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Should I continue taking my combivir medication?
Dec 7, 2008

Like many others may I start by congratulating you on this website - I have spent lots of time browsing through confusing, conflicting jargon elsewhere before stumbling on this website ran by an individual that talks in understandable English and who truly cares about worried people that often ask many difficult, delicate questions.

As with many other posters I plan to give a large sum of money to the charity you have established.

I was exposed to the risk of HIV on the island of Ko Samui on November 23rd.

I was having protected intercourse with a sex worker in a brothel. She performed oral with the condom still on, before continuing with intercourse for another five minutes. Shamefully I then asked to her to take the condom off for her to finish me off orally (she had started at the very beginning orally with no protection before I put the condom on for intercourse).

The next day it occured to me (after a wake up call of having a yeast infection) that my penis had therefore been exposed not only to the fluids from her vagina which she had sucked off when she performed oral while I had the condom on. But there was also a significant amount of blood from her vagina which she had sucked off the condom.

After going to a hospital in a panic, I was given a 30 day course of combvir (it was around 23 hours after the incident), which I have been taken as prescribed once in the morning and once in the evening, both after a meal.

Anyhow, I have been in correspondence with the owner of the brothel through email (I am travelling the world by coach, so had to leave Ko Samui the next day). Not only was he adamant that there was no HIV in the place, but he agreed that he would take her to be tested. He has since emailed me that she has no infections, and he is going to scan and email me a copy of the medical report.

I therefore have the following questions:

1) On receiving a medical certificate proving the woman does not HIV, should I stop my combivir treatment early, or continue for the full 30 days (or for that matter, 28 days, which is what I have read in some forums is the right amount of days, which would mean I wont have to take it on Christmas day!). In all honesty the side effects - drowsiness, nausia etc are not pleasant but are certainly manageable.

2) I understand the 3 month mark is the definite point to get tested and be as close as possible to 100% certain, but are there any other points I could get tested to ease things psychologically?

Hence

3) Would an STD test after two weeks that shows I do not have any STDs indicate that I am also very unlikely to have HIV. This would be on the grounds that it is likely she has STDs, and if she hasn't passed them on then she probably has not passed HIV on too.

Many, many thanks for your time.

John.

Response from Dr. Frascino

Hello John,

The island of Ko Samui? Now that's exotic! Most folks who go to Thailand travel only to Bangkok (often only to get their cocks banged) and then return home. Traveling the world by coach sounds both adventuresome and romantic!

1. Regarding PEP (post-exposure prophylaxis), it is recommended only for significant HIV exposures. Oral sex carries only a very slight risk for HIV transmission and consequently PEP is not routinely recommended for this degree of risk. If indeed you trust the brothel owner and the scanned test result, there would be even less reason to take PEP. (The only potential risk if she is currently testing HIV negative would be the very unlikely possibility she is in her window period. This possibility is remote at best.) With the limited information provided, I would advise it is safe to discontinue PEP (Combivir). I would agree with your plan for an HIV test at the three-month mark.

2. The vast majority of HIV-infected individuals will have detectable levels of anti-HIV antibodies in their blood within four to six weeks. Consequently, a negative test after six weeks is very encouraging. However, for a definitive and conclusive result, you'll need a test at three months.

3. No. Unfortunately you cannot use other STDs as a surrogate marker for HIV transmission.

Thanks for your interest in making a donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and very warmly appreciated. It will help turn hopelessness into hope for those struggling to meet the challenges of coexisting with the virus. In return, I'm sending you my best good-luck/good-health karma that your definitive three-month test remains negative and that you enjoy safe and healthy travels around the globe.

Be well.

Dr. Bob



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