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Unprotected Top
Mar 26, 2005

Hi Dr Bob -

This is my first time browsing this forum, thanks so much for the helpful info.

I had read other sites on safe sex and foolishly came to believe I was relatively safe barebacking if I was top. So yesterday I felt it was OK for me to bareback/top a guy I've been seeing who is POZ.

After reading your site I now know the significant risk. The question I still have is whether or not I should do PEP? This is the first I've heard of it.

He says his viral load is undetectable.. not sure if that makes a difference. All I know is I've got another day before the PEP/72 time runs out. I called my primary care doctor, and his NP called back saying to make an appointment to see him later this week, but they didn't see the urgency !

Thanks so much for this site - I wish I had read it before yesterday.

p

ps. I agree with the others that you are cute :)

Response from Dr. Frascino

Hi P,

Unprotected anal sex with an HIV-positive partner does place you at risk for STDs, including HIV. The risk for the insertive partner is always considered to be less than for the receptive partner, however it is still considered "significant." If your partner's viral load is undetectable, that may further decrease the likelihood of HIV transmission. The decision whether to take PEP is a personal one. Weighing the risks of taking potent anti-retroviral drugs for 28 days versus the potential benefit of decreasing the chances of viral transmission following a significant exposure is a complex task. What I can tell you is that your risk would be considered significant enough to warrant offering PEP therapy. Emergency rooms and urgent care clinics should be well equipped to get you started on a standard regimen right away if you decide on PEP. Even if you begin PEP, I would advise consulting an HIV specialist as soon as possible. With additional discussion, he or she will be able to advise you further about your risk; if PEP should be continued; which PEP regimen would be best; how often and when to do follow-up HIV tests; handle any medication side effects, toxicities or drug interactions and address any other questions you might have.

Spread the word to your friends: whether pitcher or catcher, barebacking is risky business.

Good luck.

Dr. Bob



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