On PEP.. And subsequent risky event

[Informed1980]

Hi everyone,

I'm new to this forum and also new to a relationship with a. HIV + partner. I have been on PEP for three weeks after an incident where I was bottom and the condom burst. Exchange of fluids occurred, and my partner is undetectable but I know that doesn't mean I am immune from infection so am on pep.

My problem is that we got very intoxicated two nights ago and I had unprotected sex where I was top. I know this is bad, no fluids were exchanged but the intercourse was lengthy...

Should I speak to my doctor and extend the PEP course? Or would I be ok? (As for the unsafe behaviour, that's already a definite no for the future)

Any advice would be great! Thank you

G

[Jeff G]

You had a re-exposure on the high end of risk factors and will need to discuss this with your doctor before discontinuing PEP .

Its possible to be exposed and infected with HIV while on PEP so you will have to let your doctor know the facts so you both can make the right decisions about PEP . It may be worth exploring the possibility of you remaining on PREP if you cant have sober sex and use condoms correctly and consistently .

There are only so many times some doctors will prescribe PEP if you continue to expose yourself to HIV .

[Andy Velez]

You should discuss with your doctor about whether or not to extend the period of PEP. If you do extend the period of PEP then you start counting from when it is completed for testing. So initially you could test at 6 weeks after the completion of PEP.  Being on PEP during the second exposure may help protect you but it's definitely no guarantee. 

A couple of details are in your favor against transmission having occured, specifically that you were protected by the condom until it broke and that you were the insertive partner during the second incident. Transmission is more difficult to accomplish to the insertive partner than to the receptive one.

You already know that excessive drinking is a big red flag to avoid when having sex. It definitely has a sad history of inhibiting one's ability to make good choices.

Good luck with this and keep us posted.

[Informed1980]

Thank you.. I have had an extension and should know in about 6 weeks how it has gone. I will keep you posted.

[Informed1980]

Hello again,

So I have been on my extension (truvada only) and on Friday I wore shoes that blistered by right leg quite badly. This has now resulted in a staph infection that I have had to have addressed by a different (and new doctor) that I did not feel comfortable sharing the fact I was on PEP. I will be speaking to my doctor on Thursday however, is a staph infection (traveling up my leg in a red line to my groin) a sign that the pep has failed?

Your help would be appreciated

Nervous

[jkinatl2]

Hello again,

So I have been on my extension (truvada only) and on Friday I wore shoes that blistered by right leg quite badly. This has now resulted in a staph infection that I have had to have addressed by a different (and new doctor) that I did not feel comfortable sharing the fact I was on PEP. I will be speaking to my doctor on Thursday however, is a staph infection (traveling up my leg in a red line to my groin) a sign that the pep has failed?

Your help would be appreciated

Nervous

Having had staph infection several times (I really can't walk into a hospital without getting one, and have a partner who spends a bit of time there), I feel your pain. The red traveling up your leg is something to see your doctor about, no question.

Staph however, is a bacterial infection. A nasty one, yes. But not a virus.

It has absolutely NO bearing nor is it any indication of viral activity, antiviral activity, HIV, or anything else. Except of course that you have a painful infection.

If it helps at all, I wear long pants when I work out at the gym. Likely saved me from several staph infections. You really can't be too paranoid about that.

Well, yes. Yes you can. But having had them, I tend to advocate a little diligence. I certainly hope things ease up for you soon. And be sure your partner watches out as well. It's not uncommon for people close to one another to pass that back and forth.


BTW, about your risk, it was/they were seriously on the "nearly the same as sex with a condom" level if your partner was undetectable. In the absence of another inflammatory condition (in studies only certain STDs were flagged) sex with an HIV positive person with an undetectable viral load is only a hair away, safety wise, from sex with a condom.

I think PEP in the first instance was a toss-up, if you had been mutually monogamous and there were no other STDs present.

I think extending it was going Waaaay beyond the call of duty, as the insertive partner is at a fraction of the risk even with a high viral load on the part of the receptive (bottom) partner. Frankly I would not have given THAT situation a second thought.

For the future, have you considered PrEP? In the US, most insurance covers the stuff and it might make these moments - and if you aware of the risks - even condoms - basically optional. Especially in moments where you assume the insertive position.