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Jun 13, 2001

dear ryan

i'm a gay male who is seeing a gay male. he is neg and knows that i'm pos.

we've had only safe sex EXCEPT the last time.....we took a break so-to-speak from the action and noticed that the condom i was wearing had broken. i had not had an orgasm.

he, by the way, is an M.D. and while i think we're still trying to process what has happened, he immediately called another doc friend about exposure prohylaxis.

he was given combivir and viramune. i don't know in what dosage and for how long.

the real question for me is. is that a valid reaction to have. is PEP a reality or guess work. if it happens again that a condom breaks, can i recommend to my partner to seek PEP?

and if there is some basis for it actually working, why haven't i heard about it before. i would have asked for it myself this past year before i found that i had become pos.

thanks for any info you have.

Response from Mr. Kull

Well, you probably have not heard about post-exposure prophylaxsis (PEP) because the scientific community has only recently begun to discuss PEP's use for sexual exposures among the general public. PEP--the use of anitviral medications shortly after a high-risk exposure to PREVENT infection--was initially used among healthcare workers who accidental needlestick injuries. Researchers found that PEP reduced the rate of infection by 79%, but some who took PEP still became infected. Research on PEP for sexual exposures is currently being conducted to see if treatments for the general public are feasible and effective.

Post-exposure prophylaxis probably needs to be started within 24-36 hours of exposure. Since the procedure is still not widely practiced, is expensive (and not covered by health insurance), and can cause troubling side-effects for people, PEP is only recommended for individuals who have a significant exposure to HIV. Criteria vary, but PEP is generally warranted when someone has unprotected vaginal or anal intercourse with an infected person or a person from a high-risk group, or for a victim of sexual assault. Programs that provide PEP are developing (mostly in urban areas) and hospitals sometimes have protocols for administering non-occupational PEP.

It is not clear whether or not your partner would have been or was infected in the incident you describe. According to the CDC, condom breaks without ejaculation rarely result in infection. Strictly speaking, your partner does meet the criteria for PEP and he potentially was exposed to HIV infected pre-ejaculate. Besides the cost, hassle and side-effects of the medications, taking PEP should not have any long-term health consequences. It sounds like your doctor friend did not have much to lose, but you're right, it is not an exact science...yet.

Please read through the articles posted on the "Post-exposure Prevention for Sexual, Needle, or Non-occupational Exposures to HIV" page at The Body for more information(


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