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PEP?
Apr 9, 2009

I had unprotected sex last night with a Vietnamese lady... who I believe is not a prositute but opportunist and would go with a guy who treats her well and has some $ to spend... Now, I am worried sick, because I am sick not using a condom. I tried humangus amounts of condoms with different shapes and sizes and whatever, but my 3rd leg just doesnt stay hard when using it... Plus, here in Vietnam there isnt a selection of condoms, and more importandly, none of them would really fit. Anyways. I still have a half course of PEP that I did not finish last time I had an exposure (and the girl that I had sex with went to test and was negative). Now, shall I start taking that other half course? And then go buy another round when I am in Thailand next? I must say I'd prefer not to take it, because it just made my whole body turn upside down last time and I felt really really bad! And: Can I take it and go to a test after 14-days and it will provide an accurate first result? I know, the 3 months mark is key, but nowadays, p24/antigen/combo/antibody/nuclear tests, etc. should have over 96% chance to provide an accurate result after let us say 14 days? Will the PEP influence that result and provide a false-negative result? Because I feel confident of stop using the PEP if after let us say 10 days the combo tests come back negative. Or am I wrapping myself into unwarranted security? Please help! Freaking out. Since the girl didnt cost me a cent and the cause here is so much more valuable than having a shag and feeling bad for the next couple of month, I will make a donation. Please let me know how as I am not living in the US. Thanks so much and I will donate US$600. Will that help?

Response from Dr. Frascino

Hello,

Your HIV risk is unprotected penile-vaginal sex with a woman of unknown status. Certainly unprotected sex does place you at some degree of risk for STDs, including HIV. PEP would be considered if it was felt your partner was most likely HIV infected and if the treatment could be started soon after the exposure (no later than 72 hours after the exposure). If you are still in contact with your gal-pal, you could accompany her (if she agrees) to get a rapid HIV test. If negative, your chance of being infected decreases significantly. (She would have to still be within her "window period" and the chances of your being that unlucky are remote at best.)

If you do decide to take PEP, it should be started as soon as possible. It's most effective when begun as soon as possible after an exposure. It should be taken for a full 28-day course. (We have no information on the efficacy of taking only a 14-day course.) Yes, PEP can have significant side effects and be difficult to tolerate. As I have mentioned here before, PEP is no picnic!

The guidelines for HIV testing post-PEP recommend testing immediately and at six weeks, three months and six months from the date of exposure. Negative results at 14 days would be encouraging but not definitive or conclusive. I cannot confirm the "96% chance" statistic, as there are far too many variables to consider (generation of HIV test being used, for instance). Even if the 96% figure was correct, missing 4 out of every 100 positive tests is not nearly accurate enough when dealing with an illness such as HIV. HIV viral load tests can be affected by PEP. (The antiretroviral drugs in a PEP regimen could drive an HIV viral load to undetectable levels thereby giving a "false-negative" result if the test was being used for diagnostic purposes.) PEP would not significantly affect HIV-antibody tests using the recommended post-PEP testing schedule mentioned above. Should you feel confident stopping PEP if your HIV combo test comes back negative after 10 days of treatment? No, absolutely not.

Finally, regarding your problem maintaining your erection while using condoms, I have several suggestions:

1. Condomania.com has a wide selection of condoms for a more custom fit.

2. You could try using the female condom with your partner.

3. Try a "cock-ring." It's a constricting band warn at the base of the penis that helps maintain erections.

4. Erectile dysfunction drugs (Viagra, Cialis, etc.) could be tried.

5. Begin a monogamous relationship with an HIV-negative partner.

Thank you for your very generous donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and warmly appreciated. In return I'm sending you my good-luck/good-health karma that your definitive HIV tests are negative.

Good luck. Be well.

Dr. Bob



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