[Question #4944] Penis head dipping for few seconds and on PEP

26 months ago
Hey Dr, 

I myself a medical student, to make it brief and short, Yesterday i had a encounter with someone i met online.  We made sure that we were HIV negative and STD free. I was last tested in January and the results were negative and had not met with anyone until this exposure. He says that he is negative but it is all verbal and no proof. his words against mine. I am currently studying on the Island and not reside in US. But the person i met is also a student and US resident but lives here on the island like me. ( i met him online though on a app)

So i got paranoid and went to the clinic to get PEP in less than 24 hours, i was prescribed Lopinavir/Ritonavir 2 tablets every 12 hours daily (total 4) and Lamivudine 1 tablet every 12 hours. 

My Exposure: We had lots of french deep kissing and body contact and before we ended he tried playing with my ass and lubed it up with his spit and perhaps precum so while doing frothing he accidentally entered or dipped his penis head  twice in my anus. the second time he did we stopped immediately. And only the penis tip entered for less than 10 seconds. He definitely had precum, then we ejaculated separately. (IDK if it was accident or on purpose) 

Point to be noted, i never had anal sex in my life, so this was my first exposure to penis entering in my anus. But i did not feel any pain maybe due to his precum and probably very brief exposure. 

I wanted to know what are my chances and how much should i trust someone with their status ? 

Is my exposure warranted the PEP. Because doctor i have visited on campus told me anything is possible so they told me it is better to take it. 

I am really confused and paranoid and today is my first dose within 24 hours. Please help! we don't have good doctors on the Island to discuss. 

And are the side effects worth the exposure ? this is my first time taking these medication. 

Please anything to help me calm my anxiety! 

Thank you for this great service! 

Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to the Forum.  I'll be happy to comment on your several questions.
1.  this was a rather low risk exposure.  Your partner said he did not have HIV or STIs.  Most people tell the truth although, admittedly, partners met on-line may be somewhat more risky than persons who you know better.
2. If he did have infection, the average risk for infection from receptive rectal intercourse is, on average, less than 1 infection in several hundred exposures.  In your case, with perhaps two strokes/insertions, your risk IF he were infected is lower than average (i.e. there would be a  more than 99% likelihood that you were not infected, IF he happened to have HIV).
3.  PEP is a personal choice, of course.  I probably would not have opted to take it but, as I said, it is a personal choice.  Having started it, if he were infected it will further reduce the already low risk of infection  Typically, other than GI side-effects, there are few side effects.

I hope this information is helpful.  If any part of this is unclear, please feel free to use your up to two follow-up questions for clarification.  I really would not worry.  EWH
26 months ago
Hello, thanks for your reply.  (btw if you were wondering this was a M4M exposure.) 

Does pre-cum carries any HIV infection ? Because i usually meet people online for jack of sessions. and i hear mix reviews about precum being infectious too. 
Same goes with deep tongue kissing ? Any risk for this too ?

Also, how would you place the risk of anal receptive verses sucking a cock without condom? without ejaculation. 

And based on the medication that i was provided. Do you agree that they are the right medication given to me as PEP ? ( I was supplied with 30 days dosage) because i just want to be sure if they are the right medication and how effective they are versus the ones that are prescribed in US.

After the incident i contacted the person and he confirmed again that he is negative and clean. but i refuse to take chances for some reason. 

So in your opinion how well does PEP works in case of accidents like this and condom breakage, since i am new to anal. i just want to be prepared next time to handle my situation in more proper manner. and i will definitely look into PREP too. 

Baseline, regardless of the situation, My PEP medication will resolve all the infection if there were any or PEP is not that effective ? 

And can i just stop worrying and just believe in PEP to do its job ? i am in school so i have a lot work to do, and this thing is bothering me! 

Does everyone face the side effects of the medication or some are exempted ? just curious ( i did not feel any side effects on my first day yet) 

When should i get tested after i stop PEP ? and what test should i take ? Rapid or a blood draw test ? 

Please enlighten me! thank you.  I will try not to post again and wait until i get tested after i stopped using prep. hopefully it comes back negative! 

Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
many questions. I'll try to help with brief replies
1. Yes, there is HIV is pre-ejaculate.  Ejaculation need to occur for infection to occur.
2. Deep kissing, no risk.  No one has ever been proven to have acquired HIV from kissing, even deep kissing with exchange of saliva.
3.  Receptive rectal intercourse is among the highest, riskiest of sexual exposures with infected partners.  Receptive oral sex is far lower with a risk of one infection in every 10,000 exposures HOWEVER, persons have become infected through receptive oral sex.  There are no proven cases of HIV due to receipt of oral sex.
4.  This combination of drugs should be effective as PEP and reduce your already low risk for infection.
5.  PEP markedly reduces your risk for infection if exposed.  If you choose to have repeated potential exposures with potentially infected partners however, PrEP, taken every day is more effective thatn PEP
6.  PEP is not 100% effective.  Current estimates are that reduces infection risk by about 80%.  It is more effective the sooner it is started and not thought to be meaningfully effective if started more then 72 hours after an exposure;
7.  Your PEP reduces your already low risk of infection.
8.  Not everyone experiences side effects with PEP.
9.  Follow-up of PEP is recommended at 3 months after completion of the medication using a combination HIV antigen/antibody test.

I hope these replies help.  Please do not worry.  Your risk is quite low.  EWH