Overseas intercourse gone wrong

Question

Hi Damon, Thanks for this forum its a great help.

I am a heterosexual male, on holiday in Bali (Indonesia) last week. During a night out I Met a girl originally from Kenya, one thing led to another & we went home (bank to my villa), during the intercourse (10 minutes in) I noticed blood on the bed I pulled out to see blood all over my penis & the condom was lost inside. The next morning she asked for money for a taxi but the amount she asked for was a large amount for a cab, (All of this has me thinking could she have been a sex worker).

I got myself to the Bali international medical centre & started a course of PEP after around 50hours after intercourse, I am also wondering the strength of the PEP as indonesia is not a first world country.

PEP Duviral make-up: Lamivudine 150mg Zidovudine 300mg

I have read reports from the internet stating extremely high infections rates in this area- got me wondering if youve come across an experience like above with blood over the penis & forsay the girl is positive with no PEP treatment, roughly how likely would it be that I am too infected? I know there is a lot to take into account here but your feedback would be appreciated.

Answer

Hi, thank you so much - I am thrilled this forum can be a valued source of support and information for you and others in the world.

I'm sorry that a night of potential pleasure on holiday went horribly wrong. Hopefully we can review some facts that will help ease your concerns.

You were certainly wise in your decision to seek out PEP within the recommended window of time (typically up to 72 hours after a potential exposure). Although Lamivudine 150mg and Zidovudine 300mg are not the standard in PEP regimens, they are not the exception either. This combination of medications, usually prescribed in a single tablet called Combivir, is an accepted and efficacious regimen used for PEP (https://www.pdr.net/drug-summary/Combivir-lamivudine-zidovudine-600; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216036).

So IF you were exposed to detectable levels of HIV, then starting on a course of PEP using Combivir fifty hours after exposure would significantly bring down your risk to nearly zero (http://www.aidsmap.com/Efficacy/page/1746573/).

Now let's look at some of those other "IFS". Your concerns of being exposed would be based on your partner (1) living with HIV and (2) not being on treatment medications. Are these feasible possibilities? Sure.

But what is the possibility that you as the insertive partner can contract HIV from a partner during vaginal sex that lasted less than 10 minutes, during at least some of the time you were protected with a condom? Now we are getting into some very low odds, less than .08% (https://wwwn.cdc.gov/hivrisk/about_the_data.html).

So when you look at how unlikely it was for you to acquire HIV from one encounter + the coverage PEP offers, I think you can see you were playing with some pretty low odds here. I'd venture to speculate that you were at more risk driving on certain roads in Bali than from this one sexual encounter (https://www.vice.com/en_asia/article/kzx9gn/hitching-a-ride-on-balis-highway-of-death).

I hope this information allows you to breathe and comprehend how truly low risk this sexual event was for HIV. I imagine it may have been startling to realize the condom was off, and that so much blood had covered your penis. But by seeking PEP early, and following up with your healthcare provider to get tested for any other STIs, you can ensure a continued sex life with joy, pleasure, and fun on the holidays. Enjoy!