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pep refused- can they do that?
May 23, 2007

Hey Doctor Bob,

How are you? I know you showing off your French and Italian- but I only know English (and Hindi and Bengali) Anyway- I called the City Clinic nervously to get PEP after performing brief oral on the erect penis of a guy who was massaging my back. The lady was polite but brushed off my concern in a way a school teacher might talk to pestering 2nd grader. She didnt even ask if he were positive, if he came in my mouth, what my oral health was. (The answers-he might be poz, no cum at all, no cuts/ sores) I argued its a 'low but real risk' per the CDC hotline to convince her and she remained stern and said NO, this time with more volume and the "I decide, you dont" tone. Can she talk to me like this? Isn't it an individual's choice to decide if they want to put up with possible adverse side effects or not? I am interested in hearing your 2 cents doc. please help me. Shukriya. (Thanks in Hindi)

Response from Dr. Frascino

Hi,

You performed oral sex on the erect penis of a guy who was massaging your back????? If he was behind you massaging your back, he must have had one giant tallywhacker for you to be able to nibble on it. Or perhaps you were in one of those seemingly impossibly contorted Karma Sutra positions? Oh well, no matter. Your HIV risk is unprotected "brief oral" on a masseur of unknown HIV status. Oral sex carries a very low risk for HIV transmission. That your exposure was brief and that the masseur didn't pop his cork would further lower this already very low risk. Consequently I would agree that PEP is not warranted and would strongly encourage you not to take it. Your concerns should not have been "brushed off" and you should not have been treated like a second grader. Rather a more thorough explanation should have been provided explaining the logic and reasoning behind the recommendation. You can read much more about indications for PEP and HIV risk associated with oral sex in the archives of this forum. After doing so I'm quite confident you'll be convinced in any language that ultimately the correct decision was made.

Good luck.

Dr. Bob



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