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urgent please: might seek PEP
Mar 28, 2007

dr. bob,

thanks for your help, in advance. long story short, a slip of judgement yesterday led me to receiving an unprotected blow job from a random woman that i had met the night before. i subsequently found out, no surprise, that she is very promiscuous. now im very worried. having reviewed this site, i saw several posts that noted a 72 hour window for commencing PEP. i called a local clinic who told me they only administer it within 2 hours of the contact, as otherwise is ineffective. can you reconcile this for me? second, i feel like it's not rational to be as worried as i am (due to statistics) but because my life is involved i am rationally worried...if that makes sense. is it safe to say that if you are the insertive partner during oral sex, the only way to have hiv trasmitted to you is if your partner has cuts/sores-> blood in the mouth (as saliva seems not to transmit)? if so, isn't that, the blood that is, something you would notice...are we talking gushing or small leaks? please respond to this because i am debating whether to persist trying to find someone to give me PEP (also, do you have any recommendations for the jax, fl area)? thanks! - mental lapse

Response from Dr. Frascino

Hi Mental Lapse,

Can I reconcile the different information you received from this site and your "local clinic?" Sure, that's easy. They are wrong! Next question!?! OK, I'll elaborate a bit more. PEP is most effective when administered as soon as possible after the exposure. So starting minutes afterward would be better than hours, which, in turn, would be better than days. In general, it is felt starting PEP beyond 72 hours is probably not going to be effective.

Next, regarding the need for PEP, I would not recommend PEP for "an unprotected blowjob from a random woman." The risks associated with PEP outweigh the potential benefits, because your chances of contracting HIV form insertive unprotected oral sex with a partner of unknown serostatus are negligible at best.

As for access to PEP if a real need should ever arise, any emergency room, urgent care center, HIV specialist's office or health department should be equipped and have the expertise to evaluate and handle these types of situations expeditiously. Then again, you do live in Florida, home of Jeb and all those Disney creatures, like Dumbo, so . . . .

My advice is not to seek PEP for this episode, but if you're worried about HIV, get an HIV rapid test at the three-month mark to put your residual worries permanently to rest, OK?

Good luck.

Dr. Bob



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