[Question #9629] PEP gay exposure

30 months ago

Hi dr,

i am a gay male . Never had anal sex . Not given oral sex in the last 2 years .

Recently yesterday , i met a male of unkoeh status , he gave me a massage and fingered me deep , stimulating my prostrate while giving me a handjob .

The fingering was rough and deep .

He also kissed me and when i got back home i realised a small tiny cut on my lower outer lip . I wouldn’t have noticed it had i not checked my lips .

I am very scared and i consulted my GP and he told me i can take PEP which i started within 24 hours . I have started when tenvir em , one tab , and raltegravir 400 mg twice daily .

Please advise if i can continue with my regular vitamins whike on pep . Also how effective is pep ? Am i safe ? I am very worried . Please advise . Thanks a lot .

Edward W. Hook M.D.

30 months ago

Welcome to our Forum. I'll be glad to comment.

You did not ask if I would recommend PEP for you in your situation. I would not. There has never been a case of HIV acquired as a result of kissing or masturbation (including prostate massage), even when it was rough. A cut or sore on your lip would not change this assessment

PEP is highly effective when started after a risky exposure. There are not precise figures on PEP effectiveness but even without PEP, your risk for HIV was less than one in a million and probably one in many millions. If you chose to continue to take your PEP, taking vitamins with it will not change it's effectiveness.

I hope this information is helpful. Please don't worry. EWH

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30 months ago

Thanks a lot doctor. Just also wanted to check a few more things :

1. I live in india and bought Raltegravir from a local chemist . I’m worried about it being genuine . Any way to confirm ?

2. Is it allowed to have alcohol during pep ?

3. What if a finger is bleeding ? and he fingered me , Though i didn’t see any cuts .

4. I read that exchange of body fluids can cause hiv . If he was also bleeding and i had that small cut , wouldn’t that br a risk ??

Request you to please confirm .

Edward W. Hook M.D.

30 months ago

Good questions. In response-

1. I live in india and bought Raltegravir from a local chemist . I’m worried about it being genuine . Any way to confirm ?

Not that I'm aware of. However, if your pharmacy was reliable, you can safely presume that the medication you obtained is genuine.

2. Is it allowed to have alcohol during pep ?

Yes

3. What if a finger is bleeding ? and he fingered me , Though i didn’t see any cuts .

Even with cuts on his fingers, this would be a no risk exposure

4. I read that exchange of body fluids can cause hiv . If he was also bleeding and i had that small cut , wouldn’t that br a risk ??

This is an oversimplification. For instance, there is no risk from kissing even with saliva exchange and no risk from mutual masturbation, even when partners get each other's genital secretions on one another- still no risk

Please don't worry. EWH

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30 months ago

hi dr,

Thanks for the revert . Had a few more questions .

1: So the pharmacy i bought it from is an old pharmacy and exists sinxe 1943. My family has been buying meds from them from years now . i got worried coz the raltigravir didn’t have the brand name of issentress on it and just had the generic drug name on it .

2: The guy i hooked up with told me he is on prep , however he told me he goes it every alternate day and the other days he takes antibiotic prophylaxis which again got me worried coz i felt he may have been positive . although he showed me his test reports of 7 months bak which were negative .

3. If a finger is bleeding or had a cut and he fingered me woulent that be equivalent to having unprotected sex , because again blood is a fluid and may enter the anus due to the thin lining . I’m confused about fingering being risk free .

4. Also for future if i just indulge in kissing and getting fingered and receiving oral sex (not sucking but getting sucked ) , can i consider myself safe ? I don’t hook up much , it’s maybe just twice a year at max .

5. Also my Gp told me not to drink during pep . However you mentioned that i could . Does alcohol affect the efficacy or PeP?

6. I am also on fluvoxamine which is an anti anxiety medication . Can i continue with that ? Does any other medicine or supplement affect the efficacy of PEP ? Please advise . Thanks

7 . The last time i took pep i had terrible side effects . however this time i don’t feel much . hence i was worried about the genuinity of the drug .

8. Do i need to get tested coz of this particular exposure. ?

9. Should i consider prep if i am only having oral sex ?

Thanks a lot again doctor .

Edward W. Hook M.D.

30 months ago

We provide up to three responses to each client's questions. This will be my 3rd and final response, following which the thread will be closed:

Generic drugs are less expensive than brand name drugs but work just as well. Just because you received a generic version does not mean that it will not work.

Your partner is taking his PrEP incorrectly but his negative test results are reassuring and associated with lower risk for HIV. You may wish to suggest that he reconsider how he is taking his PrEP

No, HIV quickly becomes non-infectious on exposure to the environment. It is for that reason that mutual masturbation is a no risk event.

Each of the activities is safe, no risk sex which is not associated with meaningful risk for HIV

5. Also my Gp told me not to drink during pep . However you mentioned that i could . Does alcohol affect the efficacy or PeP?

Repetitive- the answer is not going to change. Alcohol does not affect the efficacy of PEP unless it makes you forget to take it

6. I am also on fluvoxamine which is an anti anxiety medication . Can i continue with that ? Does any other medicine or supplement affect the efficacy of PEP ? Please advise .

No their are no interactions between your PEP and fluoxamine

7 . The last time i took pep i had terrible side effects . however this time i don’t feel much . hence i was worried about the genuinity of the drug .

I have no comment on this. Do not know if your prior PEP was the same medication. Further, on some occasions, side effects occur sometimes but not others

8. Do i need to get tested coz of this particular exposure. ?

As I've already said, this was a no risk exposure and I would not have recommended PEP

9. Should i consider prep if i am only having oral sex?

There has never been a proven case of HIV acquired from receipt of oral sex. Performing oral sex on untreated, HIV-infected partners is low, but not no risk sex. The estimated risk for infection, IF your partner is untreated and infected is estimated to be 1 infection for every 10,000 exposures on average.

I hope this information is helpful. Take care. EWH

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