Question
Is PEP effective if taken 48 hours after exposure?
2 July 2021. Related: All topics, PEP/PEPSE.
I paid for sex with a woman but the condom tore and I only realised after I was done. There is a high chance that she was HIV positive. I started PEP after 48 hours.
I got a PCR test done 17 days after exposure. It had a less than 20/ml (undetectable) result.
Now between 14 and 35 days after exposure I have had signs of thrush, mild red rash on my face and a couple elsewhere. But no fever or swollen lymph glands.
Can the rash and thrush be because of utter stress and obsession?
My doctor says that the PCR can be relied upon and that I am negative.
Can the PEP have reduced the viral load to less than 20/ml as I took it for 15 days before the PCR test?
Please give your expert advice. I am very anxious. Thank you.
Answer
Thank you for your question.
The risk of HIV from one broken condom is very low. If your partner had an undetectable viral load on treatment, then the risk would be zero. If they were not on treatment the risk might still be only 1 in 300 or lower.
You cannot guess someones HIV status so your assumptions might also be wrong.
You started PEP within 48 hours, so it is likely it will work.
PEP – stands for Post-Exposure Prophylaxis. It is a term used for taking HIV drugs to reduce the risk of infection. PEP usually involves taking a combination of three HIV drugs for one month. The earlier PEP is started, the more likely it will work. Ideally, this should be within a couple of hours. If this is not possible, then still the earlier the better.
Some guidelines include a two-day window to do this (i.e. within 48 hours). After this, effectiveness is much less likely. Other guidelines allow up to 3 days (i.e. within 72 hours). Sometimes this may be more for psychological benefit. For example, if someone is very stressed or traumatised.
No guidelines recommend starting PEP after 72 hours.
After finishing PEP you need to wait a 4-6 weeks before testing.
If the PEP has worked, or the person was not initially infected, this will show as a negative HIV test. The test you did 17 days after the exposure will not be accurate yet.
If the PEP has not worked, this will be shown in a positive test result. Testing 4 weeks after PEP will detect 95% of infections. Testing after six weeks will detect more than 99% of infections. This result doesn’t need to be tested again.
If PEP has not worked, serosonversion usually occurs 1-3 weeks after PEP is finished. However, only 80% of people show symptoms.
Please test 6 weeks after you finished PEP is finished. If you test any earlier, you need to take a second test 3 months later.
Viral load (PRC) tests are not approved to test for HIV. In some cases they can have a role.
Please see a doctor to talk about your symptoms he best way to confirm what is causing them is to see your doctor. He/she will be able to diagnose and treat the symptoms accordingly.
Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq
Note: This answer was last updated in July 2021 from an original post from December 2011.
Hi Medo, what injections and pills were you given? PEP alone is enough for HIV prevention. Were the other treatments for other things? The exposure you have described does not sound high risk. Do you know if this person was HIV positive? as you have used a condom, even if it did slip at some point, you would have been protected for at least some of the time which reduces your risk. The symptoms you have mentioned can be caused by a number of things. HIV is the least likely as you are on PEP after a low risk exposure.
I had sex with a sex worker and she was menstruating. I used a condom, but it slipped. I don’t know exactly if I continued having sex. I didn’t notice that the condom slipped, but I saw it hanging from her vagina. I have my doubts about this situation because I didn’t feel any different but I assumed he slipped so as not to leave anything to chance. In addition, she was touching her own blood and masturbating to me with her hand. The third situation is that my finger had a wound two days ago and I was inserting my finger into the vagina. After that, 9 hours later, I went to the doctor, who gave me 3 injections, 6 pills, and 2 pills of Zithromax, in addition to post-exposure prevention pills. It is a pill of TDF + lamvidovine with a pill of doltugravir daily. I have to use it for 28 days. What aroused my suspicions is that she tried to remove the condom from me, but I refused, in addition to the conversation that took place between me and her, which made me doubt her. This is what prompted me to rush to the hospital. Now I am on the 15th day after the exposure, I am still using the medicines, but I have sweating since the first days, as well as painful urination and back pain, which disappeared on the seventh day after I got two needles in the hospital, as well as hemorrhoids and blood when defecating, and it continues until now, with a small rash at the level of The skin is brown like dots in the arms and lower neck, and itching lightly with insomnia, in addition to that I noticed that I lost a little weight and decreased muscle mass and fat in my body. But despite this I will continue to take the medicine until I finish the cycle. Are these symptoms related to the side effects of the drugs, and is the exposure incident itself dangerous enough to require a pep? Please answer, God bless you, because I am very concerned. Thanks in advance.
Hi Jitendra, this is a very low risk exposure. As this sex worker did mention that they are HIV negative, there is no reason not to believe this. Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Today i got my reports i was not infected before with hiv as i had unprotected sex with sex worker on 20.01.2023 i didnt know her status. She claimed she dont have hiv but hard to trust . So iam in tension .i started pep within 72 hours . Taking DLT (TLD) XAPAVIR LT MEDICINE AS PEP CAN U PLEASE tell mee by your experience how much chance of mee of getting Hiv… iam in to much tension…
Hi Philipe, yes it is safe to be taking PEP. Your risk of exposure is quite low as you did start with a condom and you did not have sex for a long time. As you started PEP within 72 hours of exposure it will be most effective.
Hi Dr,
I’m 31 years old male. On 13.1.2023 midnight , I had had condomless sex with a girl just for one time ( in fact condom was taken off during sex and I didn’t put it new one as I was too drunken at that moment ) . It’s was just one intercourse and just 2 minutes long. The next morning , I found out she is infected with HIV with No current treatment (ART) . I was so freak out and panic at the moment. Fortunately, I got PEP within 24 hours ( 18 hours exactly ) . Now I am so panic of getting infected. Is that safe for me after taking PEP ??
Hi Jack, unfortunately 5 days after exposure is too late to start PEP. PEP needs to be started within 72 hours or it will not have any effect. As this person informed you that they recently tested negative, it remains likely that there was no risk to you. Taking PEP will now only extend the wait before you can test. If you remain anxious about your status, it would be more beneficial to stop with PEP and test 6 weeks from now instead of continuing your course.
Hi I had a few minutes of unprotected sex with sex worker a week and half ago. I got on PeP 5 days after and I’ve been taking it. Is it just a waste of time? I took a Oraquick test before starting pep which was negative. Please help… the escort said she had tested negative for everything 6 weeks before our sex but I don’t know her so not 100 percent sure
Hi A, oral sex carries very low risk. There has never been a documented case of HIV transmission via oral sex. Saliva has antiviral properties which makes the transmission of HIV extremely difficult through this route. As this sex worker has explained that she was recently tested this further reduces the risk. In the UK this would not be an exposure that would require PEP. The symptoms you are experiencing are not caused by HIV. It is common for these symptoms to occur due to stress about HIV, or it could be a common infection e.g., a cold.
Hi I’m A. I had protected sex with commercial sex worker at brothel house on 14th of January. She gave me protected oral sex at first and I also gave her. My protection (condom) was not neither slipped nor broken. One week before I went to brothel house, I just recovered from flu but I remained a little bit sore throat. I worried that she is commercial sex worker at brothel house and I gave her oral sex. She said she was tested 3weeks ago and government doctor allowed her to work. Is there any chance I can get HIV transmission? On 15th of January I consulted with doctor and explained about my situation. He said HIV transmission thru oral sex is very low risk. He told me what the procedure I have to do and he recommended me to take PEP treatment if I am too worry. Now it’s my 4th day of PEP treatment but now I feel like tired, my tongue feels like weird, and also feel like having mild fever and sometime my body joint pain. Also lost in appetite. Are these the symptoms of HIV? I tested repid testkit before I taken PEP and it’s negative. I feel anxiety, and stressful. I decided I will never sex with commercial sex worker for sure. Please kindly reply.