Pep or no Pep

[Westcoastguy101]

My question is whether I should get the pep prophylactic? I know there is no definitive answer and my facts are a little bit murky.

Here are the facts: I always use a condom for anal intercourse, but last night when the guy withdrew from me after 15 minutes or so, I could not find the used condom (in a dark place/I had placed initially the condom on the guy's dick and it was there on initial entry).  There is definitely a possibility that the condom fell off when he withdrew from me, but I am a little concerned.  I asked the guy (anonymous partner) if I should be concerned because I could not find the condom.  He replied not to be, that he was clean, and that in any case that he had not ejaculated (although I know that it can be transmitted in pre-cum). I did not notice any blood on my part and was not particularly sore afterwards.  In any case I will get tested in 3 and 6 months to male sure that I am still negative.  Any advice on whether to take the PEP?

[Andy Velez]

There is a good possibility the condom got lost during withdrawl. That is a not uncommon event when the insertive partner doesn't hold on to it while pulling out.

As the receptive partner your risk is higher than it is for the insertive.

If you're going to do PEP, the sooner the better within 48-72 hours and the earlier the better the chances of it being effective.

You have to make the final decision of course. It's between the possible side effects of the meds, which varies by the individuals and preventing transmission.

For future reference it's improper to use the term "clean" when referring to HIV status. The issue is a virus and whether one is HIV+ or negative, not clean or dirty.

Good luck with whatever you decide. 

[Westcoastguy101]

Thank you for your guidance.  I do realize that the decision is mine to make, but I was looking, if possible, for a more detailed response. 

Please note that I did do pep around four years ago for a condom breakage with an hiv positive person with zero detection levels of hiv, and although the drugs were difficult at first, I did come out maintaining my negative status.  I also realize that the chances of seroconversion on a one time exposure are relatively small (one percent?), I thought you might have some other factors or information that I should consider. Lastly, I only ask for further guidance as on the one hand it seems like the probability of seroconversion is very remote, but on the other hand can I take that risk no matter how remote (guess only I can answer that one).

Thanking you in advance on your guidance on this stressful issue.

[Andy Velez]

We don't deal in percentages of risk here. We simply evaluate on the basis of the information we're given.

In your case I think there is a good chance the insertive partner had the condom on until he withdrew. That puts the possibility in your favor. However I wouldn't call your risk a "remote" one.

We're just guessing here and you have to decide if that is reassuring enough to make you willing to take a chance against taking the meds and possibly experiencing some level of discomfort.

That discomfort is temporary. HIV is forever. You decide.