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Please answer quickly...time of the essence
Oct 12, 2007

Dear Bob- I am a wreck, and need to make a decision about whether to start PEP very quickly. Please answer this. Last night I hooked up with a t-girl prostitute. It was not out first time, and everything in the past was always protected. I know that the risk through oral is low, but here is what happened. She went down on me without a condom, as she has done in the past, and rimmed me. I am not particularly worried about that. I have always used a condom when going down on her. However last night i went down on her briefly without a condom. Mostly I licked the shaft and balls, but i did lick the head for maybe 5-10 seconds. Additionally, I took the whole thing in my mouth about 3 times for maybe 3 seconds each time. Worse, i had noticed some precum earler from her penis, but did not see it while i was giving her head. there was no ejaculation by her. Lastly, i had done some cocaine, so my mouth was dry, and when i blew my nose this morning, there was some blood in my mucous, which could have been in the back of my throat. Here is where the story gets worse. She stated in the past that her mother was a nurse and that she gets tested every three months and is negative. When we were done, she went to the bathroom to clean up and her purse was on the floor. I looked down, and noticed a pill bottle was in there. I got very nervous and looked at it, and it was Atripla. I confronted her about it in hopes that she would say that she keeps it for PEP in case of an accident, but she told me some cockamamie story that it was not hers, even though her name was on the pill bottle and it was in her purse. I think it is fair to say that she is confirmed HIV+. I know the risk is low, but in this circumstance, knowing that the girl is positive, would you recommend that I start a PEP regimen? I don't have much time, so please answer quickly. Im very worried.

Mike

Response from Dr. Frascino

Hello Mike,

Unfortunately your time-sensitive question arrived while I was out of town and unable to respond. Consequently to PEP or not to PEP is now a moot point, as we are well beyond the 72-hour cutoff.

First off, I should note your use of cocaine led to additional risk behavior. This is a common theme. I urge you and all tweakers to quite cocaine. It will ruin both your health and your life.

Regarding t-girl hooker, I agree her story is cockamamie and she is most likely "virally enhanced." However, would you be at any less risk if you hadn't found her Atripla? We must always assume our sexual partners are HIV infected and take all precautions to prevent STD/HIV transmission.

Would I have recommended PEP if I had been able to respond within 72 hours of your exposure? No.

If you remain worried, a single rapid HIV test at the three-month mark is all that I would recommend.

Good luck.

Dr. Bob



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