[Question #13352] Oral and Prep

1 days ago

I finished a 28-day course of PEP (Biktarvy) on August 14, 2025, and tested HIV-negative afterwards. I waited about 3 days before restarting daily PrEP. Because of pharmacy delays, I restarted with Truvada from a bottle that had been opened ~2–3 months ago (originally for on-demand use) and which I also traveled with. About 3 days after restarting PrEP, I had an exposure: I gave unprotected oral sex to 4 men at a bathhouse, and one ejaculated in my mouth (I spat it out)

Given that I had only been back on PrEP for ~3 days and the pills were from an older, previously opened bottle (I’ve read Truvada guidance about not using pills >6 weeks after opening), should I be concerned about my level of protection for this oral exposure. Also, with only a 3-day gap after finishing PEP, would I still have had any residual protective benefit from PEP (Biktarvy) at the time of this exposure

H. Hunter Handsfield, MD

23 hours ago

Welcome back but sorry you found it necessary.

You're overthinking all this. First, performing oral sex on men is very low risk for HIV, regardless of PEP or PrEP. A calculation by CDC estimated one chance in 10,000 of being infected if the penile partner has untreated HIV. That's equivalent to giving BJs to infected male partners daily for 27 years before it would be likely to be infected. (This includes oral sex with ejaculation in the mouth.) Second, warnings about drug expiration dates reflect the available data, not necessarily what is actually a true expiration date. For example, if it is true that Truvada has been found to be effective up to 6 weeks after opening, that doesn't mean it would not be effective much longer. And yes, you probably were also somewhat protected for 3 days after your last Biktarvy dose.

Between the inherently low risk of oral sex plus your PEP/PrEP treatment, you are at no risk for HIV. You really shouldn't worry about it.

HHH, MD

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