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Does Mr Kull's advice still stand?
May 12, 2006

Hi Doc. I wrote to you recently about my experience ( a few days ago, protected vaginal sex with a working girl, lasted about 10 mins, menstrual blood on/around pubic area, condom intact, washed off with cold soapy water afterwards ). Perhaps I should have made it clear of my intention to donate. Your cause is very just and I will spread the word about your site to anyone I can here in Spain.

I trawlled through the posts and found a response which suggests that testing is not warrented ( http://www.thebody.com/Forums/AIDS/SafeSex/Archive/TransmissionNon/Q11037.html ), however this was 5 years ago. Does Mr Kull's advice still stand? Recently there was a guy who's doc gave him PEP for a similar exposure to menstral blood and you said that he shouldn't have had sex while he was on PEP, but didn't mention that he didn't even need to be on PEP in the first place ( ie since he used a condom ), here's the link ( http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Treatment/Q166252.html ). Ok, the women was hiv positive, but I do not know the status of my ex 1 night stand. Perhaps I misinterpreted what you were saying, but the response I expected was " why did the doc give you pep if you used a condom? ". Do all mixed status couples have to do this everytime they have protected sex? I'm still a little worried.

What about gay guys who have alot of protected anal sex, surely there is occassionally blood around the bottom of the condom or around the pubilc area? Is this not the same?

The guys at the Terrance Higgins Trust in London told me not to worry, that if the condom stayed in place, did not break or tear, and I had no open wounds where the blood had been, then there was no risk, regarless of her status. Doc, it was the sight of blood that phsycologically makes me panic more.

I took a test 9 months ago and since then have been using condoms religiously. If I'm gonna go down, I'd rather go down singin' and dancin' in the glory of full skin contact rather than a freak with my rubber party hat on, that would really suck.

So Doc:

1. Does Mr Kulls advice still stand? 1.whats my risk from this event? 2.is testing warrented?

I have no symptoms, only anxiety and stress!

Thanks in advance if you consider my questions. A donation will be made.

Response from Dr. Frascino

Hello,

Let me answer your three specific questions first and then I'll try to clear up any misunderstandings from the previous posts, OK?

1. Yes.

2. Negligible to nonexistent.

3. If you are worried and clearly you are then a single ELISA test should be obtained at the three-month mark to put your fears to rest.

Regarding my previous post (reprinted below), the questioner was asking whether unprotected sex with his wife was risky, because he was on PEP following a previous episode involving a different partner who was HIV-positive. He wanted to know if his wife could wind up becoming HIV positive, even though PEP kept him negative. Clearly he was confused about multiple aspects of HIV transmission and PEP. I, therefore, answered his question and then tried to clarify the various potential outcomes of his having unprotected sex with his wife. I did not address whether or not PEP was indicated, as this was not the question. (He had already been on it for several weeks.)

If you were to ask me if you should take PEP for your exposure, I would say no. HIV cannot permeate intact skin. No way. No how.

As for whether mixed-status couples "have to do this every time they have protected sex," no, of course not. Protected sex is indeed protected, assuming the latex condom is used properly and does not fail. And as for "gay guys who have a lot of protected anal sex," the same principles apply. (By the way, where is the "pubilc area?")

Finally, there is no "glory of full skin contact," whether singin' and dancin' or groanin' and moanin', if you are "going down!" I strongly suggest you keep your rubber party hat on and party on!

Thanks for your donation (www.concertedeffort.org).

Dr. Bob

Sex during PEP Jul 8, 2005

I am currently on HIV PEP (triomune which I begun within 10 hours of exposure) after I discovered a considerable amount of menstrual blood on the base of penis shaft where condom ends. skin intergrity looked ok but Source partner tested hiv postive. Here is the question. Two weeks after I commenced PEP I had one episode of unprotected sex with my wife. Was this risky enough to transmit hiv to her so that in the end she tests postive whilst I test negative?

Worried Isaac

Response from Dr. Frascino

Hello Worried Isaac,

Two points need clarification here.

First, whenever someone is on PEP, it means they've had a significant enough exposure to HIV that there is a risk of acquiring HIV. PEP is given to try to abort a potential HIV infection. Consequently, while someone is on PEP, they should always use latex condoms with their sexual partners to prevent the potential further transmission of HIV infection. Therefore, you definitely should have used protection when having sex with your wife.

Next, could you transmit HIV to her, but remain HIV negative yourself? No, this is not possible. The only options are:

1. You are not HIV positive, (either you did not contract HIV at the time of your exposure or the PEP worked) and therefore since you don't have it you cannot transmit what you do not have on to someone else.

2. PEP failed and you are HIV positive. In this case, there is actually the possibility you could have infected your wife. Then you both would ultimately test positive. There is also the possibility that PEP failed, you are positive, but despite your unprotected sex with your wife, you did not transmit the virus. Then end result in this case would be that you are HIV positive, but she remains negative.

The only option that is not possible is the one you ask about where you transmit HIV to her, but you remain HIV negative.

Isaac, I suggest it's time you level with your wife, confront your mistakes and adopt behaviors that are more responsible. It will not only prevent future worries, but it's also the right thing to do.

Good luck to you both.

Dr. Bob



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