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Author Topic: PEP worthwhile?  (Read 1167 times)

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Offline j9214

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PEP worthwhile?
« on: July 09, 2021, 09:13:38 pm »
Hi everyone,

Posting this because Iím somewhat worried about a very recent encounter.

I had anal sex with a man whose HIV status I canít be sure of (I was the receptive partner). We used a condom, but it broke. He felt it break as it was happening and stopped right away. I examined it and, although it was hard to tell for sure, the only tear I could find in it looked pretty small. Kind of surprising since Iíd always heard that condoms break pretty dramatically. I have no idea whether the head of his penis remained covered, but the tear I noticed wouldíve definitely been nearer to the head of his penis than the base.

I understand a condom break is an HIV risk, but I am currently traveling and trying to decide whether to get on PEP. I only feel comfortable visiting my local ER (as opposed to an out of state hospital) because I know my insurance will be accepted, but by the time I can arrive there tomorrow it will have been over 50 hours since exposure. I would try a clinic, but most will be closed as tomorrow is Saturday. I really do not want to stare down the face of a hospital bill if I can avoid it.

I guess my question is, is it worth it to get on PEP after 50+ hours given this scenario? I know itís ultimately my decision, but any advice or input would really help.

Thanks!

Online Jim Allen

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Re: PEP worthwhile?
« Reply #1 on: July 09, 2021, 09:35:30 pm »
Hiya,

Look if the condom broke during the intercourse it's a risk and one that warrants PEP.
 
As you already know, taking PEP would be up to you. If you do want PEP do keep in mind that for it to be effective you would need to start within 72 hours, although the sooner the better.

If you do start PEP then test at 6 weeks post finishing PEP with a blood-drawn HIV antibodies test, this result would rarely ever change and retesting at 3 months post finishing PEP is generally not needed but more for peace of mind.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your healthcare provider about PrEP in the future as an additional layer of HIV protection

Keep in mind that some sexual practices described as Ďsafeí in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get 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.

Kind regards

Jim

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« Last Edit: September 07, 2021, 04:37:05 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline j9214

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Re: PEP worthwhile?
« Reply #2 on: July 10, 2021, 06:01:34 pm »
Hi Jim,

Thanks for your reply. I actually ended up starting PEP today. Truvada/Isentress. Unfortunately the ER doctors could only give me a 7 day supply, and although they were willing to call more in to be filled as a prescription, they were not sure that it would be necessary. I kept telling them that I'm sure PEP is supposed to last 28 days. The Isentress tabs are 400 mg, and I guess I'm now wondering if this is a higher dosage than someone would normally get for a 28 day course of PEP. Can't think of why else they'd be so sure it was only a 7 day course.

I'm planning to fill a prescription for the rest, but I have to say I'm a little worried about any possible medical problems the meds could cause. I started my course on the late side, at 56 hours post-exposure, and I'm just not sure the risks of the medicine paired with the cost of filling the rest will really be worth it. I might feel differently if I had started within 24 hours.

Really kicking myself for getting into this situation in the first place.

Online Jim Allen

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Re: PEP worthwhile?
« Reply #3 on: July 10, 2021, 09:09:28 pm »
The daily dosage, truvada (tenofovir/emtricitabine) one blue tablet daily, plus Isentress 400mg (raltegravir) 1 tablet (often pink) twice daily would be pretty standard.

The 7 days is just a starter pack and you need to fill a prescription for the rest. Regarding the health concerns, generally, people should not be expecting any issues other than perhaps a few days of mild adjustment/settling in but talk to your doctor again if you have concerns.

HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Online Jim Allen

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Re: PEP worthwhile?
« Reply #4 on: July 10, 2021, 09:12:44 pm »
After you have finished PEP (Post Exposure Prophylaxis), waited and tested as per guidelines given, it would be a good idea to have a conversation about PrEP (Pre-exposure prophylaxis) with your healthcare provider as it would provide you with an additional layer of HIV prevention for the future.

« Last Edit: July 10, 2021, 09:15:55 pm by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline j9214

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Re: PEP worthwhile?
« Reply #5 on: September 06, 2021, 11:20:49 pm »
Hi Jim,

Thanks again for your replies earlier this summer. I finished PEP on August 6th, exactly a month ago, and am planning to be tested in 2 weeks.

I understand that physical symptoms are generally not specific to HIV, but over the past few days I've been experiencing pain between my neck and jaw and along my ear. My ear also continues to pop, and it feels like this could be due to swollen lymph nodes. Again, I'm very much trying to focus on the lack of specificity of symptoms and not assume anything is related to HIV, but the timing of these symptoms has made me incredibly anxious.

I know you don't deal with symptoms in your risk assessments, but with someone who was on PEP might you expect to see ARS occurring a month after meds are finished, assuming the PEP failed? Generally I have read that ARS symptoms, if any, would show up a bit sooner, but it seems possible that PEP could've delayed things a bit.

Any thoughts you might have on this would be appreciated.

Online Jim Allen

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Re: PEP worthwhile?
« Reply #6 on: September 07, 2021, 04:24:52 am »
Nothing you mentioned is HIV specific, see your healthcare provider and treat whatever is causing it.

HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

 


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