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Clueless in Chicago
Jul 21, 2006

Dr. Bob: I promise, as god as my witness, a donation this time! That being said, I have a question. A month ago, I had unprotected sex with an HIV poz man. I topped him and came inside of him. Although, we hadn't planned on having sex, it just kind of happened. The next day, my doc prescribed a pep regimine, which I took for the 28 days. My concerns are this: I have a second hole in my penis from a piercing that I got in college (it has since healed), also, we didn't use lube when I penetrated him (I just slide in). He's on meds and has an undectable viral load. He didn't top me. I am very angry and upset with myself for taking such a risk, however, I would like to know what that risk really is, given the factors I have presented to you. Also, I had an HIV test this week and it came back negative. Should I still be concerned, given that I topped him and I went on a pep regimine? Thank you SO much Dr. Bob!

Response from Dr. Frascino

Hello,

The estimated per-act risk for acquisition of HIV from unprotected insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 episodes. We don't have specific stats for healed penis piercings (OUCHAMAGOUCHA) nor for barebacking with or without lube. The best I can offer is that a healed piercing would not affect risk. Not using lube may increase the risk of trauma to the delicate anal and urethral membranes, thereby potentially increasing transmission risk. And having an undetectable viral load would decrease the likelihood of HIV transmission. Beginning PEP "the next day" and continuing for a full 28 days would also significantly decrease your risk of contracting the virus. The sooner PEP is started after exposure, the more likely it is to be effective in preventing infection. It must be started no later than 72 hours after exposure.

Your one-month negative HIV test is encouraging, but not conclusive. You'll need a follow-up test at three months. If negative, the CDC would recommend an additional follow-up test at six months, due to your documented significant exposure.

No reason to promise a donation "this time," whether or not God is your witness. My advice is free and available to all. Donations should only be made in the spirit of generosity, compassion and a desire to help those less fortunate than we are. They should never be given or promised in an effort to encourage me to answer a particular question. OK?

Dr. Bob



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