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Truvada as PEP -- needed?
Dec 30, 2007

Dr. Bob:

I was just prescribed a 28 day course of PEP by an HIV clinic and am wondering if you think it is necessary.

Last night, I topped (with a condom) a man who claims he is negative. Shortly after penetrating him, the condom broke and within five seconds I was fully withdrawn. I did not notice any blood on the condom or my penis. Other than some mastrubation, we did not re-engage in sex after the condom broke.

This guy says he always practices safe sex and, to his knowledge, is HIV- though he admitted he is due for his annual check. I did my routine screening [negative] a few weeks earlier and this was my first sex after that test.

I called my doctor about an hour after the condom broke and within 12 hours had been seen by the HIV specialist and was prescribed Truvada.

I asked last night's date to go to the clinic for an OraQuick test this morning and he did. It came out negative. I have no reason to believe this guy lied to me about his use of condoms or that he is positive, but the clinic seems to not want to take any chances. The doctor prescribed the drug before the guy took his OraQuick test, but the nurse practitioner said he could still be in a window period and that it would be safer to take PEP.

My question: given those facts, would you have prescribed Truvada as a form of PEP for me?

Response from Dr. Frascino

Hello,

To PEP or not to PEP can be a difficult question to answer over the Internet, having only limited information about the potential exposure and risk. However, from the information you provided five seconds of insertive anal exposure due to condom failure with a partner who tested HIV negative the following day I would not recommend PEP. Rather than relying on the nurse practitioner's advice, I'd suggest you talk directly to the HIV specialist physician and advise him your partner tested negative. The chance your bottom boy is in his window period and that you would acquire HIV from such limited exposure is extremely remote at best. Too remote to warrant PEP in my opinion.

Good luck.

Dr. Bob



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