PEP or Not?

[wmk1]

Hello Doctor,

I met up with a guy who I have been chatting with through a social media website and we immediately hit it off.   After a night of drinking at the pub we decided to go back to his place.  I have always practiced safe sex doctor and have always been extremely careful.  What happened yesterday, I feel completely ashamed of myself and stupid and I keep having anxiety attacks.  In the heat of the moment he inserted my penis inside of him without a condom or lube, he used his own spit instead.  I'm circumcised btw.  After roughly 1-2 minutes I realized I just made a huge mistake and pulled out.  I immediately asked him if he was HIV neg and he said he was and was tested a week ago with negative results.  After we finished I went home and couldn't sleep.  I texted him and asked him again if he was negative to get a sober response and he said he was and received negative results on June 5th.  I'm aware what happened was risky.  I'm very informative when it comes to HIV and STDS.  I guess what I'm looking for is some peace of mind and a professional response on my situation.

What worries me most doctor is that he didn't ask me if I was negative after I asked him.  But maybe that's just me being worrisome again as I expected him to ask me as well and be just as worried as Iam.  My questions are:

1) Should I consider the PEP medication?
2) Should I believe him and wait to get tested at 3 months?
3) Should I ask him to come with me and get tested this week to find out if he is being honest?

Thank you for your time,

WMK

[Edward W Hook, MD]

Welcome to our Forum.  I'll be please to comment.  PEP is proven to prevent HIV for persons with recent (within 72 hours) exposure to partners known to be infected with HIV.   From what you tell me, your partner was not likely to be infected with HIV- he specifically denied being infected and most people tell the truth.  He was even able to give you the specific date of his last test.  

If he was infected, being the insertive partner for rectal intercourse is associated with a 1/2 of 1% chance of infection (i.e. one infection, on average, for every 200 exposures).

Thus, in answer to your specific questions:
1) Should I consider the PEP medication?
Use of PEP is a personal decision.  I am sure that if you want PEP you can get it.  Decisions about PEP are a personal decision in which one should consider the likelihood that infection will occur, the likelihood of drug side effects, one's personal anxiety and the cost of the drugs (expensive, typically in the neighborhood of $1000).   If you choose to try to find someone to provide you with PEP, please hold them accountable for all that goes with it (i.e. follow-up, answering your questions, etc.).  

2) Should I believe him and wait to get tested at 3 months?
This too is a personal decision.  Testing is always a good idea.  You do not need to wait three months for accurate tests however. With currently available 4th generation HIV tests, you can get a definitive test result from testing 4 weeks (28 days) after your exposure.

3) Should I ask him to come with me and get tested this week to find out if he is being honest?
This too is a personal judgment and you cannot force him to test. If he is willing it will be highly reassuring for you and that is a good thing.

I hope these comments are helpful.  If I were you, I would not seek PEP related to this exposure.  I would get tested for other, more common STIs like gonorrhea and chlamydia however- these tests can be done within 2-3 days of your exposure.  EWH

[wmk1]

Thank you very much for your response doctor.  Since I'm from Canada, is a Point of Care rapid test 4th generation? Can I rely on that at 4 weeks?

[Edward W Hook, MD]

Typically point of care tests are 3rd generation tests which give reliavble results at 8 rather than 4 weeks.  I suspect that 4th generation tests are available although you may need to ask around for them- start with your health department or an HIV advoccy group.  EWH