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Hello again old friend
Oct 2, 2006

Dr. B- Long time reader and many time donater here. I finally thought I got it right and have been exclusively using condoms. On Friday, I met a girl at a club and she came home with me. We had both been drinking. I put a condom on before sex, and it was feeling to good. After roughly three minutes, I noticed that the condom had completely broke. It has been about 48 hours, and because it is the weekend, I have not found an open clinic to get PEP. I am very upset. I know all the stats, but have two questions:

1) Assuming the condom broke immediately, the time of exposure would have been 1.5-3 minutes. Would this be considered a brief exposure (as oppossed to full on sex), and if so, would a brief exposure carry less likelihood of transmission than a long exposure.

2) I am going to look for a clinic tomorrow, but most of the clinics are closed due to Yom Kippur. Assuming the worst, that this woman was positive (she stated that she tested negative in March, but who knows), would you recommend PEP in this situation?

Thanks

Response from Dr. Frascino

Hello,

Welcome back to the forum. Sorry it has to be under such stressful conditions!

To answer your questions:

1. Certainly the briefer the exposure the less the overall risk of HIV transmission. However, even a brief exposure is an exposure and therefore carries some degree of risk.

2. PEP would be offered in this type of situation, but not necessarily strongly encouraged. There are many factors that come into consideration in ultimately deciding whether to PEP or not to PEP the likelihood that the partner is HIV positive, exposure to menstrual blood, the level of concern/worry of the exposed individual, etc.

Regarding PEP availability, any emergency room should be able to evaluate your risk and prescribe PEP, if warranted, to get you started ASAP. If PEP is begun, I would recommend you see an HIV specialist over the next few days to more carefully evaluate your exposure risk, optimize the PEP regimen, handle any PEP-related side effects or toxicities and arrange for post-PEP HIV testing.

One final thought: if you are still in contact with your club-gal, you might ask her to get an HIV rapid test now. If negative, that would very dramatically reduce any chance you contracted the virus.

I'm sending you my best good-luck/good-health karma, OK?

I'm here if you need me.

Dr. Bob



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