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Potential anal exposure; on PEP. Chance of me remaining negative?
Sep 13, 2009

Hello Dr. Bob,

On 9/6/09 morning I was having anal sex with a fuckbuddy, me being on the receptive end. We were using lots of lubes and condom and things were going smoothly. We decided to take a break, so he took off his condom and we were making out. Then without warning, he inserted into me (I was on my stomach and he was on top of me, so he had full access to my bare ass). I freaked out as not only did I felt pain, but I realized he did not use a condom in this surprise attack. I told him to pull out, and he asked "why I'm clean". At my insistence he eventually pulled out, but his penis was inside of me for a good 20~30 seconds. He did not cum during the brief episode insertion, though there may have been precums. I wiped myself and noted no blood, but pain was definitely there. In fact, I attempted to take him again (after putting a condom on) but failed due to pain inside. He told me he was tested a year ago with a negative result, and have not had unprotected anal or vaginal sex (he's bi and only tops) since then. That gave me little comfort since he could be infected during last year without knowing due to not testing, so I went to ER by myself and received PEP (Truvada 1 tablet 1x/day + Kaletra 2 tablets, 2x/day). The ER doc also examined my anus and did an occult fecult blood test (which really hurts!) and told me the result was good as there was no bleeding inside. My first dose of PEP was taken at approximately 3.5 hrs after exposure.

Considering the scenario and timing of PEP, what's my chance of not being infected by HIV? My fuckbuddy said he'll get tested this week and let me know his result. He hasn't contacted me yet, but if he tested negative, is my chance of remaining HIV negative increased?

As you mentioned many times, taking PEP is no walk in the park. I've been having minor headache/nausea/diarrhea with moderate fatigue/drowsiness side effects from these drugs. It's only been 4 days and I'm already dreading having to take these medications for the next 24 days. I really can't imagine what's it like for you and millions of other HIV/AIDS patients who have to take these toxic medications on daily basis. It really put things in perspective for me and I'm going to do more than ever to practice safe sex and never put myself in this situation ever again. I have donated before (thanks for your receipt to allow for tax deduction), but will donate again to your charitable foundation; its service is much needed by our society.

Finally will you please send your good luck karma to wish my test result at 6wks, 3 months, and 6 months to be negative? I know it works and I badly need it!

Sincerely appreciate all your help!

-P

Response from Dr. Frascino

Hi P,

Another Mr. McBarebacker claiming to be "clean" while launching a surprise attack on an unsuspecting backdoor? Wow, that's the third one in two days. See below for another scenario similar to yours. The same information and advice I recommended to that questioner also applies to you.

Regarding the use of PEP for this type-e of situation, recommendations vary. Many HIV specialists would not recommend PEP in this setting because your degree of HIV acquisition risk is reasonably low.

As for your HIV acquisition risk, the CDC estimates that the per-episode statistical risk for acquiring HIV from unprotected receptive anal sex with a partner confirmed to be HIV positive is 50 per 10,000 exposures. Your estimated statistical risk would be less because we do not know the HIV status of Mr. McBarebacker, the potential exposure was very brief and you took PEP within 3.5 hours of the incident. If Mr. McBarebacker retests and is HIV negative this week, your risk significantly decreases. The only possibility of infection then would involve your buddy still being in his window period (recently HIV infected but still testing HIV antibody negative). The odds of this actually being the case are remote at best.

Thanks for reminding folks that PEP is not a walk in the park. I and many other HIVers have been popping fistfuls of the potent drugs for more than a decade and have had to cope with some bizarre and extremely unpleasant side effects/toxicities. However, without the medications there is no doubt I would not be here responding to your question. Rather, I'd be in a decorative urn on Steve's (Dr. Steve, the expert in The Body's Tratamientos forum) bookshelf probably stuck between the Harry Potter books and The Godfather Blu-ray DVD deluxe edition. So, you certainly won't hear me complaining!

Thank you for your tax-deductible donations to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). They are warmly appreciated and urgently needed. Your one gift will touch many lives in desperate need. On behalf of those lives please accept my heartfelt thanks. I'm sending my very best good-luck/good-health karma that your post-PEP HIV tests remain negative. I'm quite confident they will.

Good luck. Write back when we can WOO-HOO together, OK? In the interim I'm here if you need me.

Dr. Bob

Help! Worried about HIV Sep 9, 2009

Hey doctor I was having sex with a casual partner where I was the receptive partner. We changed positions where I was on my stomach and he took the condom off to change into a newer one. He went back into me and I noticed a different feeling, as it was burning previously, and noticed he was barebacking me for about half a minute. I called him the next dat to ask his status and said he was negative, and wouldn't have been unsafe if he wasn't. Since then , today being day nine, I've noticed I have an ulcer on the inside of my cheekbone, my glands feel swollen and this evening have noticed my eyes are sensitive and I feel like my heads swelling. The thing that worries me is the fact that even though there was no cum or blood present, would the burning in my anus pose a risk for precum to enter me? I'm sorry if this is long, but I'm very worried as I have not experienced most of these symptoms before and I am getting anxious, as I need to wait another few weeks before I get tested and I feel I've done something stupid by not paying enough attention to what was going on behind me. Thank you, donation will definitely be made!

Response from Dr. Frascino

Hi,

Your top gun is a scumbag for unilaterally deciding to go commando Rambo on your backdoor! It's interesting that he claims to know he's negative and states he wouldn't have played Brokeback Mountain Boys with you if he wasn't negative. Hmmm. Exactly how does someone who barebacks know or even assume he is HIV negative??? That doesn't make much sense to me.

There is no doubt this unprotected backdoor action places you at some degree of risk for STDs, including HIV. Consequently an HIV test at the three-month mark is warranted. In the interim you could call Mr. McBareback and ask him to get a rapid HIV test. If he tests HIV negative, you can relax significantly, because your HIV risk would then be limited to the possibility that your partner was still in his window period (HIV infected but not yet having enough anti-HIV antibodies in his blood to test positive).

Your symptoms are not suggestive of or worrisome for HIV acute retroviral syndrome (ARS).

I do think you've learned an important lesson from this entire experience. It's extremely important to be adamant with your sexual partners regarding the necessity of using condoms. You could warn them that if they dared try to sneak in your backdoor without being appropriately attired in their latex raincoat, you'll go all Lorena Bobbitt on them!

Good luck!

Dr. Bob



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