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PEP or no PEP

Jul 13, 2007

Hi Doc, Last Monday I had unprotected anal sex with a man I had never met before. I expected him to use a condom, and when he didn't, I asked him to pull out before coming, which he did. Tuesday, I panicked, came to my senses and went to S.F. Cityclinic and got started on PEP. I talked to my new friend today,(Wednesday) and he said that he gets tested frequently, the last time 2 months ago, and he has always been negative. He is getting tested tomorrow, Thursday. If his test results are negative, is it necessary for me to stay on PEP? I understand that I took an incredibly stupid risk, only somewhat mitigated by the guy not coming in me. I keep thinking of the Robin Williams joke that man is born with a dick and a brain, but only enough blood supply to run one at a time. This comes after having been very careful for the last twenty-five years, and staying HIV negative at least until now. Thanks for your help

Response from Dr. Frascino


I agree unprotected anal receptive sex does place you at risk for STDs, including HIV. The HIV-transmission risk would be mitigated somewhat by not allowing ejaculation in the love canal. The risk would be further reduced dramatically if your top gun does indeed test HIV-antibody negative. In that case, a potential risk would exist only if your Commando Rambo was still in his window period and thus without detectable levels of anti-HIV antibodies in spite of being HIV infected.

Should you continue PEP if indeed he tests antibody negative? That decision is ultimately up to you. Certainly your risk would be markedly less than either having an HIV-poz or HIV-status-unknown top-guy. In similar situations at the Frascino Medical Group, there have been guys who decided to stop PEP and just get a three-month HIV test. Others have decided even a small HIV risk was too much for them to consider stopping PEP. They took the full 28-day course and had follow-up HIV tests out to six months per the post-PEP guidelines. We have seen no seroconversions in either group.

You can discuss this further with the HIV specialist following your case at Cityclinic if you wish. I don't believe there is as wrong or right answer, assuming you are tolerating your PEP meds.

Good luck.

Dr. Bob

Follow Up 3: Thinking of Checking Out of This Anxious Existence

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