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Oral Sex, PEP and testing
Oct 10, 2003

Dear Dr Frascino

I live in South Africa, where doctors have about 4 years of university training instead of 8. So my question to you:

I performed oral sex on a man of unknown HIV status, and swallwed some of his semen. I had to take an out-of-town business trip early the next morning, but when I got home my worries over what I had done prompted me to go to a clinic. The doctor there said he considered my behavior fairly low-risk, but offered PEP if I wanted it. I chose to take it and started Combivir immediately. This was about 65 hours after my possible exposure.

An initial baseline ELISA test was negative, and I had had no potential exposures for close to a year prior to that.

I completed the 28-day treatment (no nasty side effects at all) and went in for a 6-week follow-up test, also negative. They have told me to come in again in 6 months for another test.

I know that a majority of people who have contracted HIV will test positive at 6 weeks and that virtually all will do so by 3 months.

My questions are these:

1) Even the CDC still recommends 6 months for a "significant event" such as rape or intercourse with a known HIV+ partner. This clinic deals mainly with rape victims, so they are probably giving me the standard recommendation. In my case, is there any need to test after 3 months?

2)Is there any evidence that taking PEP might delay seroconversion, so that my 6-week negative test might be considered meaningless and even a 3-month test not definitive?

For what it may be worth, the lab used a 3rd-generation ELISA test.

I'd really be grateful for your answer.

Thanks for a great forum and for being one of the most understanding and humane people I've run across.

Joe in Joburg

Response from Dr. Frascino

Hello Joburg Joe,

In my opinion, your minimal risk did not warrant the risk of PEP. To answer your questions:

1. The 3-month test is conclusive for your situation. 2. No, the test would still be accurate.

Good luck on your 3-month test.

Dr. Bob



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