Taking PEP more than one time

Question

I am thinking of getting PEP for a second time. It's been 7 weeks since I finished my first course of PEP, and I tested negative at 6 weeks post PEP. Now I had this exposure where I was having protected anal sex with another man, but at one moment, while he was rimming me, I didn't realize he placed his penis on the entrance of my anus and forced it for about 5 seconds before i realized and pushed him away, I don't think there was a penetration, maybe just shaft, but I'm afraid there could be precum involved, especially because my anus still is quite sore and hurt. My questions are:

  1. is there a risk if I take another course of PEP now very close to the finish of the other one? It will probably be an old regimen.
  2. do you think PEP is warranted in this case?

Answer

Hello and thanks for posting.

  1. If you had a second HIV exposure, even within the time you were taking a first PEP regimen, conventional wisdom would dictate that you should continue for an additional 4 weeks time- even if it's the same regimen.

A somewhat unorthodox view would say however, that since you were taking PEP for about 3 weeks prior to the latest exposure, this actually comprised a pre-exposure prophlaxis (or PrEP). PrEP can be very effective in reducing risk of contracting HIV, and should generally be taken for at least several days before and a week or more after the last exposure.

  1. If you had condomless penetrative anal sex, even briefly, I'd consider that a potential exposure, unless you know that your sex partner was HIV negative or positive with an undetectable viral load. Even then, without a high degree of certainty, PEP would be a consideration.

  2. I know you didn't ask three questions, but I generally advise HIV-negative sexually active men (and transgender women) who have sex with men to consider if PrEP is appropriate for them. Two episodes of possible exposure that make one consider post-exposure prophylaxis suggests that you are possibly at sufficient risk to take a daily PrEP pill for prevention.

Hope that's helpful. Be well, BY