Is PEP warranted for this exposure? Second opinion.....

[RainMiller999]

I've been seeing a MtF transgender person on and off for about five years. We've hooked up about three or four times each protected anal sex. I'm always the top. Everything was safe as I'm always cautious. Yet the last time, two nights ago, I noticed that the pleasure in the sex was too good and found out that the condom broke and the whole time I was exposed. It was for about five to six mins and the condom was all the way to the back leaving me fully exposed as if I didn't even wear one. I panicked and asked her if she's negative and she assured me she was. But I have anxiety issues. I don't know the person that well but they seemed assured themselves that everything is ok. I told her I was going to get PEP and get tested so they should come clean now but they said I'll be fine because she knows she doesn't have anything.
I went to the local HIV clinic and spoke to a specialist who mediated between me and a doctor on call. I explained to them my situation and they calmed me down a bit with some stats that say the risk for one encounter of unprotected insertive anal isn't that high and that in my situation they would leave the decision of PEP to me because. The doctor said that he's sure that I'm most likely ok and that people rarely lie about their status. If my partner said they were negative most likely they probably are. He also said that HIV is a tough std to catch and in my situation the odds are in my favor that I don't have it but still left the decision up to me. That the risk was low to almost negligible. I looked on their website which stated that PEP is rarely recommended for insertive (top) anal intercourse exposure or oral. Is this true? I just want to double check and have decided that no matter what I'm taking the PEP for peace of mind. This was a really helpful and caring clinic.
I just want to double check this stuff with you guys to see if it's on the up and up. Thanks!

[Ptrk3]

Your decision to seek PEP is up to you and your healthcare providers, ultimately.

For risk assessment purposes, we forum moderators always presume that a partner of unknown HIV status is HIV positive (if your partner in this incident is, indeed, HIV negative, then you are not at risk because of it).

Yes, you are at potential risk for HIV infection since you had unprotected anal sex ("insertive"), since, for risk assessment purposes, we presume your partner is positive.  Yes, the "insertive" partner is at less risk.  Yes, HIV is difficult to contract, even if one is engaging in risky activities.  Nothing your healthcare providers told you is incorrect:  everything is true.

That said, your decision whether to go on PEP is a personal one and should be an informed decision based on the facts as you know them.  This is your decision.

Whatever you decide in regard to PEP, I would advise that you consider testing for HIV antibodies six weeks after the incident you describe, then at 13 weeks past the incident for confirmation of the six week results.

[RainMiller999]

Thanks for the quick reply, I want to take the PEP just to be sure but I am having an issue. In order to be eligible for the free PEP I have to show proof of income 2 check stubs. I am having an issue with this as I get direct deposit and tried to get the check stubs online but there was an administrative lock for too many logins (I forgot my password). I am in the 48 hour window and tomorrow at 4pm it will have been 72 hours making PEP ineffective. Hopefully I can the copy of the checkstubs in time but if not can I show a bank statement of my direct deposits and I also have access to the online time card to prove I work.

Do you know how these things work? I am freaking out and the clinic is closed? Could I go to the local emergency room and request enough PEP to last for a couple days until I am able to resolve the matter and get the rest from the HIV clinic?

[RainMiller999]

Also, the word the doctor used specifically was "negligible" risk for my one encounter. I looked up negligible risk and it seems almost that he meant to say that he is pretty certain a test might come back negative. That was the impression I received from the clinic providers. The stat he provided me was somewhere in the realm of .1 percent something like 11 per 10,000 encounters, I believe, I was just so frazzled I didn't hear well. That he would be surprised if it did come back positive. I am just making sure. Either way I want to take PEP. I am just assessing the risk after this one exposure.

[Ptrk3]

In terms of the odds, it is quite unlikely that you contracted HIV from this single encounter and if your partner was HIV negative, impossible.  But I can't assure you over the internet of facts I do not know.

I'm sorry for your anxiety, but I think it's better for you to rely on the healthcare providers that you see face-to-face in making your decision.

[Ptrk3]

RainMiller999:  no once can send you a private message since you have not posted more than 3 times. 

However, here is your answer to you pm'd question about the cost of PEP out-of-pocket with no insurance.

I really don't know, but I would guess in the thousand dollar range or more.  You would still need a prescription, however.  I would urge you to discuss your situation further with your healthcare provider and listen to his or her face-to-face advice/recommendation on your individual set of facts.

[Jim Allen]

Hi

Please do not post outside this one thread again as it will lead to a 30 day ban next time round. The rest of the forum is off limits and only for people living with HIV.

As for the broken condom incident, the good news is that until the condom broke it would have been protecting you, also as you were the insertive partner
it would be less risk than being the receiving partner as example. 

Now saying all that you did have a risk from the unprotected intercourse and so testing would be advisable. As you have started PEP the guidelines are to test at 6 weeks past finishing PEP and then at 13 weeks again to confirm the result.

If you are experiencing problems with the PEP go and see your doctor. 

Here's what you need to know in order to avoid hiv infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

More information on HIV Basics, PEP, TaSP and Transmission can be found through the links in my signature to our POZ pages, this includes information on HIV Testing

Kind regards

Jim

Please Note.
As a member of the AM I Infected Forum you are required to only post in this one thread no matter how long between visits or the subject matter. You can find this thread by going to your profile and selecting show own post and it will take you here . It helps us to help you when you keep all your thoughts or questions in one thread and it helps other readers to follow the discussion. Any additional threads will be deleted.

[RainMiller999]

Mr. Dublin,

I apologize! I didn't read the forum rules correctly and thought that to continue posting I would need to buy a subscription. Please feel free to erase the post I posted in the other forum. Again I apologize.

[RainMiller999]

If anybody knows, is Truvada alone an excellent PEP regiment? I have read some stuff about Truvada being excellent as a stand alone regiment to fight against infection. Is this true?
 

[Jim Allen]

Truvada is a combination of two drugs in 1 pill. It is at times prescribed alone as PEP, what you need to do is take your medication as prescribed by the doctor.

Jim

[RainMiller999]

UPDATE: I want to thank you guys for the info. The doctor was able to put me on a combo of Truvada and Isentress for 30 days. I received the medication between the window period of 72 hours but late in the period at 68-69 hours. I hope they are still effective. Any thoughts on that?

So far they're tolerable. One thing that has me a bit worried is that I woke up a bit sweaty from last night and felt anxious. I am thinking perhaps it was a night sweat? I have no fever or no other symptoms, I feel perfectly fine. The only thing I can think of is that given my current anxious state I get a little cold and I turned up the AC to 75 degrees and slept under three covers which I normally don't do. Especially since I live in a hot city. But can night sweats occur at four to five days after exposure?

[Jim Allen]

Your overthinking things.

The PEP is highly effective before 72 hours, so take the PEP and test.
If you think you are sick see your primary care doctor / GP and treat whatever is making you ill or accept that living in a hot city means sticky nights and stress keeps you awake.

Look you will be fine no matter what the outcome and to be honest broken condom single event would be highly unlucky to start with and you started PEP on time, all in all I am expecting a negative result when you do test.

Jim

[RainMiller999]

Thanks for the peace of mind, Jim. For future reference sake, on the question of relative risk and single exposures, if I come out fine with this one incident, and the same thing happens say five years down the road or more with a different person, does the risk rate stay the same per exposure or has the risk been elevated due to the past exposure, even if several years before? Just want to know if in the future I should consider PrEP.

[Wade]

Everyone including your doctor has told you your risk was negligible...
I don't have a crystal ball and I have no idea what you will do 5 years from now.

PrEP is an added layer of protection and you should use condoms for all anal and vaginal intercourse until you are in a trusting monogamous relationship and both have been tested for all STIs and HIV.

Wade

[RainMiller999]

Wade sorry I didn't meant to imply that I was still asking about this particular exposure. I know the risk was pretty negligible and I am on PEP, so peace of mind I have now.

What I was asking was just out of curiosity and future planning. Condoms break all the time. My encounter was with a busted condom which I never thought would happen with a person I've had protected encounters with before.

I was asking IF another similar encounter with a broken condom and a different person happens relatively speaking years down the line of having protected sex, would that single exposure constitute more of a risk than the last one I had (the one I was asking about in the OP) in terms of odds? In other words, I beat the odds the first time, would the second accident be less in my favor?

I am only asking in terms of stats and relative risk data currently available. I just want to possibly add PrEP as an extra layer of protection, since as you know condoms break.

[Jim Allen]

Hi

Were going in circles with you so lets cut to it.
 
Its irrelevant, we don't do odds as you can't calculate an individuals odds.
For all we know the person is newly infected and that would increase a risk by 25 X and to be honest some people will always shoot a hole in one and be positive on the first and only risk.

Condom broke = Transmission risk

Now or in 5 years or in 10 years condom broke = Risk.

There is no way on god green earth to know the other persons status no matter what they say and even if they test today all it means is he/she was negative some 13 weeks ago.

If condoms are breaking often than something is wrong, start using different ones, correct size, correct lube and plenty of it, remember to re-lube when needed and change condoms during the session if you are changing positions also before proceeding make sure no air is trapped in the condom.

Take the PEP as prescribed, test and move on, stop worrying about what others do and focus on yourself.

Jim 

[RainMiller999]

Appreciate the feedback guys. I know what to do and will hope for the best.

This should've been enough comfort:

Look you will be fine no matter what the outcome and to be honest broken condom single event would be highly unlucky to start with and you started PEP on time, all in all I am expecting a negative result when you do test.

Thank you Jim. If I may ask, would it change your opinion at all if I clarified that I was fully exposed for five to six minutes after the condom burst and did not ejaculate? I am hoping my initial original post clarified this point. Anyways, thanks again.

[Jim Allen]

Thank you Jim. If I may ask, would it change your opinion at all if I clarified that I was fully exposed for five to six minutes after the condom burst and did not ejaculate? I am hoping my initial original post clarified this point. Anyways, thanks again.

No, it does not change the assessment

Jim