[Question #8811] PEP Urgent

39 months ago

I made a horrible mistake 2 days ago and met a guy online. We kissed a lot and then he performed oral sex on me for about 5 minutes until I ejaculated. He had told me before I met him that he was hiv negative. He told me late last night that he actually was positive and that he lied to me. He apologized and then blocked me so I have no way to talk to him. I’m so scared now. I have read that if you start prep within 72 hours you may avoid infection but I’m fast approaching that time and I am not even sure if I could get it or how. Please help me on what I should do! Thanks so much

Edward W. Hook M.D.

39 months ago

Welcome to our Forum and thanks for your questions. I’ll be glad to comment and provide some information. I’m sorry to hear of your partner’s failure to be honest with you. The exposure you describe was very low risk. Kissing, even deep kissing is safe and not associated with risk for HIV. Similarly, there are no proven cases in which HIV has been acquired from receipt of oral sex, although the CDC ( which tends to be conservative) classifies the risk of infection from oral sex as about one infection per 20,000 exposures to an untreated, infected partner (I.e. chances are more than 99.99% that you would not be infected). Further, if your partner was on effective therapy for his HIV, he would not be infectious. Bottom line, your risk for infection is near zero.

That said, some persons in your situation would still choose to take post exposure prophylaxis (PEP) to further reduce their risk. PEP effectiveness is highest when taken soon after exposure and is considered ineffective if more than 72 hours has passed since exposure. Starting PEP in your situation is a personal choice. If you choose to start PEP for this exposure, you will need to wait an additional 4 weeks after your exposure before your follow up test results will be conclusive (I.e. 10 rather than 6 weeks).

Personally, given the information I’ve provided, we’re I in your situation I would not seek PEP but of course it is a personal decision. EWH

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39 months ago

Thank you for your response but unfortunately I’ve already passed the 72 hour mark. I was so upset late last night when he told me that I was not thinking clearly and miscalculated the dates. I did call my doctor but of course the office is closed. I’m in a rural area this weekend and the local hospital/clinic doesn’t carry that drug. So I guess I’m screwed. I did have a few more questions please

1) I assume your advice would be to not have sex with my girlfriend?

2) I have read a lot over the past few hours and I saw that someone can get a PCR test after 12 days instead of waiting 6 weeks. I can’t bear the thought of waiting 6 weeks to find out. Do you know about that test?

3) I have read a lot of other responses on this site and I’ve seen others who had oral sex performed on them and it seems there were times that you or the other doctor said the risk was zero and the advice was not to go on PEP or even to get tested. So I’m a little confused. Can you help me understand that please?

Thank you

Edward W. Hook M.D.

39 months ago

Thanks for your follow up. I do not think you are “screwed”. Straight to your questions:

1. Already indicated, your risk is extraordarily low, if there is any risk at all. Clearly the safest and best approach is To not have unprotected sex with your girlfriend, Although, once again your risk is minuscule if there is any risk it all. Where I in your situation, I would not hesitate to have unprotected sex with my girlfriend.

2. You are correct. A PCR test taken at 12 to 14 days is very, very strong evidence that you were not infected. Conservatively and out of an abundance of caution, many experts would still suggest a follow up fourth generation combination HIV antigen/antibody test at six weeks even with a negative PCR test but I am unaware of any person who has had a negative PCR at 12 to 14 days who them develop a positive test.

3. I think you are mistaken. In reviewing previous posts on the forum, I believe you will find that in nearly all instances, persons were writing about receiving oral sex from partners who they did not know had HIV status of. Further, we regularly state that there have never been approved case in which HIV was acquired from receipt of oral sex. This is what I told you. I also told you that, were I in your situation, I would not seek PEP. The basis of this statement is because the risk of infection is virtually zero.

Please do your best not to worry. EWH

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39 months ago

Dr Hook

Thank you for your comments and encouragement. I did take an HIV RNA test on Monday which was 12 days after my encounter. The results show non reactive or normal for both HIV 1 and 2 Qualitative RNA. The lab says it’s conclusive but also it’s only about 95% accurate. I know from your comments that I will need another test at 6 weeks post event which I think is the 4th generation test. So my question is how much did my chances of being ok improve from this test and do I still need to plan on taking the 4th generation at 6 weeks? Thank you again so much!

Edward W. Hook M.D.

39 months ago

Thanks for your follow up and thanks for letting me know about your HIVRNA results. As I have already told you, your risk is so low that in your situation I would not have even bothered to test. Your testing however additional strong evidence that you were not infected. FYI, I have never seen or heard of a person with a negative HIVRNA test at 12 days who subsequently become positive.

Please don’t worry. As you know, we provide up to three responses to each clients questions this will be the final response as part of this track. Take care. EWH

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