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Mucous Membrane Sperm Exposure - Posting 5th time, please respond
Jan 10, 2013

Dear Shannon,

As I have been receiving mixed answers from different experts, I would really appreciate if you could help me with risk assessment of the situation described below.

Exposure: I am not circumcised, and after receiving vigorous oral sex for a minute or so, my sexual partner ejaculated, and a copious amount of his cum ended right on the glans of my penis. For about a minute or two I myself masturbated with his cum covering my glans, until I came. I then immediately went and washed myself with cold water and hand soap.

PEP: I went to the ER and started PEP with Truvada and Kaletra 22 hours after the exposure described above. For 3 days and a half I took both drugs, but I stopped taking Kaletra for 36 hours as I did not have the funds to get it. During those 36 hours, I continued to take Truvada as prescribed. The doctor said it was ok to reintroduce Kaletra once I got it. I have been taking both drugs since, but was 5 hours late once with my Truvada.

The partner: I don't really know him, but he claims that he tested negative 1.5 months ago, but he had other encounters with men before me since. He said it is too soon to get tested but that he will get tested again to determine his status.

My questions:

1. How high is the risk I exposed myself too? If my sexual partner tested negative 1.5 months ago and had other encounters in the meantime, he might be in the midst of seroconverting which would make him super infective. Given the nature of my exposure and the fact that I am not circumcised, how high are my risk levels?

2. The fact that I temporarily had to discontinue Kaletra, and only took Truvada, for 36 hours, will it dramatically decrease the effectiveness of my PEP?

Please reply to me, as I feel I have deteriorated mentally so badly that I am starting to have panic attacks several times a day and I'm also feeling depressed, and finding it hard to go to work or go about my daily life.

Thank You, Rensk

Response from Ms. Southall

Hi I'm sorry you haven't received an answer yet to your question. Oral sex carries the lowest risk of HIV transmission. Being uncircumcised doesn't increase those risk for oral transmission. If you glands had cuts or sores your chances would increase but just only slightly.

Your question about PEP, there are new studies out that show taking just Truvada is enough and has been approved for PEP.

I don't feel that your exposure put you at a significant high risk for HIV transmission again because we know that oral sex carries THE lowest risk of HIV transmission.

To give you peace of mind you should go through the testing period. The guidelines are to be initially tested at 3 weeks post exposure then again at 90 days if this test is negative than so are you.

Be well, Shannon



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