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PEP After Unprotected, Insertive Anal Sex: Anxiety (PEP AND THE NEED FOR HIV SPECIALIST, 2011)

Jul 11, 2011

I recently engaged in unprotected anal sex with another man. Because I cannot be absolutely certain of his HIV status (his testimony to me was that his last HIV test was negative three months prior and that he hadn't engaged in any sex since) I chose to contact an emergency PEP service and begain taking the Kaletra/Truvada combo. I am on my second day and thus far my side effects have been limited to a little stomach upset, mental anguish over what poisons I may be putting in my body and the harmful side effects that could still await me. I am in a back-and-forth mental turmoil over the choice I made to take PEP. I will see the doctor in two days for an HIV rapid test and tests of my liver. Might you address my anxiety issue about taking PEP and provide any additional guidance in preparation for my visit with the doctor? I am a 29 year old caucasion, homosexual male with no prior history of STD illness.

Response from Dr. Frascino


Unprotected anal sex is always risky business. It does place you at some degree of risk for STDs, including HIV. PEP is generally only recommended when there has been a significant HIV exposure. If in doubt, starting PEP is the wisest course of action. However, you should then have a formal evaluation of your degree of risk by an HIV specialist to ascertain if PEP is truly warranted, appropriately prescribed and worth continuing. As I have mentioned many times in this forum, anyone who has an HIV exposure significant enough to warrant starting a course of PEP should be evaluated and followed by an HIV specialist physician. See link below. Hopefully the physician you are scheduled to see over the next few days is an HIV specialist. Following his more detailed evaluation he'll be able to specifically address your concerns about PEP and also help with your "mental anguish."

No doubt this entire anxiety-provoking ordeal has taught you that unprotected sex is not worth the potentially catastrophic consequences. I'm hopeful your experience will serve as a cautionary tale for others who may be considering barebacking.

Good luck.

Dr. Bob

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