Stupid High Risk Mistake

Question

I am 32 and live in Manila(Philippines). A few days ago I was extremely intoxicated, went to a bar with Transvestites, and received unprotected anal receptive sex. I received PEP (Lamivudine/Zidovudine - 150mg/300mg) 34 hours after the incident. My questions are is it possible HIV is living in the rectum and I am still being exposed - am asking because it seems like length of exposure is one of the factors for risk? Should I use an Enima or something to try and make sure I get anything left remaining out? Also What are the standard risks associated with that (I heard 1 in 100 but not sure if that includes instances where the guy/girl finishes inside) and how effective is the PEP I received (after 34 hours)? I am extremely worried. I have never had anal receptive sex before, cant believe I did not use a condom. Any info would be greatly appreciated.

Answer

Hello,

I totally agree with you. This was a really stupid high-risk mistake. What were you thinking? Unprotected receptive anal sex is the riskiest sexual activity for HIV transmission. Certainly post-exposure prophylaxis (PEP) was warranted.

I would strongly advise against using an enema. This will not decrease your HIV-acquisition risk and could perhaps increase it if you irritate or traumatize the anal canal during the procedure. HIV statistics for risk really don't apply to an isolated individual exposure, as there are many variables involving both the virus (viral strain, viral load, etc.) and the host (immune integrity, concurrent infections, local trauma, etc.).

There are no specific statistics for how effective PEP is at 34 hours. At this point you are doing all that you can to prevent or abort an HIV infection. My advice is that you complete the full 28-day course of PEP and then follow the post-PEP HIV-testing guidelines. Finally, I sincerely hope you have learned form this massive lapse in judgment and will never put yourself at risk again.

Good luck!

Dr. Bob