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Time sensitive question regarding PEP from an AIDS activist
Jan 11, 2009

Dear Dr. BOB,

How r u? I hope u r doing fine, u have helped me a couple of years ago and since then I have been doing a lot of volunteer work for my local HIV/AIDS network as I promised u. I have a quick question and I was hoping u would help me. 6 hours ago I had sex with a friend of mine (she is female and I am male), I used a condom, however half way through I felt sthg weird so I pulled out and found out that the condom has broken. I didn't use lube and it was one of those ultra sensitive durex condoms so I am sure that was part of why it failed. I pulled out a few times and in between changing positions to make sure the condom is good and put some of my saliva on it so I am pretty sure it was about a minute or so that I was in her vagina while the condom was broken, may be even less. I immediately went to the bathroom and washed myself very well with soap and water. MY friend is not a promiscuous person as far as I know and she said she got tested for everything on November 08 and that the last time she had sex was in July of 08 and it was with a condom. she assured me that the only person she had unprotected sex with was her ex husband (she got divorced 8 years ago)and she has always used a condom after that with any partners she had and that she gets tested annually when she sees her ob/gyn . She even said she will show me the papers later today to assure me. Can u please assess my risk and tell me if I need to go to the ER to get PEP? I know I will get tested in 13 weeks from today coz that was a brief unprotected exposure but wanted to know based on my story what my probabilities are. I respect all the work u do and as a matter of fact I am working right now on a fund raising event for my local AIDS network. Keep up the good work doc and hope to hear from u before the 72 hours pass.

Your friend, Jason

Response from Dr. Frascino

Hey Jason,

Welcome back to the forum.

Regarding your dilemma, if your gal-pal had sex in July of 08 and tested HIV negative in November of 08 and has not had any potential HIV-acquisition risk since then, your HIV-acquisition risk would be essentially nonexistent. The real question is how do we know if our partners are really being completely honest?

My advice is that since your gal-pal is a friend, why not have her get an HIV rapid test now? If negative, you can relax considerably, because your only remaining risk would be the remote possibility that she was very recently infected and still in her window period.

Whether or not you can arrange this, PEP would not be routinely recommended for such a brief exposure with a partner who you feel is probably telling the truth about her negative HIV status. A single HIV-antibody test at the three-month mark will give you a definitive result and is all that is recommended. The odds are all in your favor that you will test HIV negative.

Jason, I also want to applaud your volunteer activities in combating the HIV/AIDS pandemic. If everyone did their part, we could stop HIV dead in its tracks! HIV remains 100% curable, but it's also 100% preventable!

Good luck Jason. Be well.

Dr. Bob



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