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Very Big Scare in Mexico & nPEP
Oct 16, 2008

Dear Dr Robert,

Last night I had the misfortune of going over the border into Mexico from San Diego on the thought of a quick release and not think about it againhow wrong I was. This is a lesson in life for all those who are thinking of the same route. I am a very loyal husband and this has been my only mishap ever, something I am hoping to put behind me.

I was taken into a brothel and one thing lead to the next and had intercourse with these two girls. I was using protection however did change the condom I was using twice, changing over between the two, however the one left and I only had intercourse with the one. During the interaction she had left and gone for a cold shower. When she returned I changed the condom and we continued. At the end she lifted herself from me and there was, (what felt like a cup of water), a torrent of fluids coming form her vagina and this covered my pelvic area. I was in shock, it felt like she had urinated but it was not urine. Before she was using ice to cool her body and I think she might have inserted some into her vagina.

I removed the condom and wiped myself clean and then exited and then on the way home headed to the hospital, I was really freaked out by the fact that all this vaginal fluid had come out on to me. I was and am still really concerned about the risk of contracting HIV at that exact moment. So I headed straight back for the border and proceeded to the Mercy Hospital.

I asked the nurse if there was any one who could prescribe to me the NPEP treatment. But no luck, she did not know what I was going on about and I was sent away and told to see a clinic. So I did this the next morning as I know there is about a 48 hour window to administer the treatment. Clinic after Clinic

After being sent away form there, and told to wait and then do a test in 2 weeks was no comfort. I know the window periods and know the treatment available, but was shocked to find that out of all 6 of the clinics I raced around to just passed the buck. I called up the PEP line, they recommended 3 medical centres, all of which did not have a clue as to the treatment, and those who did were closing at 4pm. So I called around some more and eventually got onto the UCSD Medical centre, but by the time I got there I was turned around again and told to come in the morning....hours ticking, very stressful.

So I am going to go there in the morning, 5am.

My question is, how much of a risk do you think I was exposed to, and do you think that taking the NPET medication would work. I have a wife and a new baby coming too. I dont know how to go about telling my wife, as we normally dont have protective sex. This would all have to change, and then the obvious question that will follow.

Sincerely Concerned,

Response from Dr. Frascino

Hello,

The Tijuana-Mama put ice in her tunnel of love and then bopped on your big bopper until Niagara Falls came out of her Bermuda Triangle??? Hmm . . . impressive. Messy, but impressive nonetheless.

Relax Max. HIV cannot permeate intact skin. Assuming you had a latex condom on during the downpour and the skin that got soaked was intact, your HIV-acquisition risk would be essentially nonexistent. I would not recommend a course of nPEP for this level of potential exposure. Because you are so freaked out, I would recommend a single HIV-antibody test at the three-month mark to put your fears permanently to rest. I'd also recommend you level with your wife. It's not only the best way to confront your guilt; it's also the right thing to do. You can then use condoms for the next three months for an extra level of protection (and to prevent you from feeling even more guilt and anxiety) until you can definitively confirm your HIV-negative status.

I'm very dismayed you had such a runaround regarding your search for nPEP! All emergency departments and urgent care centers should be equipped to provide PEP (or nPEP) when indicated. For future reference, HIV specialist physicians are another resource. I'm confident if an HIV specialist evaluated your potential HIV-acquisition risk, she would not recommend PEP, but rather just a three-month test. You can read much more about nPEP and HIV-sexual transmission in the archives.

Good luck.

Dr. Bob



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