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PEP Question - Urgent!
May 20, 2011

Please help me Doc - I really need your advice...I'm desperate!!

I'm a guy who earlier today had an encounter with a male escort - this is the first time I've had sex in a year - my last HIV test last month was negative. I decided to try something new so I hooked up with a dominant master and we had vigorous sex for around two hours. During this time I performed oral sex on him several times and we had anal sex (I was passive) 4 times. We used a fresh condom for each round of anal sex (which was vigorous and rough, using poppers - Im a bit sore) and to my knowledge none of the condoms broke or failed - I managed to test three of them with water afterwards and they were intact. The escort gave me several enemas to make things cleaner and more hygenic (using his douche which he hadnt used recently and he smeared it with antispectic gel first), he performed watersports on me (urinated on me) and spat on me - the urine and spit both went in my eyes, they stung a bit - there was quite a lot of it. There was also a lot of kissing and exchange of a lot of saliva. In terms of oral sex I have chapped lips and a tingling spot on my lips which seems inflamed i.e stingy but doesnt appear to be bleeding or open - I also bite my cheeks unconciously - this has me worried although I dont think I have any open wounds as such. I have a scratch on my arm from being tied up.

He did not ejaculate at all.

After the session was finished we were talking and I asked the escort his HIV status which he told me he was positive - on treatment and currently undetectable. He told me not to worry as he didnt put me at risk of HIV and he works in healthcare advice. My questions are:

1) Are any of the details above worrisome in terms of hiv infection?

2) Is the oral sex and anal sex detailed above a huge risk?

3) Is saliva/urine in eye an HIV risk?

4) Would you recommend that I seek PEP?

5) If you were me would you be concerned? Would you take PEP in my circumstances?

6) Do I need an HIV test?

I always become hugely paranoid about HIV after I've had sexual contact - but I spoke to my doc here and they said the rough sex with an HIV + puts me at exceedingly high risk and I should get PEP - at the PEP clinic they said PEP not advised as the sex was protected - I dont know what to think......please help me

Response from Dr. Frascino

Hi,

No sex for a year and then wham-bam you and a S/M hooker dude, who also "works in health care advice," have four bouts of anal sex, multiple bouts of oral sex, several enemas, copious water-sports and spit, and you were tied up. Hmm. See what happens when you don't have sex for such a long time? Things tend to be just a wee bit over-the-top, wouldn't you say?

Responding to your questions:

1. No, assuming the latex condoms were used appropriately and didn't break.

2. Nope, not if "protected."

3. No. Saliva and urine that do not contain visible blood are not considered an HIV-transmission risk.

4. I'd take a more detailed history before making a firm recommendation, but from the information provided, no, I would not.

5. No, but then again I wouldn't have that sort of encounter either. No, I would not take PEP.

6. Primarily to gain psychological peace of mind, a single HIV-antibody test at the three-month mark could be helpful.

I do not agree with your doctor regarding the degree of HIV risk or need for PEP. You might consider finding a more competent physician and firing the one you currently have.

Dr. Bob



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