Just Had an HIV Exposure? What to Do From the First Hour to 3 Months

If you are reading this right after something has happened, please take a deep breath first. Fear is normal, but the good news is that we have tools that really work, and you still have time to act. This article sets out what to do in order of time. Go through it one step at a time.

Step 1: Straight after the event

• Do not douche the vagina or rectum, and do not use strong antiseptics. They irritate the lining and may increase the risk. Washing the outside with clean water and mild soap is enough.
• If fluid got into your eyes, rinse with plenty of clean water. If it got into your mouth, spit it out and rinse with water.
• If you had a needlestick injury, wash the wound with soap and water. Do not squeeze it.
• If possible, politely ask your partner about their HIV status, and if they have HIV, ask whether they take treatment and when their last viral load test was.

Step 2: Assess how big the risk is

The chance of HIV transmission from one exposure to a partner who has HIV and is not on treatment varies a lot by type of exposure. The US CDC's estimates per 10,000 exposures are:

The risk is higher if there are sores, another STI, or your partner was recently infected, and it falls to practically zero if your partner is on treatment with an undetectable viral load, according to U=U, or if you are already using PrEP correctly. Kissing, hugging, saliva and sweat do not transmit HIV.

Semen in the eye or mouth carries a much lower risk than penetrative sex, but not zero. A doctor will consider each case based on your partner's status and the amount of exposure.

Very lowOral sexVery low risk

4–8 per 10,000Vaginal sexInsertive 4, receptive 8

11 per 10,000Insertive anal sex

63 per 10,000Sharing injecting needles

138 per 10,000Receptive anal sexHighest risk

Lower riskHigher risk

CDC estimates when the partner has untreated HIV. Falls to almost zero if the partner is undetectable (U=U) or you use PrEP correctly.

Step 3: If it has been less than 72 hours, contact a doctor about PEP now

PEP (post-exposure prophylaxis) is a 28-day course of antiretroviral medicine that must be started as soon as possible, ideally within 24 hours, and no later than 72 hours. Do not wait until Monday, and do not wait for a blood test before asking for advice. Read the details in PEP: emergency HIV medicine after exposure.

If you are already on PrEP but are not sure whether you took enough doses, talk to a doctor as well.

Step 4: Test for HIV before starting medicine, but understand what it means

An HIV test today, whether a fingerstick or a lab test, can only show that you did not already have HIV. It cannot tell you whether you were infected this time, because you are still in the period when infection cannot be detected. A negative result today is therefore no reason not to take PEP. Read about test kits in HIV self-test.

Step 5: Other things people often forget

• Emergency contraception if pregnancy is possible. The sooner the better; it should be taken within 72–120 hours depending on the type.
• Hepatitis B: if you have never been vaccinated or do not know whether you are immune, the doctor may start vaccination straight away.
• Doxy-PEP for some groups, such as men who have sex with men or transgender women who have had syphilis or chlamydia in the past year. Taking doxycycline within 72 hours helps reduce bacterial STIs. See Doxy-PEP.

Step 6: If you were sexually assaulted

Go to a hospital as soon as possible for PEP, emergency contraception, medicine to prevent STIs, care for injuries and evidence collection. If you can, try not to shower or change clothes before you go. Thai government hospitals have One Stop Crisis Centres (OSCC). You can call 1300, Thailand's 24-hour social assistance hotline. In an emergency call 1669 (medical) or 191 (police); the Tourist Police on 1155 can help in English. What happened is not your fault.

Step 7: Book your tests at the right times

Details of the window period for each test are in HIV window period and when to test, and multi-pathogen STI testing is covered in 14-pathogen STI PCR testing. Use condoms every time while you wait for results.

1. 0–72 h
   Contact a doctor about PEP

   Best within 24 h; don't wait for a working day

2. Day of event
   Baseline HIV test

   Hepatitis B, syphilis as advised

3. ~2 weeks
   Gonorrhea, chlamydia PCR

   From exposed sites, or sooner if symptoms

4. 4–6 weeks
   HIV and syphilis tests

   If on PEP, after finishing the course

5. ~3 months
   Confirmatory HIV test

   Syphilis and hepatitis C as risk requires

Use condoms every time while waiting for results.

Step 8: Look after your mind while you wait

The waiting period is when many people worry so much they cannot sleep, search the internet all night, or test again every day. Please stick to the testing schedule your doctor has set, limit the time you spend searching, and talk to someone you trust. If the worry is affecting daily life, read STI anxiety: when the fear keeps you awake or call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support).

Step 9: Plan for next time

If this kind of risk could happen again, PrEP is a better answer than relying on PEP over and over, and you can start it straight after PEP. Read PrEP vs PEP, and learn about choosing a lubricant that helps prevent condom breakage in Lubricant matters more than you think.

How the clinic can help

At Dr. Kris Clinic, I offer private advice about your risk, both at the clinic and through telemedicine. I assess whether you need PEP, can send a fingerstick test kit and medicine to your home, and set up a complete follow-up testing schedule. English-speaking consultations are available. Every step follows professional guidelines and respects your privacy.