Apr 15, 2006
Hi Doc, I recently had anal sex with a guy. The condom broke and I pulled out almost immediately (I think). I went to the doctor and he put me on P.E.P. The medication makes me feel sick and I am wondering if I did the right thing by going on this medication. I am unaware of the status of my partner , however he agreed to get tested for HIV and I am awaiting the result. Did I do the correct thing? How risky was my encounter given that I feee I recognized the breakage and pulled out as quickly as possible ?
Thank You Very Much
Going Crazy in Toronto
Response from Dr. Frascino
Hello Going Crazy,
The estimated per-episode risk of acquiring HIV from unprotected (or broken condom) insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. Your estimated risk would be significantly lower, because we do not know the HIV status of your partner and your exposure was presumably extremely brief.
As you discovered, PEP is no picnic. (I've been downing fistfuls of antiretrovirals daily for over a decade!) Should you continue the full 28-day course of PEP? If your partner's HIV test is positive, yes, I'd suggest you complete the course. If he's negative, I'd suggest you stop. Yes, there is the small possibility that he might be in the "window period," during which he's infected but not yet making enough anti-HIV antibody to be detectable on our screening tests. However, the odds of this being the case are extremely slight. And if you couple those odds with your very brief potential exposure, I would suggest PEP is not warranted. If for whatever reason you decide to continue PEP, I would suggest you consult with an HIV specialist who can accurately document your risk, optimize your PEP, manage any PEP side effects or toxicities and arrange for appropriate follow-up HIV tests.
Toronto is a great city in which to go crazy, but not that kind of crazy.
I'm sending you my best good-luck/good-health karma that both you and your partner's tests are negative.
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