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Apr 9, 2009

Dr. Bob, I just submitted a question and realised I put in the wrong email address, so here it goes again with the right one and hopefully I can get a quick response as I need it because of my considerations for PEP. Summary: I am a male, had vaginal intercourse in Vietnam with a woman of unknown status (I know she is not an angel though from seeing her at parties and in clubs ...) plus she lives far from the city and usually tends to spend weekend nights with guys so she doesnt need to get back home... she tends to hang around the rich and surely gets her share of it (not in cash, but in other ways I am sure)... now.. I cant use condoms.. well, its an excuse, because I can and I should.. and I tried different brands (if I can get my hands on them here) and shapes and sizes... but my woody just becomes soft and looses appetite.. so I usually decide to go without.. most of the time i get the girls to test themselves together with me.. for their own and my safety.. this one didnt consent.. and i cant force her... anwyays, its my fault and my problem now and i do have experience in this area... i used to be psychologically treated for my women/sex-related problems and my hourly appetite for sex with different woman (young like this one: 20yrs old) has helped, but here in VN where I live now, I have no access to psychological treatment.. and am on my own.. I had a previous exposure some time ago and received PEP from a doctor in Thailand.. I still have half a course because I didnt take the full course (because the girl got tested negative on combo/p24/antibody tests... i decided not to take PEP because I have taken it previously in a full course and it stirred my body upside down... ) So question now: Shall I start taking the other half course I still have and get testet in 14 days and if it's negative discontinue? I know you are going to tell me about the 3-months mark.. but am I wrong to assume that p24-combo/antigen/antibody/nuclear tests, etc. are over 96% effective after 2 weeks? Now, here comes another question. Has there been any research on how PEP influences a test result and could show a fals negative test during the course of medication? I know it's all hypothetical and probably I will die because of stress, anxiety and other psychological problems before I get infected with HIV... but I dont want to take the chance, because one would drive the other into even deeper problems.I heard 3 months mark is based on one of the longest seroconversions that have ever occured but in most cases detection can be after 14 days? I also heard ARS is very very common and not only happens in some cases but in most cases during seroconversion and symptoms are clearly more severe than a cold or something? I hope this entry makes somehow sense and helps other people not to be as stupid as I am and use condoms and stuff... I am well educated about the risk of transmission... and statistics like 1 in 10,000 etc. dont work... because they didnt work in the financial industry either, why would they work here (like six sigma events can only happen in millions of years.. not really as we have seen last year)... so there is the chance that you are that one person in 10,000... and please guys out there.. there is nothing safe out there... gays are not the risk factors i think.. they are equally at risk.. the risks are in the people going to places for cheap sex or with girls with flexible morals and infect them. In Asia (and Bob, please correct me if I am wrong)... male-female-male infection is much much much higher than in other parts of this world... and I am one of the people not carefull enough.. I am looking forward Dr. Bob for your assesment and inputs and appreciate the time you spend in answering this within a reasonable time horizon as I do not want to miss the 72 hours deadline for PEP if you believe its warranted. Take care all of you and especially dr. Bob. Let me know is US$500-US$600 can help and how I can transfer it from overseas!

Response from Dr. Frascino


See below.

Dr. Bob

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


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. 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 ( 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

Technical Testing Question (what I meant to ask!)

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