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My partner and I were bad--PEP?

Feb 14, 2010

Dr. Bob,

I've been poz since 2001--although I didn't know it until 2008. My partner luckily remained negative. After learning my status, we practiced safe sex. Well, until tonight. We hadn't seen each other in a while and hadn't had sex in a long time.

We had unprotected sex where I was the bottom. I hadn't bottomed in over a year. We got carried away. Afterwards, I felt so nervous and guilty. We had sex for several years that I didn't know my status and he remained negative. I promised I would never infect him. When I read stories on here similar to this, I would think what the fu*k were they thinking.

I haven't had to start meds yet, because my numbers had been good. I had been debating to start even though my CD4 was in the 800's. However, my viral load keeps creeping up into the 20,000's. Twenty-thousands. Anyway, I thought maybe everything would be okay. Tops are at risk, but I've read it is a lot less than being bottom. I began to worry again when I used the bathroom. There was a tiny bit of blood on the toilet paper--just turned paper pink. I guess this was due to not taking it for a long time or wiping too hard. There was no blood on him at the time. He doesn't seem to be too concerned, but I am. If I infect him, I just couldn't deal with it. I know I messed up here. I told him maybe PEP would be in order, but he doesn't think it is necessary.

I can't believe I put myself in this situation. I read your posts and know better. We are all human. Do you think PEP is warranted? As I said, he remained neg all those years before I knew--back when my viral load was probably sky high after infection. For anyone reading this if you answer--don't mess up and think with your junk.

Response from Dr. Frascino


It is true that insertive (top) sex is always less risky than receptive (bottom) sex. However, "less risky" doesn't mean no risk. PEP would be offered in this situation, particularly because you are not on antiretroviral therapy and have an elevated HIV plasma viral load. If longer than 72 hours have elapsed since your lapse in judgment, all you can do is wait and encourage him to get HIV tested at the three- and six-month marks. That he remained negative "all those years before" you knew about your status doesn't mean he's immune. Each exposure is a new risk.

Dr. Bob

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