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PEP Clarification for concerned Negative Top

May 24, 2011

Dr. Bob,

I have a fairly time sensitive question for you. Yesterday (Sunday) morning I had insertive anal sex with a guy that I had been out with a couple times. Upon initial penetration (literally the glans hadn't fully gone in yet) the condom broke, we both recognized it and stopped immediately to put a new condom on before continuing. Today (Monday), he told me that he is HIV+, just found out his diagnosis 5-6 weeks ago and is not currently on medication. At his last test he was at 23000 copies with a c-4 count of 643. I'm curious to know if it is recommended that I get on a PEP. Since finding out his status this morning I have been reviewing as much information on it as I can but a great deal seems contradictory and most focus on receptive anal sex partners or insertive anal sex partners who didn't realize that the condom broke until they where finished. For us it was an immediate to both of us when it broke and we took action right then. Any advise would be helpful. Thanks.

Response from Dr. Frascino


I would need to take a more detailed history to make a firm recommendation one way or the other. If the glans of Mr. Happy hadn't even entered the backdoor when the condom broke and you retreated immediately, it's doubtful you had any exposure to the love canal and PEP would not be warranted. If, however, Mr. Happy did manage to get inside without wearing his raincoat, PEP would be warranted, particularly because your bottom guy is confirmed to be positively charged and is not on antiretrovirals. There is no doubt that if you had any exposure, it would have been very brief. PEP in situations such as these is often "offered" but may not come with a strong recommendation. Consequently, if you're concerned there may have been an exposure, take the 28-day course of PEP. If you're quite certain there was no exposure, then PEP would not be warranted. One option would be to start PEP now and follow-up with an HIV specialist over the next few days. He will take a more detailed history and advise if PEP should be continued or not.

Good luck.

Dr. Bob

HIV related question
Very worried Irish man!!

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