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Oral, JO, Fingering and Truvada
Dec 5, 2012

Good Afternoon, I've asked this question several times and I am hoping for a response. I also have another question about Prep/Truvada. i had an encounterin which I provided oral to my sex partner. I licked his testicles and shaft avoiding the head of his penis. He places a condom on and I continued oral, with the head of his penis in my mouth. While the cndom was on, i also masterbated his penis. At one point, he rubbed the opening of my anus with his finger, he did not go deep. He finished masterbating and ejaculated into the condom. Can you tell me if these acts are risky and warrant testing. I test bi-annually. In addition, I would like to start taking Truvada for prevention. What are the criteria for doing so? Thank yoy for your anticipated response.

Response from Dr. Young

Hello and thanks for posting.

Based on this single event, I can't say that you are at sufficient risk to justify daily pre-exposure prophylaxis (PrEP).

However, PrEP has been shown to significantly decrease the risk of HIV infection beyond typical "safe practices", particularly among sexually active gay men. PrEP requires engagement with a health care provider, periodic HIV testing and monitoring of your health through clinic and laboratory tests.

The US CDC issued Interim Guidelines on PrEPThese guidelines (and an earlier release aimed just at gay men) make several key points:

1) PrEP should be targeted to individuals at very high risk for HIV infection, such as those with a sex partner who is HIV-positive.

2) It is critical that those using PrEP take the daily medication consistently, as the level of protection has been shown to be closely related to levels of adherence

3) Concerning women who are pregnant or trying to conceive, health care providers should discuss available information about potential risks and benefits of beginning or continuing PrEP so that an informed decision can be made. While no adverse effects have been found among infants exposed to TDF/FTC during pregnancy, most of the relevant data have been collected among children born to HIV-positive women using the drug for treatment. Data are incomplete for children of HIV-negative women who become pregnant while using PrEP.

4) PrEP is not a stand-alone solution: It should be delivered as part of a comprehensive package of prevention services, including counseling to reduce risk behavior and encourage adherence to the daily pill regimen, access to condoms, and management of other sexually transmitted infections.

5) Individuals prescribed PrEP must be confirmed to be HIV negative prior to use, and their HIV status, experience of side effects, adherence, and risk behaviors must be monitored regularly during use.

Hope that helps. BY



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