[Question #596] put on PEP two nights ago after risk

43 months ago
Hi doctors,

Two days ago I was put on PEP at my request after being deeply fingered by a guy who had pre-cum on his fingers. He did not penetrate me with his penis. 

Today I checked in with a GP who gave me hell and told me to stop PEP immediately, citing low risk and the drain I was placing on the health care system for wasting their time and budget (which my rational mind entirely agrees with).  

I was only given 6 days of PEP from the ER and it's likely when I go to the sexual health clinic they will not give me the rest of the months worth for the reasons cited by the GP.

I guess my biggest concern is the exchange of body fluids. He had precum on his fingers from touching himself, and then deeply inserted them into my vagina (almost immediately). This happened multiple times. 

It'd be great to get your risk assessment. Should I stop PEP like the GP recommended? 

Thanks in advance
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to the Forum.  I'll be pleased to comment.  My sense is that your GP is well informed and whomever agreed to give you the PEP was not.  Masturbation of any sort, including ano-rectal masturbation of the sort you describe is generally considered safe sex.  Interestingly, this is the case despite that fact that it is typical for persons engaged in mutual masturbation to get their partner's genital secretions on one another in the course of masturbation.  This is testimony as well to the fact that it is DIRECT, not indirect (i.e like on a partner's hands) sexual penetration that results in most STI, including HIV, transmission and explains why most exposures to persons known to be infected do not lead to infection.

In your case, not only was your exposure safe sex but from what you write, it appears that you do not know that your partner had HIV.  Putting these together, like your GP, I see no reason to continue PEP and would not have recommended it in the first place.  I do not fault you for being concerned but it is always a disappointment when professionals do not use medications correctly for all of the reasons your GP mentioned.  PEP is not only costly but has side effects in some.  I agree with stopping the meds at this time. 

I hope my comments are helpful.  EWH

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43 months ago
Thanks for your reply Dr Hook.

In the last few days I revisited the clinic and they took me off PEP, citing even if  he was HIV positive, the risk is still too low from vaginal fingering to warrant PEP. What I'm concerned about now is if he had any cuts, as most people usually do have cuts here and there on their hands and fingers. In the presence of cuts and sores on the fingers that could've been bleeding lightly, what kind of risk would we be talking about? I'm guessing it becomes quite a concern. I have seen other sources say the virus 'dies' upon exposure to air, but I think this is overly simplistic. Would you agree?

Obviously I will be testing in 3 - 6 months (given I took 5 days of PEP the window period would probably be delayed beyond 3 months). By golly it's going to be a long, anxious few months. 


Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Actually, most people have cuts and scrapes on their hands and fingers and, despite this, masturbation of the sort you describe has never been associated with risk for HIV.  If I were you, I would not be worried at all.  For that matter, I personally see no medical need for testing.  I realize you will probably test for your own peace of mind but urge you not to worry in the interim.  EWH

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43 months ago
Thanks Dr Hook.

Given I took 5 days of PEP, when should I test with 4th generation testing for a definitive answer? 3 months post the last dose of PEP?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
The official recommendations for follow-up testing following PEP are for three months following completion of the medications however there are few data on this.  In all likelihood testing with a 4th generation test at 28 days will be sufficient.  In the interim, please don't worry about this.  As we have already said, your risk of infection following the exposure you describe is effectively zero.  

As you know, Forum guidelines call for three responses to clients' questions.  As a result this will be my final response.  If there are further questions you will need to start a new thread.  I hope my comments have been helpful to you.  Please don't worry about the events you have described.EWH 
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