Does the PEP course affect the window period of HIV?

Question

Hi doctor,

I had intercourse six months ago without a condom (but after six months of intercourse, she checked HIV (Human Immunodeficiency Virus) antigen and antibody, p24-negative), but she was positive for Herpes Simplex Virus (HSV-2). Again, five months ago, I had intercourse with a condom (but oral sex without a condom). Then, the very first day, PEP started, but it took only 24 days. The other four were aborted due to side effects.

However, the second week of the next month, I had back pain associated with driving and had moderate pain while driving. Then, the next month, the first week started with a burning feeling during urination, burning of the feet, and painful defecation with frequent defecation. I then checked HIV (antigen and antibody, ELFA (enzyme-linked fluorescence assay) method), HSV 1 and 2, VDRL (Venereal Disease Research Laboratory), TPPA(Treponema pallidum particle agglutination assay), chlamydia, and gonorrhea PCR (Polymerase Chain Reaction).

All Negative except HSV-1 (It has been positive for 15 years). The STD (Sexually Transmitted Disease) doctor gave me Acyclovir for 10 days, but I took it for 15 days. While on Acyclovir, around three months back, I had a penile lesion, but it settled within seven days. However, others stayed the same. Then, I started having lightheadedness (I had it most days and more hours during the day). After that, the doctor started treatment for prostatitis.

I took it for two weeks, but no improvement. Then, skin itching (the common place is the upper back, but no visible rash), and sometimes had formication. Skin itching started the very next day after the Covishield vaccine. Then, after four months of exposure (the second girl, because I think the first girl cleared HIV, she did an HIV test this month, and it is negative), I did the HIV antigen and antibody CIMA test, and HIV antigen and antibody p24 all tested negative. And HIV RNA (Ribonucleic acid) was negative. Also, after five and a half months, HIV antigen and antibody p24 were tested twice with two reputable laboratories and were negative.

Now I have mild burning of urination and mild burning of feet, headache on and off, back pain (while driving), neck pain on and off, mild burning feeling of the back, mild itching all over the body, and upper back itching (but no rashes). Does PEP (Post-exposure Prophylaxis) delay the window period this much? If so, how does it increase the window period? Should I test more, or have my tests already shown conclusively? Should I worry about non-gonococcal urethritis and sexually acquired reactive arthritis? Even though I had negative chlamydia and gonorrhea PCR tests. Does PEP affect all those fourth-generation test results? Please give your opinion.

Answer 1

Hi,

Welcome to icliniq.com.

I am first going to mention the best part of the complete description given by you: Both the partners, with whom you had exposure, were tested HIV (human immunodeficiency virus) negative. You had started post-exposure prophylaxis and completed it for 24 days. Although four days short of the mentioned guidelines, it will be considered adequate in your scenario. Your HIV tests are also negative after about five months since your last unprotected exposure. So, to answer your question, I am just mentioning the following facts:

The recommendations are to get tested at four to six weeks after last unprotected exposure by a rapid fourth-generation HIV combo test. If the result is negative, get a confirmatory rapid HIV antibody test at three months after last exposure. If the test is negative at three months and there is no further exposure, there is no need to repeat the test. This stands true in your case as well, even if you had taken PEP (post-exposure prophylaxis).

Besides this, if your source at both times was HIV negative, and if you had no other exposure, HIV infection cannot be acquired. However, it can be acquired if there is unprotected exposure to an HIV-infected person. Also, there are numerous factors that determine the risk of acquisition, which can not be applied in the scenario where the source was negative.

Regarding the penile lesion or prostatitis history, which you mentioned, it reflects other STIs (sexually transmitted infections) that share the same route of acquisition (unprotected sexual contact, anal, vaginal or oral). Non-gonococcal urethritis is curable with a short course of antibiotics. You can share your earlier prescription and medication taken for it so that I can advise accordingly. The other symptoms that are mentioned could have various reasons and do not necessarily mean HIV.

You can share your reports through this platform if you feel comfortable. I suggest the following tests:

Complete blood count.
LFT (liver function test).
Serum creatinine.
HBsAg (hepatitis B surface antigen).
Anti-HCV (antibody to hepatitis C virus).
VDRL (venereal disease research laboratory test).
Herpes simplex 1 and 2 IgM (immunoglobulin M) and IgG (immunoglobulin G).
Serum Vitamin B12 and D3 levels.
Thyroid profile.

As far as HIV is concerned, you can consider your test result conclusive if there is no further exposure. The above-mentioned tests will help to identify other STIs (Sexually Transmitted Infections) or any other chronic ailment.

I hope this was helpful.

Thank you.