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Urgent ! Should I stop my PEP?
Aug 17, 2011

Hi,

I had vaginal sex with an african-american sex worker 3 days ago. I realized that the condom had broken after i withdrew after ejaculation. I was shocked to see the condom broken. I spoke to the lady and asked her if she was clean of STD's and HIV. She said she is clean, because she just delivered a baby 3 months ago and had all the tests done at that time.

I was not able to ask her for how long she was sexually active after she gave birth. But being a sex-worker I believe she has been working immediately after her nursing period.

After reading on the internet the availability of PEP, i went to the ER by 20th hour of infection. The doctor there referred me to another doctor with whom i got an appointment only on the next day.

When I asked the doctor regarding PEP, he assessed the situation and said that it was entirely my decision whether i should start PEP, given the low risk of transmission and side-affects of PEP. I wanted to buy myself some time to research...so accepted the prescription and started taking the medication. This is my third day of PEP, and I am wondering if I should continue it. (I do not have insurance and the medication is $3,500 for full course).

I gave my blood samples for STD tests. The reports have not yet come. But i believe HIV cannot be detected within such short periods of time.

Should I continue PEP or stop it, given the risk of transmission.

Response from Dr. Frascino

Hello.

In situations like yours PEP is usually offered but not strongly recommended. If your partner is deemed likely to be HIV infected, PEP would be recommended. However, if she is more likely uninfected, PEP could be avoided and only HIV-antibody testing performed.

If you are still in touch with the sex worker, one option would be to ask if she'll consent to a rapid HIV test now. Results are available within a few minutes. If she tests negative, you could discontinue PEP, because your HIV-acquisition risk would be limited to the rather remote possibility that she was very recently infected and still within her seroconversion window.

Hope that helps.

Good luck.

Dr. Bob



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