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Risk of Unprotected Topping and whether to seek PEP
Jan 4, 2012

Hello. I am hoping you can help inform a decision. 38 hours ago I met a guy i had been talking to online for a couple of days. His profile said HIV- and he confirmed he tests every 6 months and last tested negative in August. Things quickly became heavy and he wanted me to top him and said i could bareback, but I would have to pull out because he doesn't accept anyone's fluids. I am cut and normally bottom (i refuse to bareback bottom), but i had no policy on bareback topping, always assuming it was safer. I topped him unprotected for 5-7 minutes total before losing my arousal and didn't ejaculate. Afterward, I discovered he regularly 'party n plays' with meth and he disclosed he had bareback bottomed (with no ejaculation) the week before. He is 51 and later complained of a rash caused by his thyroid medication. Drugs, bareback bottoming, and rash have set off many alarms in my head and I confronted him and he confirmed again his status, though mildly offended. Given his test was 5 months ago, In my mind, he's is a high risk for HIV. My question is whether my risk is great enough to seek PEP since I'm still in the 72 hour time frame. I haven't had any other unprotected sex in 8 months and tested negative 1.5 months ago. I plan on getting std tested this week, but my main concern is whether this risk warrants PEP. Btw, my policy has been updated ro reflect no bareback topping or bottoming.

Response from Mr. Cordova

Hi there:

This person's activities - unprotected receptive anal sex and Crystal Meth use, set off alarms for me as well. Hopefully he was truthful in his statement that he doesn't let anyone ejaculate inside him. Not letting partners ejaculate inside of him, would certainly lower his risk of acquiring HIV. His negative HIV test in August only tells us that he was negative three months prior to that in April/May. A lot can happen in nine months, especially if you're doing Crystal Meth, have multiple partners, and aren't using condoms.

The risk of acquiring HIV from an act of insertive anal intercourse, for men who are circumcised is 10 out of 10,000. The risk is there, but not entirely that high, especially considering that you only did this one time. The question is whether or not you are willing to take that risk.

Bottom Line: Is transmission possible? Yes. Is it probable? No.

If you choose to get PEP, you will need to do it within 72 hours from the exposure. PEP should be available at all urgent care centers, emergency rooms and many private physicians' offices (particularly those of HIV specialists). Be aware that insurance may not cover the cost, and the medication is very expensive.

I hope this helps.

In health,

Richard



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