to a lab, not an insti one) and not sure when to do the test.

Offline Jim Allen

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Re: Best time to test following exposure
« Reply #1 on: December 18, 2021, 02:48:22 pm »
Hiya,

Quote
Edit: for what it's worth the other person claims to be HIV negative and on PREP. Not sure I believe that as when I asked a 2nd time they just said they were recently tested and didn't mention PREP.

Nothing anyone mentions about their HIV status in a risk assessment is worth anything.

Quote
A little over 4 weeks ago I received oral sex from a stranger of unknown status. It was for less than a minute and I didn't ejaculate but the other person did ejaculate on my penis including the penis head.

What you posted is no HIV risk to you whatsoever. Lacks all the conditions needed, I am not sure what you said to the hospital or if it was an ID specialist but what you mentioned here was certainly no HIV risk to you.

Quote
hey did baseline blood test and I had a follow up full STD test (including veinous blood drawn to test for HIV) a few days ago, 29 days post exposure. I am waiting for the results.

If you acquired HIV it was not from this encounter, so collect the results from the baseline that has already been taken and move on with your life.

Use condoms for any intercourse, consider talking to your healthcare provider about PrEP as an additional layer of HIV prevention and test out of standard routine for HIV & easier to acquire STI's at least yearly.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your health care provider about taking PrEP going forward as an additional layer of HIV protection.

Keep in mind that some sexual practices described as ‘safe’ in terms of HIV might still pose a risk for transmission of other STI's, so please do get tested regularly and at least yearly for 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.

Kind regards

Jim

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« Last Edit: December 18, 2021, 03:55:37 pm by Jim Allen »
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Offline lee97

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Re: Best time to test following exposure
« Reply #2 on: December 18, 2021, 04:11:00 pm »
Hello Jim and thankyou for responding. I told the doctor at the ER exactly what I told you. They showed me the PEP guidelines and likened the incident to a semen splash to the eye with a risk of <1 in 10000 and that was the reason for not giving PEP.

Insertive fellatio is not listed as zero risk even in the guide and the other person's semen coming into contact with my penis must add to the risk.

The baseline test was negative and I had not had any kind of sex in the 7 months prior (and that was protected vaginal). The doctor I saw at the GUM clinic (29 days post exposure) said it is very very unlikely that I acquired HIV from this incident and said she had never had a patient acquire it this way before but that its not zero risk. Have you known anyone to get HIV in the way I describe?

I should have added that I shaved a few hours before and may have had little cuts on the base of the penis.

So let's assume the other person is positive and with a high viral load and semen came into contact with shaving cuts, the urethra and membrane around the foreskin (I am uncircumcised) - does that increase the risk in your opinion?

And what about the testing? I have the kit so may as well use it. Should I test at 6 or 12 weeks?

One other thing I forgot to mention is that around 7-10 days after the encounter I developed a rash with whitehead spots on my chest and shoulders. It cleared up after about a week. I also had diarrhoea for a few days but I think that is the stress of this incident, I haven't stopped thinking about it since and spend hours a day reading up on it.

I am holding off getting my covid booster dose until I have finished HIV testing as I don't know if that will interfere with the results. Do you know anything about that?

Sorry for all the questions. I have been worrying out of my mind and can't concentrate on anything else at the moment
« Last Edit: December 18, 2021, 05:48:36 pm by Jim Allen »

Offline Jim Allen

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Re: Best time to test following exposure
« Reply #3 on: December 18, 2021, 05:50:10 pm »
There is no need to delay getting your covid vaccine and I have already answered the other questions with my first reply.

There was no HIV risk, nothing you added changes that, so collect the results from the baseline testing that has already been taken and move on with your life. Use condoms for any intercourse, consider PrEP and test at least yearly out of standard routine.

Jim.
« Last Edit: December 18, 2021, 06:09:25 pm by Jim Allen »
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Offline lee97

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Re: Best time to test following exposure
« Reply #4 on: December 19, 2021, 05:53:28 am »
Hello Jim. Sorry, I am not meaning to be argumentative and hope you appreciate why I am concerned.

I am being told by an ER doctor and a GUM specialist that it is not zero risk. I am reading in official guidelines from NHS/CDC/BHIVA/BASSH/Terrence Higgins Trust that it is not zero risk

Now can you say with complete confidence it is zero risk? Where is the evidence to back that up? I cannot see why health providers would be wasting resources to test for something if the risk was zero.

Since you don't want to answer my testing question I have ordered another postal kit and will just test at both 6 weeks and 12 weeks. I will post the results. Thanks again

Offline Jim Allen

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Re: Best time to test following exposure
« Reply #5 on: December 19, 2021, 06:29:02 am »
 ::)

I did answer your testing question. Test again in 12 months time as an annual routine like every sexually active person should.

Regarding why it's no HIV risk, well firstly when you receivce oral sex lacks it the conditions required for acquiring HIV, saliva is also hostile towards HIV corroding the receptors needed to infect and thus it makes perfect sense that after nearly 40 years of this pandemic, there hasn't been a single documented case of HIV transmission to an insertive partner (the person being "sucked"), and you will not be the worlds first.

As for getting fluids on your penis, HIV is fragile and sexually limited to being aquired inside the human body.

None of this is new information and is well understood and free to look up. Some of the credentials you mentioned published this but sadly there are a few who also hang onto outdated info such as claims kissing is an HIV risk or spitting when this has also been debunked long ago, I presume those that hang on to these myths do so out of CYA situation but there is no point stressing about issues that have been debunked decades ago or are purely theoretical.

As for exposure to the eye, there has only been one recorded & confirmed HIV case and that was following a blood splash in a lab, I don't see why you think that relates to sexually getting cum on your penis but it's not the same.

« Last Edit: December 19, 2021, 06:34:24 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Jim Allen

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Re: Best time to test following exposure
« Reply #6 on: December 19, 2021, 07:13:41 am »
Quote
I cannot see why health providers would be wasting resources to test for something if the risk was zero.

I don't know what the person you spoke to was thinking.

However, I can provide some examples of why I tell people that I meet face to face, on calls / online to test at times despite the scenario being presented not being any HIV risk to them whatsoever.

If the individual is sexually active yet has not been tested previously or hasn't been tested routinely. I will also push for testing if I don't believe they disclosed the full details from an encounter or if they mentioned being under the influence.  There are also a half dozen more reasons, but the above would be the main ones.

It's a bit like why does my own consultant keeps testing me for syphilis, 5 times in 18 months, despite me insisting I don't belong to any risk group and sadly don't have the sex life required for there to be a need to test so often outside of routine.

Now, I would presume they test me because like myself I too often see people downplaying their real risks, exposures or mistakenly dismissing a real exposure that did warrant testing and therefore they just test by default regardless of what's claimed. It's for sure is part of the reason why I include in my signature that people need to test routinely regardless not only for HIV but far easier to acquire STI's.

I also know some people will recommend testing and at times PEP if the person has a high level of anxiety over no-risk scenarios or theoretical concerns but I don't and would rather educate and ask them to consider talking to a therapist instead.

Anyhow, what I am totally unwilling to do is pretend what you posted is a risk, as doing so would be incorrect and a disservice to you and the community.

So to wrap this up I do wish you well but consider the topic closed, I have provided you with an assessment based on what you posted, given safer sex information and testing recommendations.



2018
https://doi.org/10.1016/j.eclinm.2018.08.001

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

We have identified falsely optimistic views of personal STI risk among a substantial proportion of those at risk of STIs in the British population, which could have a negative impact on efforts to promote safe sex and STI testing, and the control of STIs.

Among those classed as having ‘unsafe sex’ in the past year (comprising approximately 1 in 5 sexually-active 16–44-year-olds), 39.2% of men and 51.0% of women rated themselves as not at all at risk of STIs

2018
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30062-6/fulltext

Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Jim: In short they analysed the genetic code of the virus from HIV-positive people and came to the conclusion that some of the self-reported heterosexual mens HIV was more than likely actually non-disclosed MSM.

2018
http://journals.sagepub.com/doi/abs/10.1177/0032885517753163

Underreporting in HIV-Related High-Risk Behaviors: Comparing the Results of Multiple Data Collection Methods in a Behavioral Survey of Prisoners in Iran

Participants reported more sexual contact in prison for their friends than they did for themselves. In men, NSU provided lower estimates than direct questioning, whereas in women NSU estimates were higher. Different data collection methods provide different estimates and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.

2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268760/

Socially desirability response bias and other factors that may influence self-reports of substance use and HIV risk behaviors: A qualitative study of drug users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias

2018
http://emj.bmj.com/content/35/1/46
Self-perceived risk of STIs in a population-based study of Scandinavian women

Subjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

2018
https://www.tandfonline.com/doi/abs/10.1080/09540121.2017.1384787

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa

2017
https://www.ncbi.nlm.nih.gov/pubmed/28509997

Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors.

2017 --In regards to STI's
https://journals.lww.com/stdjournal/toc/2017/07000
Sexually Transmitted Diseases: July 2017 - Volume 44 - Issue 7 - p 390–392

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.

2016
https://www.sciencedirect.com/science/article/pii/S0010782416305418
Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

Jim - Not a conclusive or in depth study but under the study participants it did find: 9 out of every 20 sex acts reported with condoms are actually unprotected

2013

Rollins School of Public Health, Emory University, and the Kensington Research Institute, Silver Spring, MD 20910, USA https://www.ncbi.nlm.nih.gov/pubmed/14655794

"At risk" women who think that they have no chance of getting HIV: self-assessed perceived risks.

more than one-half of the "no perceived risk of HIV" sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors


2009
The Validity of Teens’ and Young Adults’ Self-reported Condom Use
https://jamanetwork.com/journals/jamapediatrics/articlepdf/380711/poa80067_61_64.pdf

A significant degree of discordance between self-reports of consistent condom use and YcPCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but
used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers

BMC Public Health 2007
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-60

Analyses of data from the Demographic and Health Surveys, Sexual Behaviour Surveys and from other countries show a similar pattern indicating under-reporting
It is probable that as HIV campaigns encouraging delayed sexual debut and abstinence before marriage reach the population, people will report behaviour
assumed to be more socially desirable.

there are some signs of differential reporting bias in our study. We found that controlling for less risky sexual behaviour substantially reduced the association between HIV and survey time among urban men, but less so among women; this may suggest that self-reports from men about sexual behaviour are more reliable. Studies suggest that respondents, especially women, tend to under-report the number of lifetime sexual partners . Therefore, analyses of associations with, and changes in, self-reported sexual behaviour should be interpreted with caution.

2010
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957626/

Self-presentation bias (wishing to be viewed in a positive light) may result in patients underreporting behaviors they perceive to be stigmatizing

Approximately a third of the men in the sample reported that they did not disclose all of their risk behaviors to the HIV counselor during the face-to-face risk assessment. These results echo similar studies of risk disclosure to medical providers



J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

In total, almost 19,000 instances of unprotected oral sex were estimated to have occurred involving the 135 couples over the ten years of the study,
but not a single case of HIV transmission was detected. The study authors conclude that:

“this seems to point to a very low probability of HIV transmission related to this practice.”
Reference

Romero J et al. Evaluating the risk of HIV transmission through unprotected orogential sex. AIDS 16:9:1269-97, 2002.

No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS:  Volume 16(17)  22 November 2002  pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

http://www.aegis.com/conferences/12wac/21143.html

Saliva neutralizes HIV-1 infection by displacing envelope gp120 from the virion.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:267 (abstract no. 21143)

Malamud D, Nagashunmugan T, Friedman HM, Davis CA, Abrams WR
Dept. Biochemistry Univ. Penn Dental Med., Phila 19104-6003, USA.

BACKGROUND: Incubation of HIV-1 with human saliva decreases infectivity. This inhibition is specific for HIV-1, with no effect on adenovirus, HIV-2 or SIV and appears to work at the level of the virus rather than the host cell. We have now identified an active protein fraction and provide evidence that the mechanism of action involves stripping of gp120 from the virus.

CONCLUSION: The specific inhibition of HIV-1 infectivity by human submandibular saliva is associated with removal of gp120 from the virus. The active fraction contains several proteins, including two high molecular weight glycoproteins.

http://www.aegis.com/conferences/4croi/412.html

Mechanisms of anti-HIV-1 activity of human submandibular saliva.
Conf Retroviruses Opportunistic Infect 1997 Jan 22-26; 4th:140 (abstract no. 412)
Nagashunmugam T, Malamud D, Davis C, Friedman HM; University of Pennsylvania, Philadelphia, PA.

http://www.aegis.com/conferences/12wac/60770.html

Neutralizing effect of secretory IgA to HIV in parotid saliva of HIV-infected patients.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:1142 (abstract no. 60770)

Moja P, Desgranges C, Pozzetto B, Lucht F, Genin C
Gimap University of St.-Etienene, France.

BACKGROUND: The aim of this study was to test S-IgA purified from secretions of HIV seropositive patients in a neutralization assay to determine whether specific S-I&A can protect from HIV infection.

CONCLUSION: These data demonstrate that secretory IgA, which is the predominant isotype in secretions, can inhibit HIVMN infection of MT4 cells. HIV neutralization has been carried out with CD4+ T cell line adapted virus strain as a standardized model system, but the use of mucosal autologous primary isolates in neutralization test would be useful to estimate the actual protective effect of these antibodies in each patient.




« Last Edit: December 19, 2021, 07:21:44 am by Jim Allen »
HIV 101 - Everything you need to know
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Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
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PEP and PrEP

 


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