MSM Unprotected sex (insertive) and now freaking out - help!

[stupidindenver]

Ok, so last night I went out with a friend to a bar and got sufficiently drunk. So drunk, apparently, that I thought it was ok to go home with a guy. Long story short, we started to have protected anal sex (I was top). Unprotected oral sex also occurred. Anyway, I pulled out and the condom came off. I reached for another and the bag of condoms fell and for some stupid reason I thought it was ok to go without. He didn't seem averse to it, and after I realized what I had done, I freaked out and ended up leaving. There was no sort of ejaculation on either of our parts.I immediately had a friend drive me to a hospital, where I promptly asked to be tested for stds and HIV. It'd been about 3 months since I last had sex (with my ex of 3 years), so obviously the tests will be accurate up until last night's mistake.
The nurse came in and drew several vials of blood, and sent it off for testing (no clue what kind); it came back negative about an hour later. The doctor did not seen overly concerned with my needing PEP, but left the option up to me. I did take it (viracept, epivir, and Retrovir); I've had a day's worth so far.
I may have scabies, or something that caused bumps on my penis that were possibly open when I had sex. The doc thought it was. The bumps, combined with unprotected anal sex make me nervous that I may have come into contact with HIV. Is the PEP warranted, or can I stop it and just wait for the 3 month test for conclusive results? I only got 3 days' dosage, and the prescription says "if I choose to continue" I can refill. I'm just FREAKED OUT right now, and would prefer to not be possibly subjected to the side effects of the PEP if it's not needed. Of course, I'll continue if it's necessary, but again, the doc did give me the option to take it. What do I do?! Please help!

[Andy Velez]

Hi Denver,

Well, as you now know mixing excessive drinking and casual sex is a really bad idea. Avoid that in the future.

Now, as far as the current situation: HIV is not an easy virus to transmit. The only risk in what you have reported is having had unprotected anal. You have had a single and apparently relatively brief possible exposure. The insertive partner is a significantly lower risk than the receptive partner. Your not having ejaculated does not affect the risk to you. (The risk with that would be to the receptive partner). The possibility of scabies in the situation is not relevant.

The likelihood with a single such exposure is relatively low. It's even lower if you are circumcised. So what it comes down to is what risk you are willing to live with on this. PEP has to be done for 28 days. The countdown for 13 weeks testing for a conclusive, negative result begins with when you complete the PEP regimen. Also PEP often has side effects as the meds are no walk in the park. I say that not to discourage you from taking them but simply to tell you what is.

You had a risk in this situation, albeit a relatively low one. You have to balance that risk with the discomfort you may experience in the coming weeks while taking PEP.

[stupidindenver]

So you think that my choosing to take the PEP was the right choice? If my risk was relatively low in this situation, as you said, then why did the doctor not insist I take it? Should I call her for a follow up before refilling the PEP stuff?

[Andy Velez]

Denver, I can't make this decision for you. The odds are in your favor that you will test negative even without the PEP. Although the risk was low, still there was risk. And HIV is forever. Weigh that against the possible discomfort of the PEP regimen.

Sure, you can ask your doctor an opinion before refilling. And also what possible side effects to expect. Ultimately you are going to have to make the decision yourself.

[Ann]

Stupid,

You need to realise that some doctors are just as ignorant and prejudiced when it comes to hiv as lay people. When this doctor prescribed you PEP, she actually went against the guidelines put forth by leading hiv/aids institutions. PEP is not recommended for an insertive encounter with someone of unknown hiv status.

You'll have to decide for yourself whether or not you want to continue with PEP. I fully expect you to test negative with or without PEP.

Ann

[stupidindenver]

Thanks Andy and Ann. I really can't thank you enough for putting my mind at ease, as well as countless others here. You guys provide wonderful advice to people when they need it most! I've decided to finish up the meds the doctor gave me, and forego further PEP. I hope I test negative, and I'll be sure to post my results at the 3 month mark, and the confirmation at 6. Thanks again guys!   

[Ann]

stupid,

You only need to test at three months for a reliable result - not six months. You can test at six WEEKS, as the vast majority of people who have actually been infected will seroconvert and test positive by this time. A six week negative must be confirmed at the three month point, but is highly unlikely to change.

Ann