Encounter with Sex Worker followed by PEP
May 23, 2010
Hi Dr. Bob,
I know you get inundated with these types of questions all the time. I've read answers to other people's seemingly paranoid responses to comparatively low risk situations. BUT it does help to have an MD respond to your specific question.
And I also know many people's e-mails begin with "I'm such an idiot" so here goes ...
I am SUCH an idiot.
I am married. I went to an Asian massage parlor. I usually get hand-penis contact from the "masseuse". They usually take their clothes off for this.
The woman this time offered me "more". I thought she was talking about oral. She put a condom on me with her mouth and began performing oral sex on me.
I don't know the brand of the condom. Something in my paranoid brain tells me to assume that it was "cheap". Not that this matters.
I don't know if any lube was involved.
Anyway, with my eyes shut I neared climax. She quickly moved up and inserted me into her vagina.
I was inside her for no more than a minute as I was climaxing already at the time of insertion.
I know the odds are low that I contracted HIV. But do the odds go up if it was a low quality condom? What about lube?
I don't think the condom ripped or broke. But I didn't examine it. She pulled it off of me quickly with some Kleenex. I assume there is almost no risk attaining HIV from the removal of a condom.
I went to a clinic within 24 hours. I am not concerned of the cost, so the physician started me on PEP with BID combivir. I realize this is overkill, but whatever.
Does the fact that the sex worker was asian raise my risk because of resistance to the PEP of Asian strains of HIV?
So, I started PEP under 24 hours after the incident. 30 days of combivir to come. No side effects so far, which is encouraging - I understand this is the biggest barrier to PEP. Should any drugs be added as more a a "failsafe" in conjunction with the combivir? How low does this PEP method take my risk?
Also, the physician at the clinic told me that, after the PEP, he could test me for HIV at 4 weeks and "almost definitively" tell me I don't have HIV. Everything that I have read indicates I need to wait 3 months. Is he talking about some test I am unaware of? Does the PEP change the test window?
To make a long story short (too late), how low is my risk?
Many thanks for your free services. I am donating right now.
Such an Idiot
Response from Dr. Frascino
Hello Such an Idiot,
I'll just make a few comments:
1. Sex workers, I mean "Asian masseuses," generally know way more about STD prevention than their "I'm such an idiot" clients. After all it's their business and they are more at risk for picking something up from their clients than vice versa! Even inexpensive condoms need to pass strict quality controls. Your fears are unwarranted.
2. I disagree with the recommendation that you should take PEP and would advise you discontinue it. It's not only a question of cost. Antiretroviral drugs are potent and can have significant toxicities and side effects.
3. Your concerns about PEP resistance are unwarranted.
4. No matter what regimen is used, PEP is never completely "failsafe." There are PEP failures (yours truly is an example!).
5. Recommendations for post-PEP HIV-antibody testing are six weeks, three months and six months from the date of exposure.
6. Your HIV-acquisition risk is very low. So low that PEP is not recommended.
Thank you for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and very warmly appreciated. In return I'm sending my good-luck/good-health karma that you are now and will always be HIV free.
Good luck. Be well.
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