Hi Doctors.  I'd like to give a little background for your opinion.  I am a married male who is bicurious.  I met another bimale about 4 months ago and we became friends and hung out; nothing happened for a long time as I am married and he has been with the same female for awhile.  He had always communicated to me that he has been on PREP for 4 years as if he ever did have a "slip up" he didnt want to have anything happen to his girlfriend.   He is also part of a study where he gets his prep at a discount as they are testing the effect of another pill to preserve organ function; he was last tested in July as part of his biannual check up.   So he and his girlfriend broke up and we were hanging out.   We ended up having sex - it was my first time.  I didnt insist on a condom as he has always relayed that PREP is considered safe sex.  Needless to say, I kind of freaked out afterwards as it was my first time (I dont think I was emotionally ready for it).   I went to the emergency room and started taking Stribild within 3 hours of the incident.  The doctors freaked me out a little more as they stated people lie about taking PREP and their sexual practices which really added to my anxiety.  They said to ask him if he would take an RNA test 10 days after our encounter and if he is negative, I have nothing to worry about and can stop taking the Stribild.   I asked him to get tested and his response was that he is on PREP for a reason to protect himself and not have to get tested that he is completely "clean" and that I have no reason to worry as he has not been with anyone other than his ex girlfriend the last year.   OK, now my questions:

It tests down to 20 copies.   I am really just looking for risk assessment on the different characteristics on what I wrote.  I am just disappointed he won't get tested as that would be the all clear but also logically understand where he is coming from.

sorry.  last comment.  Not that it matters, but he did show me his pills a couple of times.  They could have been aspirin for all i know.

Welcome to our forum and thanks for your question. I’ll be glad to comment. Let me start with assuring you that Stribild is recommended as a highly effective, well tolerated post-exposure prophylaxis regimen and having started it so soon following your exposure is an optimal approach to PEP.  Yes, if you were exposed, the Stribild should be highly productive.  ---

Dr. Hook.  I apologize for this annoying question and I know there are no absolutes in science.   When you say highly productive, do you mean you have never seen or heard of a case that started so soon, stuck to the regiment and turned positive or that its 80% unlikely you will become positive out of this one encounter in worst case scenario.

Sorry Formthe typo in my initial response. Rather than productive I meant to use the word protective. That said, precise calculations of the protective affect of PEP are challenging because infections among exposed persons are relatively uncommon. Remember that less than 1% of unprotected rectal exposures to untreated HIV-infected partners lead to infection. If you then factor in the efficacy of pep exceeding 90% for persons who start the medication in a timely fashion and take the medication as directed, doing the sort of study which would provide precise estimates of the protective affect would require huge numbers of participants. This is simply not readily possible.  If your partner were infected and untreated, even in that circumstance which does not seem to be the case for your situation, your risk for infection would be less than a small fraction of 1%.---

Dr. Hook - thank you so much for your replies and information.   Sounds like I have nothing to worry about as long as I stay on the regimen especially since I started so early.   The man is still adamant that he hasnt been with anyone since his girlfriend and last test and remains on Truvada for PREP.  He goes back for a check up with his doctor in early november (testing and all) so will also know then.   Last question.  I see so many different views.  I am going to take your advice and get swabbed for anal Chlamydia and Gonnorhea.   What is the right time frame to do so?  Some places say 5 days and others 2 weeks.  What is your recommendation?

I am pleased that you found my comments helpful. That’s what we’re here for. Tests for gonorrhea and chlamydia will provide conclusive results at any time more than five days after your exposure.---