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pre-cum and anal bleeding
Apr 29, 2012

I recently had a sexual encounter with another man at a gay cruising spot in a park. At first we were masturbating each other, but then asked me to penetrate me. I said yes as long it was with a condom. Then he masturbated himself a bit and with the same hand put the condom on this penis. I noticed when he was jacking off there was a lot of pre-cum, and then I said it wouldnt be ok and I didnt let him penetrate me, but he rubbed his penis on me anus anyway. The problem is that a couple of hours before that I had a minor rectal bleeding after shitting. When I recalled that, I panicked and left. I went to the public restroom to wipe my anus and I saw small traces of blood on the toilet paper.

Now I am trying to assess the risk of the situation. Isn't this the same as unprotected anal sex, in a way, since the pre-cum that was first on his hand and then on the tip of the condom got in contact with my bleeding rectal fissure?

Two hours later I went the local ER and they put on PEP (Truvada and Zidovudine). They gave me a 10 days supply and told me to go to a HVI specialist and get the rest of the medication to complete the 28-days. So I went to see a doctor 3 day afterwards, and she told me that Truvada alone would be Ok, that I could discontinue the Zidovudine, since I had some skin reactions.

My second question is: Is Truvada alone effective enough? I read online the ideal regimen would be Kaletra and Truvada.

Response from Dr. McGowan

I agree with the approach of starting PEP in your situation. I am glad you got started right away. There is no correct answer to your question about what the best treatment for PEP would be. The only studies have been with using a single medicine (zidovudine) for people exposed during medical procedures. The most important things would be the amount of exposure (in your case minimal) and the timing of getting on meds (in your case in 2 hours, which is optimal). Since we do not know if your partner was actually infected it is up to you and your doctor to determine the need for treatment. The current CDC guidelines would recommend either Efavirenz or Kaletra. plus (lamivudine or emtricitabine)plus (zidovudine or tenofovir). Which would be 3 drug combinations. In New York state, the current recommendation is to use Combivir (zidovudine + lamivudine) + tenofovir. Modification of these recommendations can be made based on side effects, tolerability and if there is known information about HIV resistance in the person with whom you had contact.

Joe



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