Is PEP recommended?

[InGermany]

Last night I got pretty drunk, and was in a dark room in a bar in Germany.

A guy I fooled around with managed to "dip" into me for about 1-3 seconds.  After he dipped in, I moved to remove him, and no further anal sex was had.

I do not know his HIV status. He did not ejaculate during that brief period of insertion.  He was uncut and I had been giving him oral sex moments before this, and I do not believe he had precum.

Under these circumstances would PEP be recommended (the clock is at about 8 hours at this point)?  I did PEP once about 4 years ago, so I am aware of how the program works.

I am an American traveling in Germany and unsure how to access the health system here.  I do have a long-term travel insurance plan (I'm here for a couple of months) which includes medical coverage.  If PEP is recommended, and anybody on this forum knows what my first step would be to interface with the German health system I would appreciate the info.

[Ann]

IG,

Your risk is very much on the lower end of the scale and I wouldn't think PEP was necessary. If you'd had full-on intercourse and he came inside you, it would be a different matter.

However, going by all that you said, I really think PEP would be overkill. Hiv simply isn't as easily transmitted as some may think and brief dipping isn't very conducive to transmission. The main risk in dipping is having it lead to full-on intercourse in the heat of the moment.

You will have to decide for yourself whether or not you take PEP.

Unfortunately I don't know how the health system in Germany works. However you can find an agency that deals with hiv near where you're currently staying by using the searchable organisation database at http://www.aidsmap.com/e-atlas

Alternatively, if you're in a large city (or can travel to one) an A&E (ER) in a large hospital would probably be able to help you. Make sure that wherever you go, you are given a rapid hiv test FIRST before you are prescribed anything. That is if you decide to go with PEP. Again, I think it would be overkill but ultimately you will have to decide for yourself.

If you do decide to go with PEP, you need to take the first dose within 72 hours of the incident. Closer to 24 is better but with it being a weekend, you may not be able to achieve that. Seriously though, with your low level of risk 36-72 hours would be fine.

I wouldn't expect you to end up hiv positive over this situation, PEP or no PEP.

You also need to know that taking PEP extends your testing window period by 28 days, or whatever amount of days you take it (should you decide to stop early).

The vast majority of people who have actually been infected will seroconvert and test positive by six weeks (or six weeks post-PEP), with the average time to seroconversion being only 22 days.

A six week negative is highly unlikely to change, but must be confirmed at the three month point - or three months after your last dose of PEP.

You also need to realise that you should be tested for all the other, MUCH more easily transmitted STIs. You can test for the other STIs ten days to two weeks after the incident, but syphilis (transmitted through skin-to-skin contact and therefore a real possibility) shares a three month window period with hiv for a conclusive negative result.

Good luck.

Ann

[InGermany]

IG,

Your risk is very much on the lower end of the scale and I wouldn't think PEP was necessary. If you'd had full-on intercourse and he came inside you, it would be a different matter.

However, going by all that you said, I really think PEP would be overkill. Hiv simply isn't as easily transmitted as some may think and brief dipping isn't very conducive to transmission. The main risk in dipping is having it lead to full-on intercourse in the heat of the moment.

You will have to decide for yourself whether or not you take PEP.
...

Good luck.

Ann

Thank you for your time Ann.

While the risk is low, I have to determine whether or not I want to roll the dice on the (admittedly small) chance of an HIV infection.  If last night I were infected how much would I kick myself for not having taking action when I could?

I suppose I should put it in perspective: Do I have a higher probability of being run down in a crosswalk than having contracted HIV?  Yet I continue to live on the edge and cross the street on foot multiple times a day.  On the other hand, were I hit by a car I wouldn't hesitate to seek medical attention...

I wish there were some sort of "decision tree" I could use to make the choice for me.  After typing that I did a quick google and I just found one here: http://www.westerntrust.hscni.net/pdf/HIV_Post_Exposure_Prophylaxis.pdf   I'm somewhat unsure of the answer to the second question (significance of exposure).

Thanks you for your speedy reply to my first post!
                                                                 

[Ann]

IG,

The paper you linked to is for occupational exposures, not sexual. Here's the BHIVA (British HIV Association) paper for PEP in a sexual exposure (PEPSE) setting: http://www.bhiva.org/documents/Guidelines/PEPSE/PEPSE2011.pdf

Keep in mind that they do not include dipping. Dipping is somewhere between full-on intercourse and frottage - the sexual rubbing of body parts together without penetration - and frottage is not listed as it is NOT a risk for hiv infection.

Ann

[InGermany]

IG,

The paper you linked to is for occupational exposures, not sexual. Here's the BHIVA (British HIV Association) paper for PEP in a sexual exposure (PEPSE) setting: http://www.bhiva.org/documents/Guidelines/PEPSE/PEPSE2011.pdf

Keep in mind that they do not include dipping. Dipping is somewhere between full-on intercourse and frottage - the sexual rubbing of body parts together without penetration - and frottage is not listed as it is NOT a risk for hiv infection.

Ann

Interesting document, thank you for putting that up.

A funny thing just happened, I stepped out for dinner and found myself face-to-face with the individual from last night.   I spoke to him, and asked about HIV status, he says he is negative and seemed genuine. (I of course have to take that with a grain of salt, he was after all attempting to have bareback sex in a dark room of a bar.)  While I was out, and before I ran into the man from last night, I stopped by the local gay info center and got a business card for a person I can talk to tomorrow morning.

Thank you for your time.

[Andy Velez]

Even a well meaning guy doesn't necessarily know his HIV status accurately. So although somewhat reassuring to have heard that from the quy in question, it should not be the basis for your deciding about PEP.

What's more to the point is that if you are sure it was as brief a dipping as you say, then the risk was more theoretical than real. But it's your decision to make about doing PEP. Given what you have described I would expect you ultimately to test negative, but that's an experienced guess.