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Lonely Democrat in TX--question about my PEP regimen--please answer!!!
Jul 14, 2005

Hi Dr. Bob--

You completely rock and truly make this time while I go through my fears of contracting this, much easier. My question is that I had a possible exposure to HIV with a man of unknown status. I was insertive. At first, it was mainly just frottage, with me rubbing against his anus after I had rimmed him. I know that there was one point where I had gone over his anus and sort of poked inside for a very short period of time. Nothing beyond the head of my penis had gone inside for a matter of about 10 seconds. I then put on a condom (which now I realize covered all of my penis except for about half an inch from the base), and began to have sex with him. The condom never slipped off or broke (I checked thoroughly afterwards). I climaxed outside of him. However, I got nervous. I wasn't really sure what to do. I wasn't totally aware of PEP (I live in El Paso, Tx), until I read around for it. So, I did not go in to get the treatment (Trizivir)until almost 60 hours post-exposure. Is this too late? Everywhere I read says that ideally, it's 1-36. I'm very nervous about this. I also called the source of the exposure, who swore he was negative (yet couldn't remember when his last test was), and that he had never caught anything. Four days after the exposure I have a sore throat (could this be from the rimming?), and right inside the tip of my penis seems a bit red. No pain or burning or discharge. My urination does seem a tad more frequent, though. I had my baseline done when I went on PEP. Everything came up NEG (HIV, Hep B, Hep C, Syphilis), except I later realized that I wasn't tested for gonorrhea or chlam. I guess my questions are: 1. Is nearly 60 hours post exposure too late for me to go on PEP? Is it less effective? 2. Do those sound like gonorrhea or chlamydia? Can I get this from rimming, or could this have been from the seconds-long "poke" of the tip of my penis inside him? 3. Could the condom have been used wrong, even though it didn't break or slip off, but also didn't ENTIRELY cover the base of my penis (again, there might have been 1/2 inch to an inch where it wasn't at the base)? 4. Do you think my PEP regimen is a suitable one in terms of what I'm taking? 5. What is the increase of my chances of contracting this disease if indeed this turns out to be gonorrhea or chlamydia?

Thank you for all that you do. I'm just very, very scared.

Lonely Democrat in Texas

Response from Dr. Frascino

Hello Lonely Democrat in Texas,

Wow, it's been a big night for cowboys in the Forum. You're the fifth cowpoke with a problem in a row!

I'll proceed directly to your specific questions:

1. PEP should be started as soon as possible after a significant HIV exposure and no later than 72 hours. Consequently, your 60 hours is within the time frame for starting PEP, but I'm not at all sure I would consider your sexual activities a "significant exposure risk."

2. If you are concerned about gonorrhea and/or chlamydia, you should get screened for these common STDs.

3. A condom not covering the one-half inch at the base of your Mr. Happy is not a problem and does not mean the condom was improperly used. The 10 seconds of anal penetration without a condom is the real concern and does represent "improper condom use."

4. Trizivir has been used for PEP, although it would not be my favorite option.

5. Having gonorrhea or chlamydia can increase the likelihood of contracting HIV. But first things first, you haven't even been screened for these yet!

Cowboy, take it easy. The odds are all in your favor that your Texas two-step cowpoke adventure did not transmit HIV. Yes, STD screening now and an HIV test at the three-month mark are warranted, but Texas-sized anxiety is not.

Good luck!

Dr. Bob



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