Risk and Need for PEP after Possible Exposure

[espas247]

Thank you all for this amazing forum. I had a lapse in judgement and went to a bath house in Spain about 10 days ago. I am a homosexual male with recent known HIV negativity. After a few drinks, I wandered down to the darker area and had a few interactions (no anal sex, just fondling/kissing) with some of the clientele. At the end of the night, I met a man with whom I had insertive anal sex (I was the "top"). He placed a condom on me and took it off at the end. I am relatively sure it did not break, but I cannot be 100% certain. Since then, he and I had talked (exchanged numbers), and he assured me he was HIV negative and had not had a partner since a negative test a few months prior. Due to my guilt and anxiety, I searched for PEP in Europe, which was IMPOSSIBLE. I eventually was able to obtain Truvada, which I started about 55hr after "exposure". I plan to take for the full 28 days. I called the national PEP hotline who told me that 2- versus 3-drug PEP has never been compared and that continuing Truvada would be OK. Other doctors had told me PEP wasn't indicated.

Could you provide me with your assessment of my need for PEP, follow-up testing, and risk?

[CurfewX]

Hi - your partner wanted to use a condom, presumably to protect himself. He definitely would have noticed, and probably would have been concerned, if the condom had broken.  Broken condoms are difficult to remove. I would not worry about this event at ALL.

If you are having non-monogamous intercourse, though, you might speak to your own doctor or a sexual health clinic about PrEP. Even if you're using condoms, accidents can happen, and nowadays it's easy to be prepared. No judgement - my son is on PrEP for this very reason. He wants to do everything possible to protect himself, and he's not in a relationship. If this is more of a one-off event, then you probably don't need to worry about it. If it's something you do when you're on vacation, you might want to just get on PrEP before you travel next time.

[espas247]

Thank you for your helpful comment. The PEP hotline recommended (if I chose to pursue) and the Australian Guidelines list 2-drug PEP (Truvada) as a viable regimen. From responses here, it seems this is overkill and anxiety-driven. What would be your thoughts?

[AnxiousNoMore]

Reread all of the advice because it can't change just because you found someone to talk to on a hotline.

[AnxiousNoMore]

I'm not sure why you keep coming back here asking the same questions, since that proves you don't believe anything you were told here.

[GuitarRox]

Well, you are using Prep incorrectly. By seeking it the way you did (anxiety provoked and not from actual need), you have put yourself in a situation.  Prep is to be used AFTER a negative HIV test and is used as a prophylactic. NOT like PEP used after an exposure. You couldn't get PEP because you wouldn't meet the criteria of needing it. It's reserved ONLY for those who have had true risk (not a 'maybe' because they are anxious) with a KNOWN HIV POSITIVE individual. This is not you and your anxiety is making you take irrational action. There is no reason to take Prep at this point for this exposure. And you 'obtained' it how? Not by someone legitimately prescribing it to be used the appropriate way. I think you need help with anxiety.  Only the  head of your penis needs covered. It sounds like the guy wants to protect himself from YOU as much as you want to be protected from him.  A one time exposure of anal sex is LESS THAN ONE percent transmission risk. You are overreacting and making things worse by playing doctor to yourself.  That's the hard cold truth.  I hope you reconsider and get help with your anxiety so you don't have to suffer like this.

[GuitarRox]

You had kissing, fondling. NO RISK. And protected sex.  Your mind is running away with you.

[espas247]

I appreciate your blunt response. I was prescribed Truvada + raltegravir (PEP) but could not obtain raltegravir in Europe. To be fair, I called the US PEP hotline who told me that I could take Truvada as PEP as there are no studies that prove it’s ineffective, so I didn’t start it without advice from the US HIV experts. I agree my anxiety is an issue but I legitimately was seeking an answer.

[GuitarRox]

You never needed pep, prep + pep. Experts in HIV are who guide this forum. You have gone out of your way to appease your anxiety and circumvented normal prescribing protocol. Feeding your anxiety this way will just increase your anxiety. you have no reason to be on prep + pep. I hope you get help with anxiety as that is likely to be what damages your life if you don't