HIV risk exposure concern

Dear doctor/s,

I am working in Africa and have had 5 one night stands in the last 8 weeks.

I have been somewhat responsible and only had vaginal sex with a condom until last night when I was with a girl and neither of us had a condom.

I was rather drunk & less cautious than I should have been & I penetrated her briefly before coming to my senses & realising how stupid this was. I withdrew after a few moments (maybe 5 - 10 seconds, no more) then she masturbated me after which I took a shower.

Now I am really panicking because I realise how stupid this was and although I have no idea of the girls sexual status she is certainly a high risk possibility for HIV.

I have also given & received oral sex on two occasions but understand from reading through your forum that this really poses no tangible risk for HIV.

I am due to return to the U.K. in 1 or 2 weeks & I have some questions;

1/ What would you consider the chances of me having contracted HIV from this single incident of brief unprotected penetration?

2/ Is 10 days the earliest for a reliable test and how reliable would that be?

3/ What would be your advice for me to cover testing for exposure from 10 days to 70 days?

I feel sick with worry now and will no doubt be imagining & looking for symptoms in the days to come as I have already in the past weeks.

Thank you!

[Dr Jose]

Hello,
Thank you very much for your post and welcome to our forum.
The fact that this unprotected sexual encounter took place in Africa, it is highly likely that the lady in question was positive in the first place. Under these circumstances I would recommend that you start PEP (post-exposure prophylaxis) as soon as possible (within 72 hours from the sexual encounter), even though the risk to you is possibly relatively low. However you are still in time to take PEP and I think this is a good idea if you have access to it where you are.
Let me answer your questions here below:

1/ What would you consider the chances of me having contracted HIV from this single incident of brief unprotected penetration? Assuming that she was positive, the risk to you is estimated at 0.1%

2/ Is 10 days the earliest for a reliable test and how reliable would that be?
Yes, this is the PCR RNA test with a reliability for HIV detection of 99%
3/ What would be your advice for me to cover testing for exposure from 10 days to 70 days? After the PCR RNA test at 10 days, I would recommend a HIV Duo test after 28 days, as well as a full STD screening for all other infections.

Best wishes,
José

Dear Dr. Jose,

Thank you very much for the reply and your good advice. I did find one hospital that Ibelieve understood my request. I have been given 2 medicines. One called Kaletra & the other Combivir. Would this be correct? The cost was a staggering 1000 euros so I have not taken anything yet unless the treatment is wrong. It is all that is available and there was just one treatment.

Please bear with me as I have just a couple more questions.

1/ Will taking these drugs have any adverse affect on the accuracy of a HIV test when I am able to have one when I return home or will the accuracy 0f 99% remain true?

2/ It has been suggested by a colleague that I have STI testing tomorrow; is this too soon?
If so when would be the earliest that this should be done?

I am so scared I hardly know what to do with myself.

Any further advice would be greatly appreciated and thank you so much for being here.

Thank you!

[Dr Sean]

Hello

Thanks for the further question - I think as Jose has said, the actual real risk is likely to be small but given the circumstances you can make it hugely smaller by using PEP.

The PEP you have been given is ideal.

1/ Will taking these drugs have any adverse affect on the accuracy of a HIV test when I am able to have one when I return home or will the accuracy 0f 99% remain true?The medications will alter the timing of an accurate test. The guidelines say that you should test at 3 months after COMPLETION of PEP. However, in our experience of very many situations like this an HIV DUO test with and HIV PCR RNA test at 10 days after completing PEP will give an accurate test result which then does not alter

2/ It has been suggested by a colleague that I have STI testing tomorrow; is this too soon?
If so when would be the earliest that this should be done?I would wait a few days - I'm unable to comment on the sophistication of any std tests you may have there so assuming the techniques are perhaps not the newest I would wait say 5 days.

Kind regards, Sean

Dear Dr. Jose & Dr. Sean

My most sincere thank`s for answering my concerns and the sound advice for and reasuurance that the medication that I have now started is correct.

I really do not know what I would have done without you!

Kind regards to both!

[Dr Sean]

Thanks so much for those nice comments, best wishes, Sean