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Sexual Assault, Withdrawl and PEP
Apr 3, 2011

My friend was sexually assaulted this past weekend. She and said ASSHOLE had consensual sex for the two days prior, but then he refused to wear a condom and violently & physically was able to ensure that was so. It was reported to the police & pictures of her injuries (bruises/bites,etc) were taken.

She is too afraid of him to press charges and is married and feeling guilt/shame as well. I can only support and share her pain. This guy has a horrible reputation as a man in general. There were non-accusatory attempts from above to try to get him to take a HIV test, which of course he dodged. Betting he doesn't know what the answer will be..

She started PEP at about 68 hours afterward after having to explain to explain her story to any number of doctors/nurses (don't they read the chart?). FYI, the hospital initially didn't want to give it since it was more than 2 hours since exposure because of 'new research", funny since they usually keep you there for 4 hours themselves..) From prior work exposure (and isn't she in this career anymore), she knows how sick this is going to make her and as a result won't be able to hide this from her husband. Avoiding sex with him during this time period won't be a issue. She is trying to assess her risk of contracting HIV against the consequence of having to level with her husband (then likely divorced..) She feels that he withdrew and said there was "stuff on the seat" and didn't feel like she was squishing around anything in her underwear when I found her. I asked if it was on the seat from leaking out of her. She now thinks he did pull out. (More afraid of pregnancy then prison?). ASSHOLE claimed to the others that he "pulled out" (and that she never said no and all the other things Rapists in Man-Skin suits say..)

I understand viral load, and pre-cum, possible vaginal tears, etc and that it is a "loaded" question to guess how much risk a assumed withdraw is a HIV risk of a unknown person. I wish you could give me a number or a chart or something. Sigh. We've both read the forums..

Is there something she can take to reduce the side effects of the medication? If she can't complete the course of medication, how much longer will she have to wait before getting a valid negative test. Would a DNA (PCR?) test be accurate instead and would a shortened course of PEP have any benefit, what is negative side effects of a shortened course of PEP?

I've gotten answers from you before, but usually for my own paranoid self. Thanks for your help.

Response from Dr. Frascino

Hello,

It's always more difficult to answer questions for "a friend," because the information in the post is already secondhand. If you've both already read the archives, there really isn't much more than I can add.

I would urge your friend to level with her husband. Not only is it the best way to confront her guilt; it's also the right thing to do. I would also recommend, as I do for anyone who has had an HIV exposure significant enough to warrant a course of PEP, that she be followed by an HIV physician specialist during the 28-day course of PEP. Yes, there are a number of potential medications to help reduce PEP side effects. This is dependent on which antiretrovirals are in her PEP regimen and what side effects she is experiencing.

I strongly advise against discontinuing PEP early, if indeed a course of PEP is warranted.

HIV DNA PCR testing is not FDA approved as an HIV-diagnostic test, due to the level of false positives, other technical considerations and cost.

Post-PEP testing guidelines recommend HIV-antibody testing at four to six weeks, three months and six months.

Dr. Bob



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