[Question #8240] Pep after exposure

47 months ago

Dear dr ,

Hope you are doing well .

I have a question regarding pep after an exposure I had . I am a gay male and have NOT ever had anal sex and Haven’t had oral sex in almost 2 years .

I tested in the first week of June 2021 and am negative .

However 2 days bak I had an exposure with a friend . We just masturabed together and his semen came on my face and some on my eye lid . Not sure if it went into the eye because I didn’t feel any burn or pain or irritation as such but again I don’t know if some small amount s of semen entered My eye .

I panicked and contacted a specialist in my city , who put me on PEP within 24 hours of my exposure .

I also got my friend tested yesterday , he is also negative .

However I have been advised to continue with PEP for 28 days .

I am facing some side effects like nausea and dizziness and drownsiness .

Also I am on fluvoxamine , which are anti anxiety pills . Is it okay to still continue with it ?

Do you advise that I continue with pep ?

Please kindly advise . Thanks a lot

Edward W. Hook M.D.

47 months ago

Welcome back to the Forum. I’ll be glad to comment. If your partner’s test yesterday, a day or two after your exposure was negative, there is virtually no risk for infection. Your nausea is likely due to the PEP you are taking. Finally, the exposure you describe was virtually no risk- getting ejaculate on your face is not associated with risk for iinfection.

If I were you, I would stop taking PEP and not worry further about this exposure. If you need the medication for anxiety I would continue taking it but there really is no reason to worry about the exposure you describe EWH

---

47 months ago

Thanks a lot doctor .

1. So even if the ejaculate went in my eye it wouldn’t be a risk ?

I mean the only reason I thought it to be a risk was because I read that in medical settings when healthcare professionals get blood splashes in the eye ; they usually get on PEP.

2. Also would u recommend any tests to be dont after I discontinue the pep at 28 days ?

3. as mentioned I am on some multivitamins and on Luvox (fluvoxamine ) pills for anxiety . Would that affect or interfere with the PEP course .

4. Also since I am an overly anxious person , I would want to get on prep.

5. When could I start with prep . Also could u please explain what is prep on demand .

Thanks again for all your help dr

Edward W. Hook M.D.

47 months ago

Sigh, your anxiety is showing. Repetitive questions will not change my assessment:

1. First, there is evidence that your partner is infected. Second, the blink reflex prevents entry of ejaculate into the eye. As I said before, this was a no risk event.

2. There is no value to additional testing at this time.

3. Repetitive. No

4. It sounds like PrEP would be a good idea for you.

5. You need an HIV test before starting PrEP. If it is negative, you can start immediately.

EWH

---

47 months ago

Thanks for your response dr .

Have a few more questions :

1. Assuming I complete 28 days of PEP, when can I get an hiv combo test done ? I would need this test in case I plan to start Prep right ?

2. While I am on PEP , is it okay to consume alcohol ? I have also been getting a bit dizzy and feeling a bit fatigued .

3. My friend tested the next day after the exposure . He tested negative . His report mentions the test name as Vitros (ECI) and the result as non reactive . Is this a fourth gen test ? Also my friend isn’t very sexually active at all . However there is always a small chance of a perosn being in the window period right ?

4. Also the pep regimen recommended is raltegravir 400 mg twice daily and tenof EM ( 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate).

However the doc I consulted told me to take these meds for 14 days as of now and then follow up with him .

Isn’t the regimen usually for 28 days ? Please confirm . Thanks

Apologies for the multiple questions but just thought I should clarify . Thanks again

47 months ago

Also can I take any meds for nausea in case it increases? I

Mean are there any meds that would affect the efficacy of PEP?

I happened to read an article that said vitamins or calcium tablets may affect the effectiveness of pep . Please advise . Thanks

Edward W. Hook M.D.

47 months ago

Final responses, after pointing out that you asked if there was a reason to continue PEP and I responded no, there was not.

1. Testing 6 weeks following completion of PEP will be conclusive. Results at 4 weeks will be almost (>98%) conclusive.

2. As already said, it is likely that your symptoms are medication related, perhaps worsened by your anxiety. Drinking alcohol will not effect the action of your PEP although it may increase your dizziness and “fatigue “. Alcohol does this.

3. I am not familiar with this test. I suspect It is 4th generation as that is the global standard for testing. The chance that he is in the window is very, very low-less than 1%.

4. Recommended duration of PEP is 28 days, not 14. If you are going to continue, I would do so as recommended - 28 days

End of thread. EWH

---