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I hope my donation makes a difference like you do for us
May 31, 2005

Dear Dr. Bob, I just donated to your foundation and I feel better.(www.concertedeffort.org.) I was sitting here depressed, anxious, angry at myself over my recent foolish behavior and thought perhaps I can make a difference in the lives of others you are trying to help. I recently wrote over two risk exposures that probably has not been read yet. I was in Thailand and Doc. I have been so safe before having never had unprotected sex so I thought I was in control. I was receivng a full body baby oil massage from a sex worker and two events happened. First she proceeded to unprotected fellatio so quickly that the pleasure vetoed my frontal lobe. Second my circumcised penis partially inserted into her for about a sec for 1/2 inch(I know this is full penetration for G.W. but not for me), barely penetrating her labia, before a I jerked it out while I we were rubbing against each other. When I returned home, my anxiety skyrocketed faster than our national debt.I went to a doctor who put me on PEP(combivir/Keletra)s/p week 1 of 4 weeks. Initial Elissa neg. Neg. for STD's on testing. QUESTIONS. 1. I've heard you say that unprotected fellatio is astronomical low risk. true? 2. Does baby oil help or hurt transmission of any kind?( I know bad for condoms). 3. Does my 1/2 inch 1 sec exposure place me at equal risk as unprotected vaginal sex ? 3. Do you recommend PEP in this situation? Why is PEP not used more it seems the side-effects are small compared to risk of HIV? Thank you for your service. Ironically I've been planning a safe sex website for thailand so i am very upset and embarassed about this for allowing pleasure to override reason. I hope I have not paid the ultimate price for one mistake. Thank you in advance.

Response from Dr. Frascino

Hi,

1. The estimated per episode risk for HIV transmission for insertive oral sex with a partner confirmed to be HIV positive is 0.5 per 10,000 exposures. Your estimated risk would be less, because the HIV status of your "worker" is unknown. I guess that would qualify for "astronomical" low risk.

2. Baby oil neither hurts nor helps HIV transmission. I agree it's bad for latex condoms.

3. Since inch is "full penetration for G.W." and 1 second is the average duration for sex for most Republicans, I would say it would count as "unprotected sex" for some. However, for most folks, the exposure you describe would be considered minimal at best.

4. The decision whether to use PEP is based on many factors; however, from what you've told me about your exposure, I would not encourage PEP. PEP should be used only for significant HIV exposures; otherwise, the risk of therapy outweighs the risk of HIV infection.

Thank you for your donation! Yes, it will make a very important difference.

Don't be so hard on yourself regarding your "recent foolish behavior." We all make mistakes. Learning from our mistakes going forward is much more important than getting depressed and anxious over past events. Remember life only goes in one direction!

Good luck!

Dr. Bob



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