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PEP yes/no and side effects
Jan 5, 2013

Hello

I am a gay male, 29 years old. I had a sexual encounter with another gay male (22 years old). He gave me oral sex and then tried to perform anal sex (he was the top). I asked him to use the condom and he did at first. Then he couldn't get hard enough and took the condom off without me knowing until later. He tried to perform anal sex with his penis inside for a few minutes (mostly soft) until I notice that he took the condom off and demanded him to stop. Of course I freaked out and quizzed him about his sexual history. He swore he tested negative 4 months ago, and since then had sex twice but all protected.

I took Lamzidivir (Lamivudine 150 mg and Zidovudine 150 mg) 36 hours after the incidence. It has been 2 days now and although I tried to get him tested again, I couldnt reach him on the phone now.

I had used 1 course (30 days of the same medicine about 9 months ago - condom broke and the guy came inside me). So my questions are:

- Would using another course of PEP be very harmful for me, short-term and long-term - Do you consider the risk low/high and would you recommend PEP? - Any future implication on PEP - what if another unfortunate incidence happen and I need to use PEP again. Would that be terribly bad for my body and less effective

Response from Dr. Young

Hello and thanks for posting.

First off, since HIV is found the the pre-ejaculate (pre-cum), penetration like you described is certainly an exposure and in my opinion, would likely warrant PEP treatment.

There's no reason to think that a second round of PEP should be any more harmful than the first; but if you find that you are repeatedly having risky exposures, you might consider asking your doctor about pre-exposure prophylaxis (PrEP). Daily PrEP with Truvada (tenofovir/FTC) has been shown to dramatically decrease transmission in adherent people.

Hope that helps, BY



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