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I was place on PEP after oral exposure
Dec 19, 2008

Dr. Frascino-

Thanks very much for providing such a wonderful and complete forum on safe sex and HIV prevention. Its been very helpful and reassuring to read through your responses to so many people.

My question pertains to HIV and oral sex (didnt think youd make it through the day without one did you?). Six weeks ago, I was in the process of shopping for an apartment with a hottie of a real estate agent. After the some heavy flirting back and forth, I gave him oral sex for about 10-15 minutes in one of the vacant units he was showing me (insert joke about showing units here). Afterwards, he told me that he was HIV positive.

He didnt climax in my mouth, but Im not sure about how much if any precum there was. My oral health is good, and he assured me that my risk from our activities was minimal. He told me hed been positive for 8 years, was otherwise healthy, and had an undetectable viral load.

I went to clinic at the 60 hour mark and after relating this story to the doctor, was put on a PEP regiment of Atripla for 30 days. I finished the regiment without missing a dosage and have abstained from sexual contact during this time. The doctor also ordered blood work to establish a baseline HIV and other STD status, all of which has since come back negative. I have felt fine for the past six weeks with no symptoms of any kind.

My questions; 1) Did this clinic overreact in prescribing Atripla? From what Ive since read, many doctors wont prescribe PEP for oral exposure under almost any circumstances and that the transmission risk most commonly quoted is 0.09% or 9 in 10,000. Was there something in my scenario that was more risky?

2) Does the PEP regiment extend the window period? I know I need to test again at the 3-month mark, but is that three months from the exposure or the end of taking the medications?

3) Given the undetectable viral load, low risk or oral transmission, the absence of a climax, and PEP, if (knock wood) the 3-month test is negative, would you still recommend a six-month follow up test?

Thank you in advance. Ive read a lot of conflicting information over the last month and your insights will go a long way towards calming my anxiety.

Concerned house hunter

Response from Dr. Frascino

Hello Concerned House Hunter,

First off, I know several real estate agents who would like to show you their units at your earliest convenience.

Next, turning to your specific questions:

1. Generally speaking, PEP would not be recommended for such a minimal HIV risk. (I see nothing in your scenario that is out of the ordinary except since it's a buyer's market at the moment I would anticipate it would be the prospective buyer who would be getting the blowjob to close a deal, not the realtor.)

2. By following the post-PEP HIV testing guidelines, you eliminate any concerns about the window period. The guidelines recommend testing at both three and six months from the date of potential exposure.

3. Yes, if you took PEP, you should follow the post-PEP testing recommendations. The odds remain astronomically in your favor that you did not contract HIV from Mr. Hottie McRealtor.

Good luck. By the way, did you wind up getting the apartment or at least a new "friend with benefits"???

Dr. Bob



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