Aa
PrEP
Hi
I have a 5 hour window left before the 72-hour window period for HIV PRep prophylaxis, so would be grateful for a quick answer. Sorry about the late enquiry, but I've been chasing this thing from so many avenues, I've forgotten this option till now.
I had unprotected vaginal sex with a Thai massage parlour girl in Kuala Lumpur (Malaysia) on Saturday 10 May around 4 pm (It's now Tuesday 13 May @ 11.30 am). She said she'd just arrived in Kuala Lumpur that day / just day or two before + had had all her 'tests' in Bangkok the week before which were 'clear'. Aside from the above act, I had unprotected oral sex (she on me + me on her) + protected anal sex (condom intact @ end), before finishing with the unprotected vaginal sex.
She appeared young, pretty, no needle marks on arms (but had tattoos) + I looked in her oral cavity & oropharynx & they were OK (I am a Medical Doctor myself). She was friendly, & when I asked again (again after the episode) about her health status, said she had a baby (there were minor stretch marks), so she said 'don't worry / no problem' re: her health status...
I had an HIV Rapid Test yesterday (around 48 hour mark), which was negative. I know it doesn't cover this particular episode, but makes me eligible for PRep. The local STD elderly doctor said I had a 17 % chance (based on his knowledge) to contract HIV (based on my history), & recommended PRep ! I asked him to show me his stats source, but even the CDC site he suggested to look at, quoted < 1 % risk (& that was assuming she was HIV infected). However the worry is if she was negative in her test last week in Bangkok, but had been infected in the preceding 4 weeks or more (window period for the test), she could actually be highly infectious (? now 1 - 2 % risk), in which case should I get the PRep ? I have no known STD's (but will be checking in about 4 weeks the whole lot), & no open wounds / cuts on my penis.
Thanks a lot in advance.
I have a 5 hour window left before the 72-hour window period for HIV PRep prophylaxis, so would be grateful for a quick answer. Sorry about the late enquiry, but I've been chasing this thing from so many avenues, I've forgotten this option till now.
I had unprotected vaginal sex with a Thai massage parlour girl in Kuala Lumpur (Malaysia) on Saturday 10 May around 4 pm (It's now Tuesday 13 May @ 11.30 am). She said she'd just arrived in Kuala Lumpur that day / just day or two before + had had all her 'tests' in Bangkok the week before which were 'clear'. Aside from the above act, I had unprotected oral sex (she on me + me on her) + protected anal sex (condom intact @ end), before finishing with the unprotected vaginal sex.
She appeared young, pretty, no needle marks on arms (but had tattoos) + I looked in her oral cavity & oropharynx & they were OK (I am a Medical Doctor myself). She was friendly, & when I asked again (again after the episode) about her health status, said she had a baby (there were minor stretch marks), so she said 'don't worry / no problem' re: her health status...
I had an HIV Rapid Test yesterday (around 48 hour mark), which was negative. I know it doesn't cover this particular episode, but makes me eligible for PRep. The local STD elderly doctor said I had a 17 % chance (based on his knowledge) to contract HIV (based on my history), & recommended PRep ! I asked him to show me his stats source, but even the CDC site he suggested to look at, quoted < 1 % risk (& that was assuming she was HIV infected). However the worry is if she was negative in her test last week in Bangkok, but had been infected in the preceding 4 weeks or more (window period for the test), she could actually be highly infectious (? now 1 - 2 % risk), in which case should I get the PRep ? I have no known STD's (but will be checking in about 4 weeks the whole lot), & no open wounds / cuts on my penis.
Thanks a lot in advance.
Thanks a million !
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
The context indicates you are seeking advice about post exposure prophylaxis (PEP), not pre-exposure prophylaxis (PrEP). I'll answer in regard to PEP.
You describe a partner who almost certainly does not have HIV. Statistically, most sex workers in Thailand are not infected (under 1% these days); and your partner is especially unlikely to have HIV, given her testing history etc (and people rarely lie about HIV status when asked directly). In addition, oral sex is free of HIV risk, or nearly so; and of course condom protected anal sex isn't risky if the condom doesn't break.
I don't know how the local doc came up with a 17% risk of catching HIV in this situation. My guess is closer to one chance in a million. It is true that if your partner was in the window period, i.e. recently infected but not yet with a positive blood test, she could have a high viral load and be highly infectious. But the statistical chance of this seems very low.
A final consideration is that if you are treated, it will prolong the period of uncertainty. Final, definitive testing after PEP may take 3 months or even 6 months. Without treatment, conclusive results are available at 4 weeks. Are you prepared to go through 3-6 months until you know for sure whether you caught HIV?
All things considered, I don't think PEP is warranted. However, we always say that PEP decisions are best left to local physicians -- this isn't a decision that should rest on the opinions of distant, online experts.
Best wishes-- HHH, MD
The context indicates you are seeking advice about post exposure prophylaxis (PEP), not pre-exposure prophylaxis (PrEP). I'll answer in regard to PEP.
You describe a partner who almost certainly does not have HIV. Statistically, most sex workers in Thailand are not infected (under 1% these days); and your partner is especially unlikely to have HIV, given her testing history etc (and people rarely lie about HIV status when asked directly). In addition, oral sex is free of HIV risk, or nearly so; and of course condom protected anal sex isn't risky if the condom doesn't break.
I don't know how the local doc came up with a 17% risk of catching HIV in this situation. My guess is closer to one chance in a million. It is true that if your partner was in the window period, i.e. recently infected but not yet with a positive blood test, she could have a high viral load and be highly infectious. But the statistical chance of this seems very low.
A final consideration is that if you are treated, it will prolong the period of uncertainty. Final, definitive testing after PEP may take 3 months or even 6 months. Without treatment, conclusive results are available at 4 weeks. Are you prepared to go through 3-6 months until you know for sure whether you caught HIV?
All things considered, I don't think PEP is warranted. However, we always say that PEP decisions are best left to local physicians -- this isn't a decision that should rest on the opinions of distant, online experts.
Best wishes-- HHH, MD
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