Dr. Basti Bharatesh Devendra
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a sexual encounter recently. I took on-demand prep (2-1-1 protocol) before I engaged in intercourse. I used a condom as well however, I am unsure if the condom broke because the escort did not mention anything and also I do not know if the condom slipped halfway during intercourse. However, I know that it did not slip completely. I missed my last dose of prep by six hours. I was supposed to take it but I took it late. Immediately I rushed to the emergency room to get Dolutegravir. However, due to my anxiousness, I must have listened wrongly to the advice and took only Dolutegravir and my last prep dosage was seven to eight hours ago. I do not know if this counts as a proper dose, but what I am sure of is that I took only Dolutegravir on the 2nd and 3rd days of PEP. Finished the PEP course. I started experiencing potential symptoms of HIV (fever, diarrhea, fatigue, joint and bone ache). From then on my diarrhea got more severe and I had to go every few minutes to hours. Turned out negative. Maculopapular-looking rashes start appearing near my wrist to my elbow. I rushed to the emergency and did a blood test. It was negative for dengue and Covid. Now I am worried was it a false negative test on the 4th gen finger prick combo test? I took the test 38 days after exposure and six days after the PEP course. What are the chances this is an HIV infection?
Hello,
Welcome to icliniq.com. Thank you for the query. The chances of transmission of HIV by single unprotected intercourse are low. Condom used but not known whether it was used rightly. This can be considered almost as unprotected intercourse. Prep and PEP (28-day course) have been completed. This further reduces the risk of HIV to almost nil. The HIV rapid test negative results after 38 days of exposure is a good sign. The chances of HIV tests coming positive later are low. It would be better, please go for an HIV antibody test after 90 days of exposure for conclusive results and to be relieved of anxiety totally. The symptoms are nonspecific and need not be due to HIV. It can be due to any infection. Please consult your doctor for examination and management of symptoms. I hope this helps.
Thank you.
Patient's Query
Hello doctor,
However, I did not use PEP correctly. As I did not take prep along with Dolutegravir for the first three days. The first day I think it counts as a proper dose because my last prep from the first Dolutegravir is seven to eight hours apart. I forgot to mention, that the maculopapular rash is present on my arms chest, and abdomen. Is it recommended that I take an RNA test to conclude this? Also, does remaining PEP medication in the body affect the p24 antigen 4th gen rapid test via finger prick?
Hello
Welcome back to icliniq.com
Thank you for the follow-up query. Some minor variations of PEP drugs or doses may not alter HIV test results much. The risk is low and PEP further reduces the risk to almost nil. Symptoms and rashes need not be due to HIV. It can be due to any infection. Please consult your doctor for examination and management. You can go for HIV RNA PCR to be relieved of anxiety, until 90 days post-exposure Though the rapid test negative results after 38 days are helpful but not conclusive. HIV antibody test after 90 days of exposure is considered conclusive. Please go for an HIV antibody test after 90 days of exposure. I hope this helps.
Thank you.
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