Assaulted in Vegas! currently on PEP

[extremelyworried1]

Hello,  
I was drugged in a hotel lounge by a latino prostitute in Vegas ,
I ended up in a hotel room having sex and the condom was only rolled about 3/4 way down on my penis, she was grinding me hard
I pulled the condom off and she gave me an extremely rough hand job
the vaginal fluid that was left on the base was being rubbed all over my penis
I pulled away and I blackout and wake up an hour later robbed of my cash and jewellery
I went to the shower and washed and I was horrified to find some small friction abrasions at the base of my penis/pubic bone  pretty roughed up, broken skin like a bad rash
I also have a dermatitis/psoriasis on my penis head and the fleshy area just below the corona
Unfortunately I had the rash at the time of the incident
I flew back to the east coast and went to an STD clinic  
Although a condom was used  i'm afraid of vaginal secretions getting into the friction abrasions and the rough hand job with left over secretions on the psoriasis on my penis
They tell me maybe I should see someone about PEP.  
I go to the hospital and a nurse tells me the exposure probability is probably on the lower end, however the decision to use nPEP  is entirely up to the individual.
She explained cost and side effects and I took first dose 60hrs post incident.
It's now 16 days on ( Truvada and Kaletra) and I have had many side effects loose stools, body rashes, headaches, tinnitus,abdominal pains etc.
I actually had such abdominal and chest pain that i skipped the last day of Kaletra( still took the Truvada)
blood work at a walk in had slightly elevated amylase and
slightly larger than normal red cells(these were both normal at baseline testing pre treatment)
also my blood pressure is slightly elevated at 132/90 it was 118/70 3 weeks ago
A) In your opinion what is my level of risk from this incident?
B) In your opinion is PEP warranted in this situation?
C) what do you think of me just using Truvada alone?
Thank you for your time

[H. Hunter Handsfield, M.D.]

This information does not change my opinion or advice.  You were at no appreciable risk of HIV, regardless of cuts or abrasions on your penis.  Even with "non-intact" skin, the transmission risk was negligible, even if your partner had HIV -- which, as we discussed, she probably did not.

[extremelyworried1]

Thank you for your reply,
I understand your position on the medication question.
However, regarding the vaginal secretion exposure to non-intact skin...
Is this not a risk factor? If I was on my back and the female on top,
She was rather wet with vaginal fluid and of course it was wet below where the condom had been rolled to, and definitely on and around the base of the penis.
Now I would agree that this happens everyday in heterosexual sex with a condom, however, she was grinding with such force that I received small abrasions on this area,
not bleeding per se, but more like a bad shaving rash on the neck sometimes looks like,
the infectious disease contact at the hospital did say this qualifies as non-intact skin.
And the psoriasis looked kind of like chapped lips, again not bleeding, but cracked .
In your opinion, I really should have no worries of transmission via this type of exposure?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I would like to help, but don't think I can.  I agree with the advice you had a couple weeks ago on the HIV community forum, i.e. I would not have recommended PEP since you apparently had protected sex and you don't know your partner(s) had HIV, which is a usual criterion for PEP.  This doesn't mean your doctor was wrong in prescribing PEP -- it's a judgment call, and if you were sufficiently frightened she might have thought treatment wise to help alleviate your fears.  As you were told, to some extent taking PEP is up to the exposed person (although I wouldn't say it should be "entirely" his or her decision).

In any case, once a decision for PEP has been made, the source for questions about the treatment, side effects, post-treatment HIV testing, etc is entirely the appropriate responsibility of the patient and the prescribing doctor.  Your questions are in the realm of asking for very specific medical/treatment advice, which is not an appropriate role for any online forum.  Also, I have no personal experience with prescribing PEP -- but even if I did, for those reasons all I can suggest is that you ask these questions of the doctor or clinic who prescribed it or, alternatively, your personal health care provider.

Sorry I can't be more helpful.  Best wishes--  HHH, MD