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Broken condom, weird doctor response (PEP), need solid advice
Jan 20, 2007

Hi doctor. I feel my situation is somewhat unique and wanted a level headed response. If you could, please read my post and reply to it. Thanks for all of your help and time!

My story:

1. I had an incident about 5 days ago (Jan. 13) with a girl I have known for about a month. She tested on the weekend of Thanksgiving (which was about 2 months ago) and she was negative for everything.

2. She recently informed me that she had VERY brief unprotected sex with an ex-boyfriend of hers (less than 5 seconds) and that was all. This occured on New Years Eve. So 13 days before we had sex. She said her ex-boyfriend had also been tested and was negative. We just don't know when he was tested or if he had any incidents after his negative test. We do know he is not bisexual or gay, and does not do drugs.

3. We were having protected sex and the condom broke. The only reason I knew the condom broke is because the sex felt really good, ha ha. As soon as I noticed this I pulled out and that was it. We might have had unprotected sex for maybe a minute.

4. I started freaking out and doing research on the internet. I came across PEP treatment. Every site said to go to a doctor and assess your risks. So that's what I did. I told the doctor of my situation and was prescribed a PEP regimen.

----------------------

My questions:

1. Is PEP neccessary in my situation? According to my math, my risk of getting HIV from her is around the probability of getting hit by lightning. Is this correct?

2. Can I stop taking the PEP? (I have been taking it for 4 days). I can't perform at work and I feel pretty bad.

3. Have you ever heard of the insertive partner getting HIV from a condom breaking from a single episode?

4. Is 13 days after an exposure enough time to build up a "risky" viral load and successfully pass it onto me. I heard a persons viral load is highest and extremely risky 6 - 8 weeks after exposure. Is this correct?

5. Should I have anything to worry about or am I dumb for worrying about getting HIV from this incident?

Thanks for your help!

Response from Dr. Frascino

Hello,

1. I would not have recommended PEP for the situation you describe.

2. Yes, I would advise you to discontinue PEP, particularly if you are having difficulty tolerating it.

3. There is at least a theoretical risk, but with the particular circumstances of your situation, that risk would be so remote as to be almost nonexistent.

4. Theoretically yes, 13 days could be enough. Peak viral loads during primary HIV infection occur just prior to the body's immune system kicking into gear to fight the virus. This usually occurs around the six-to-eight-week time frame, but there is considerable variability from person to person.

5. I don't believe you should be worried. However, because the condom broke, a single HIV test at the three-month mark would be warranted.

Dr. Bob



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