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Freaking Out! Help Quick! Your the best ;)!
Aug 31, 2004

Dr. Bob,

I have been reading your columns for a while now and I love them!

Now, it's my turn for a desperate question.

Last night (Saturday 28th of August) I decided to try my first Male to Male sexual encounter. So, I got a hold of an escort in NY. The cutest one possible of course ;). We pretty much went right into anal intercourse as me being the receiver. Now, about 15 mins into it I realized he did now put on the condom that I brought for him!!! I made him put it on at that point which, really, was only about 5 more minutes of intercourse.

Now, he tells me he is 100% HIV negative.

As quickly as possible, do you think this warrants a PEP treatment regimen or am I taking it a little to far? I am very, very stressed out!

He is a fairly expensive escort too.

To add some more info to the story, my friend is a male escort and tells me that escorts are pretty good with themselves and who they hook up with. Also, usually escorts get tested quite often in that line of work.

So, I am sitting here anxiously waiting for your response because I only have about 48 hours left to make a decision on PEP treatments. AND, if you do think that this warrants PEP treatments, how do I go about getting a prescription? I don't know where to go!

Thank you so much for your time.

Response from Dr. Frascino

Hello,

First off, PEP, post-exposure prophylaxis, should be available at all emergency rooms and urgent care centers, as well as through any physician's office, including, of course, those of HIV specialist physicians.

The real question here is whether you should consider taking PEP. As with any medication, you need to balance the potential benefit against the potential risk of drug toxicities and side effects. We don't have adequate information to definitively recommend for or against PEP in non-occupational exposures, such as the one you describe. Certainly PEP should not be used by folks who have had HIV exposures that are considered low risk for viral transmission (such as getting potentially infected blood or other body fluids on intact skin) or for folks seeking care too late for the anticipated interruption of HIV transmission, i.e. greater than 72 hours after exposure. PEP is a complicated medical therapy and not a form of primary HIV prevention.

Evaluation of your risk would have to take into account the fact that unprotected receptive anal sex carries the highest risk of potential viral transmission that being estimated to be 0.1% - 3% per episode with a partner confirmed to be HIV positive. That unprotected ejaculation did not occur and that we do not know the HIV status of your rent-a-stud would decrease your estimated risk statistic.

I would not believe rent-a-boy's assertions that he is 100% negative, even if he had a lie detector strapped to his little soldier who was standing at attention. After all, he did dive right in commando style, right? That means this dude is more than willing to take risks.

So what to do? The ultimate decision is yours. You have placed yourself at some degree of risk; however, the odds are still very much in your favor for not having contracted HIV from this single five-minute potential exposure. Should you decide to proceed with PEP (and I'm not saying this is what I would personally recommend), you should receive medical evaluations by a qualified physician, including HIV antibody tests at baseline, four-six weeks, 12 weeks, and six months.

I hope you'll find this information useful in helping you make your final decision. Unfortunately, yours is not a clear-cut situation where we can confidently say the potential benefit of PEP is worth the potential risks involved in taking it. Some folks (and HIV specialists) might opt for treatment, but I'm sure there would be a greater number who would advise against it in this specific situation.

Good luck with whichever path you choose to follow.

Dr. Bob



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