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Previous nPEPer, different decision
May 13, 2008

Hi Dr. Bob,

Thanks for all you do on this forum - you're a legend!

I previously took nPEP in December of last year after what was subsequently considered an unwarranted exposure (receptive anal sex with guy of unknown status, three thrusts for less than a minute with no ejaculation, broken condom). The nPEP drugs made me very ill, and I feel that I should have listened to the advice of the professionals and not gone on the medication.

Last week I slept for the first time with a new guy that I have been seeing - he sheathed up, and we checked the condom regularly - however, half way through we felt the condom give, he thrusted a couple times, we realized, and he withdrew. We stopped and finished off outside. He tested negative recently and assured me he had taken no risks, and given my previous knowledge and discussions, plus my bad experience with nPEP, I decided not to seek out treatment.

That was a week ago, and now I feel like I'm totally freaking out - I feel like I should have gone and sought nPEP again. My new guy is away at the moment, as am I, and not in a position to get tested. I know it's too late now, but I would appreciate your perspective on whether you would have considered nPEP warranted in this situation... my complete freakout in this situation I am worried is really pushing away my new guy.

Thanks! Sleepless in San Fran

Response from Dr. Frascino

Hello Sleepless in San Fran,

Since you are already beyond your nPEP treatment window, this has now become a moot point. The way I would have handled it if you had taken the short scenic drive from San Francisco down to Los Altos and the Frascino Medical Group immediately after the incident, would have been to ask your top-gun-guy to get a rapid HIV test. If he was negative (likely from what you have written), I would have certainly strongly recommended against nPEP. In the unlikely case he was positive, I would have offered nPEP.

Considering this episode occurred a week ago, I see no point in focusing on "what ifs." Life only goes in one direction: forward. Stop worrying about what you could have or should have done. That's all irrelevant now. (I tend to agree with your decision, by the way.) Stop freaking out. It's not helpful; nor will it change the ultimate outcome of your tests. Plus you mentioned your "complete freakout" is pushing your new guy away. Psychological counseling might help you control your anxiety during the three-month waiting period. Also, even though you are beyond your nPEP period, you could still have your potential Mr. Right get a rapid test. If it's negative, you should feel remarkably relieved. Your risk would then be reduced to the remote possibility that your new guy was in his window period.

Now stop worrying and get some sleep. Those black circles and bags under your eyes are not at all a good way to bring sexy back.

Good luck.

Dr. Bob



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