PEP (HIV Post Exposure Prophylaxe) in BKK & Anxiety

[Alex66]

Hi

I am a 50 years old mail, working as Expat in Vietnam being sometimes in Bangkok on business...

just wanted to share my anxiety and fear close to panic after I had an unprotected vaginal sex (condom broke) with an outcall massage girl in Bangkok on October 22.

since then I cannot cool down as I'm under permanent stress being panic regarding possible HIV infection.

I was received fairly well in PULSE Clinic in Bangkok and got PEP Medications from them on the same day (it was Saturday, I thought Bumrungrad was closed). However I liked the approach and the way they treated me there.

Can be recommended, in case somebody confronts similar issues.

working in Vietnam I'm pretty much concerned on how i shall handle my issue later on after PEP is over, as the Vietnamese healthcare expertise cannot be compared at all to what is available in Thailand.

My intention is then to come to Thailand again upon PEP Completion after November 18 to get tested properly again.

Just a question whether there are any limitations for the people entering Thailand and being possibly infected with HIV?

Maybe I'd even start looking for a job here in Bangkok?

i must say I've nobody to talk to here in Bangkok or in Hanoi on such sensitive matters and this makes my mood even worse...

Did anybody have a similar experience?

looking forward to hearing from you

 

[Sheryl]

First of all, it is extremely unlikely you are HIV+ if what you describe was your only risk exposure. The odds of a man contacting HIV from a single heterosexual encounter are very low and then you have taken PEP. Between these two factors your risk is very, very, very low.

 

The risk of HIV transmission for a man from a single vaginal intercourse encounter is only about 4 in ten thousand.  Then further reduce that  by about 80% since you took PeP -- you are looking at something like a 1 in 10,000 risk at this point.  Hardly cause for panic.

 

Secondly there are no restrictions on HIV+ persons entering Thailand nor living and working here. There are plenty of other restrictions on working here, but not that.

[Alex66]

Thanks Sheryl for a comment.

yes, that was the only exposure I had.

a very straightforward question: Apart from being depressed about the whole thing, I've another problem, which is my relation to my girlfriend.

I was unfaithful to my girlfriend and that is the fact.

I have a dilemma whether I need to disclose the whole thing to her.

on the other hand - she's exposed to an HIV Risk as I'm not yet clear, whether I'm "clean" myself after my Saturday's encounter. This is absolutely not acceptable for me...

this is what also makes me feel pretty bad...

I still hope, being on PEP would mean less infectious, however after PEP - if the thing is still inside me...

Still cannot understand, why I was so careless...

[Sheryl]

The health risk to your GF is negligible since as already explained, the likelihood that you have HIV is very, very, very low.

 

However, it is not zero, and your GF does have the right to protect herself from it if she so chooses, whether by not having sex or insisting you use a condom.

 

In not telling her, you deny her the chance to exercise that right.

 

You also compound the cheating with dishonesty.

 

Everyone is different, but if I were her, I'd be more outraged at the lying -- especially given that you know you are placing her at a small risk - than at the infidelity.

 

So yes, I think you should confess to her. No guarantee she won't break up with you, though, especially since you didn't confess straight away.

[Alex66]

Thanks Sheryl

I shall confess to her.

I did not do it as I am still on a business trip.

returning tonight.

I believe her health is much more important than my attempts to look decent...

[Alex66]

In any case PEP is quite a hard time - psychologically - to go through, and the anxiety slowly builds up...

Another question is when I shall get tested?

if I make a PCR Test - can I do that even before PEP is completed (for example, on November 2 or even on November 14, which shall be more than three weeks after possible risk exposure)?

As I understand (reading internet publications), this test can identify the HIV Virus in the blood even if the antibodies production has not started yet?

How reliable is that test going to be?

[carlyai]

What's PEP, and should you have some handy in case you do something silly like have unprotected sex?

Sent from my SM-J700F using Tapatalk

[Dagnabbit]

I think you have a few things to consider.

 

First of all the "1 in 10,000" risk of transmission is a bit misleading as it's not qualified. Does it presume the woman is HIV+, or does it presume some sort of regular distribution of infection rates? If the latter - you probably tipped the odds in your favor barebacking a Thai hooker.  

 

In this article - http://www.catie.ca/en/pif/summer-2012/putting-number-it-risk-exposure-hiv - it puts your rate at 1 in 2,500  - presuming the female is HIV+. That is a big presumption to make, for sure - you don't know this woman was HIV+. So it really comes down to whether your story of a broken condom is real or just you too embarrassed to admit she let you in uncovered. If the latter, there is a reasonable chance she was HIV+

 

So it's still 1000's to one PRESUMING that you have no cuts or scrapes on your genitals. 

 

As for your guilt trip - you really need to get over that. Your confession will not benefit her in any way. You are doing that simply because you feel guilty. While it'll be a weight off your mind, it's going to destroy your partner.

 

Is that really the way you want to play this? It's quite selfish.

 

[Halsted6]

13 hours ago, Dagnabbit said:

I think you have a few things to consider.

 

First of all the "1 in 10,000" risk of transmission is a bit misleading as it's not qualified. Does it presume the woman is HIV+, or does it presume some sort of regular distribution of infection rates? If the latter - you probably tipped the odds in your favor barebacking a Thai hooker.  

 

In this article - http://www.catie.ca/en/pif/summer-2012/putting-number-it-risk-exposure-hiv - it puts your rate at 1 in 2,500  - presuming the female is HIV+. That is a big presumption to make, for sure - you don't know this woman was HIV+. So it really comes down to whether your story of a broken condom is real or just you too embarrassed to admit she let you in uncovered. If the latter, there is a reasonable chance she was HIV+

 

Quoting Sheryl: The risk of HIV transmission for a man from a single vaginal intercourse encounter is only about 4 in ten thousand [or 1 in 2500 as you indicated].  Then further reduce that  by about 80% since you took PeP -- you are looking at something like a 1 in 10,000 risk at this point.  Hardly cause for panic.

 

 

[Alex66]

The broken condom story is true.

If the situation had been different, I would have described it in a way it was.

That was a condom brought by her, most probably local one, of somewhat lower quality.

You're right, I've no idea of her HIV Status.

She stated she had tested negative just two weeks before or so as a result of "regular check".

By the way I made HIV ELISA and Syphilis test on October 31 - on the 10th day after that risky exposure, which took place on October 22.

Both were negative.

I understand, it's too early to test anything but still just to find a bit more peace of mind.

Keeping on taking PEP...

 

 

[Alex66]

Regarding my girlfriend- I had to leave on a business trip for another two weeks, to Europe this time and this is where I'm writing this from in the night having woken up already because of a jet lag...

so those 1.5 days we were together after my previous trip went by fast I was telling I was not feeling well, etc - in other words avoided any sexual intercourse with her.

So, two more weeks to consider, what I shall do next.

Most probably will also do PCR Test after November 12-13 to see the Status. I've heard those tests can detect the virus itself but not antibodies...

 

[Sheryl]

PCR can detect the actual virus as early as 2 weeks after exposure. However,  being on PEP can affect the reliability of the test because it may keep viral levels so low that even PCR can't pick them up.

 

The standard recommendation for people on PEP is an antibody-based  test 4 weeks after exposure and then repeat at 3 months.

 

Do not forget Hepatitis, risk of that is greater than of HIV. You should get a full Hepatitis panel done.

[Alex66]

Thanks Sheryl

you write: "The standard recommendation for people on PEP is an antibody-based  test 4 weeks after exposure and then repeat at 3 months"

"4 weeks after exposure" means also exactly just after PEP is over...

I'll do that, including Hepatitis...

I hope that shall work well...