Possibility of transmission to others while on PEP

Question

Dear Doctors, thank you for making this resource available. Here's my story. On the 21st June, I had intercourse with female sex worker, insertive vaginal of unknown HIV status in South-Africa, allthough she was Chinese. We used condoms, which was changed by her to a new one after oral. I'm not 100% sure about the status of the condoms as she removed them realy quick, but think they were fine. Subsequently on the 23rd I startet a course of PEP after reading about it on your site. 15 days after starting PEP I had protected sex with my wife, in this case the condom was in tact, but there may be a possibility that some ejaculate fluids came into contact with her which flowed down the inside of the condom as it felt realy wet.

My questions is what you suppose my risk is to have obtained infection while with the sex worker. Secondly and more importantly, what is your realistic view on the possibility that I may have transmitted hiv to my wife?, should she be taking pep?

Answer

Hello.

Your HIV-acquisition risk would be essentially nonexistent, assuming the latex condoms were used properly with your sex worker and didn't fail (break). PEP was not warranted for this episode! If you read about PEP on this site, you should have learned that it is prescribed only for significant HIV exposures.

As for your wife, you ask if she should be taking PEP! No, of course she shouldn't. Frevinsakes! There is almost no chance you are infected (at least from the South African-based-Chinese-hooker incident you describe). Plus, you had "protected" sex with your wife, and the condom remained intact. The chance of ejaculate flowing down the inside of the condom is not all that likely. Condoms should fit tightly, even when Mr. Happy becomes Mr. Softy.

I would suggest you level with your wife. Your fears are most likely being amplified by your guilt. Leveling with your wife is not only the best way to confront your guilt; it's also the right thing to do!

Dr. Bob