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PEP - insertive unprotected anal sex
Jul 25, 2011

So, last night I had unprotected sex with a black male in a sex club in San Francisco. I was a bit drunk (alcohol + sex clubs = a big mistake), and well... finished a bit sooner than I normally would. Obviously, this was a bad move on my part.

Here's where I'm confused though. I called the city clinic and was told pretty much unequivocally that I should get a PEP (really it seemed like I was given this answer a bit too quickly). However, the clinic was closed since it's Sunday, so I went to see my normal clinic which is open on weekends to avoid a trip to the urgent care center. My doctor looked up some statistics that he shared with me and stopped just short of saying that he didn't feel a PEP would be worth the risk.

I mentioned that the city clinic said something about a hotline for doctors. He called the hotline and got put on hold forever. Since I was pretty much satisfied with the data my doctor gave me (which said I have something like a 0.06 chance of getting HIV), I left with the understanding that he would call me when he heard back from the hotline.

Lo and behold, the hotline called him back and said that I might want to consider a PEP "a bit more strongly", and that my risk was something like 1 in 1000.

With me receiving so many mixed messages, my decision was that it's difficult for me to justify such an expensive and difficult treatment, even with a risk of 1 in 1000.

I have to admit though, I'm still in a bit of a double bind. Did I make the right decision, or should I give a PEP another thought?

Response from Dr. Frascino

Hello.

Unprotected insertive anal sex is risky business. The CDC's estimated per-act statistical risk for acquiring HIV from unprotected insertive anal sex with a partner confirmed to be HIV infected is 6.5 per 10,000 exposures. We do not know the HIV status of your bottom-guy, which would decrease your estimated statistical risk. However, that your wham-bam-thank-you-Sam occurred in a sex club in San Francisco could increase your statical risk. I would offer a course of PEP in this situation. Please note PEP is most effective when started as soon as possible after an exposure. If more than 72 hours lapses from the time of exposure, PEP is no longer warranted, as it would be ineffective.

Good luck.

Dr. Bob



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