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Urgent - PEP assessment
Dear Doctors,
I had a one time incident of unprotected vaginal intercourse (approximately 45 mins) with a sex worker in Jakarta. This was in a relatively seedy environment, that most would say provides an increased risk relative to the general population or a more upscale brothel. This was the opposite of upscale and simply a error in judgement / lack of willpower. She didn't make any motion to use a condom and seems that unprotected is the norm.
I am at the 36 hour mark and unsure about what to do, the nearby international clinic is closed and the hospital nearby does not speak English well. I could probably go in with a list of drugs and they would give them to me but I would prefer a professionals opinion.
I contacted the girl and she agreed that she would go get tested tomorrow (not sure if she will, as she said she would today but did not show) but by the time that occurs I will be at the 60 hour mark and that does not seem to bode well in the current animal studies.
There is also the unknown about the A/E subtype that is supposed to be easier to transmit via heterosexual intercourse. The Jakarta government states that the vast majority of new HIV cases in the city are from heterosexual acts, and particularly from csw's in Jakarta.
With this in mind, do you recommend I find PEP at this juncture.
Sincere thanks,
I had a one time incident of unprotected vaginal intercourse (approximately 45 mins) with a sex worker in Jakarta. This was in a relatively seedy environment, that most would say provides an increased risk relative to the general population or a more upscale brothel. This was the opposite of upscale and simply a error in judgement / lack of willpower. She didn't make any motion to use a condom and seems that unprotected is the norm.
I am at the 36 hour mark and unsure about what to do, the nearby international clinic is closed and the hospital nearby does not speak English well. I could probably go in with a list of drugs and they would give them to me but I would prefer a professionals opinion.
I contacted the girl and she agreed that she would go get tested tomorrow (not sure if she will, as she said she would today but did not show) but by the time that occurs I will be at the 60 hour mark and that does not seem to bode well in the current animal studies.
There is also the unknown about the A/E subtype that is supposed to be easier to transmit via heterosexual intercourse. The Jakarta government states that the vast majority of new HIV cases in the city are from heterosexual acts, and particularly from csw's in Jakarta.
With this in mind, do you recommend I find PEP at this juncture.
Sincere thanks,
MEDICAL PROFESSIONAL
Welcome to the Forum The choice of whether to seek PEP or not is ultimately a personal choice as I am confident that you can find someone to prescribe it if you wish. As I suspect you know, PEP is recommended for persons who have a KNOWN exposure to an infected partner and this is not your situation. In Indonesia, most CSWs do not have HIV and if your partner is infected, your risk for infection from a single exposure is relatively low - 1 infection, on average per every 1000-2000 exposures.
The best possible approach would be for you to have your partner tested. If her test is negative, then clearly I would advise against PEP. If you cannot get her tested and she continues to avoid you, this is someone worrisome and I can understand if you choose to seek PEP. 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.). Further and finally, as you also know, your decision must be made quickly. The sooner after exposure PEP is started the more effective it appears to be. PEP is not recommended more than 72 hours after infection.
I realize that I have not told you yes or no. If I were you, I probably would not start PEP but this is a decision you must make. I hope the information I have provided is helpful in your decision making. EWH
The best possible approach would be for you to have your partner tested. If her test is negative, then clearly I would advise against PEP. If you cannot get her tested and she continues to avoid you, this is someone worrisome and I can understand if you choose to seek PEP. 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.). Further and finally, as you also know, your decision must be made quickly. The sooner after exposure PEP is started the more effective it appears to be. PEP is not recommended more than 72 hours after infection.
I realize that I have not told you yes or no. If I were you, I probably would not start PEP but this is a decision you must make. I hope the information I have provided is helpful in your decision making. EWH
MEDICAL PROFESSIONAL
Thanks so much for your follow-up. Sounds like all has ended well. Glad to hear that your partner was negative when tested (for everyone's involved). I completely agree with the actions you took and congratulate you on your level-headed approach to a worrisome situation. EWH
To conclude this thread I just wanted to round out my story.
I did in fact get a hold of my partner and she was incredibly kind enough and understanding to get tested. She was negative. I did not start PEP, and can chalk this up as a learning experience, albeit a difficult one.
Moral of the story fella's, unless you want to have doubts and paranoia it is better to wrap it up.
That being said, if you are in a similar situation right now and you are freaking out, try to relax. I was convinced that I had contracted HIV from a person who in the end didn't even carry the virus. Don't give in to the medical anxiety, it simply isn't productive.
Thanks again to Dr Hook, for his timely and professional advice during a difficult situation.
I did in fact get a hold of my partner and she was incredibly kind enough and understanding to get tested. She was negative. I did not start PEP, and can chalk this up as a learning experience, albeit a difficult one.
Moral of the story fella's, unless you want to have doubts and paranoia it is better to wrap it up.
That being said, if you are in a similar situation right now and you are freaking out, try to relax. I was convinced that I had contracted HIV from a person who in the end didn't even carry the virus. Don't give in to the medical anxiety, it simply isn't productive.
Thanks again to Dr Hook, for his timely and professional advice during a difficult situation.
MEDICAL PROFESSIONAL
Sorry for the delay in answering- I was traveling. I agree that if she continues to dodge your efforts to determine her status and you decide to start PEP, the sooner the better. EWH
Thank you very much for the professional opinion Dr. Hook. My only followup is this...
If we assume she dodges the test again, and I presumptively conclude (right or wrong) that she is in fact HIV+, would you recommend that I start PEP at what would be the 58-62 hour mark?
I realize this is opinion not official advice, I will make my decision alone.
Thank You.
If we assume she dodges the test again, and I presumptively conclude (right or wrong) that she is in fact HIV+, would you recommend that I start PEP at what would be the 58-62 hour mark?
I realize this is opinion not official advice, I will make my decision alone.
Thank You.
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