Should I consider a PEP

[worriedguy343]

Doctor -
Thank you for your time.
I am a bisexual male.  I got drunk last night and ended up having sex with a transexual sex worker.  We had unprotected oral, I had receptive anal, and she/he came on my abdomen.  I was extremely adamant about her wearing a condom for the anal sex.  I saw her put a condom on and I feel like she wore it the entire time.  We stopped and started a couple different times so a couple different condoms were used.

After the sex I mentioned that I had just gotten a negative HIV test.  I asked her about her status and she looked scared and like she was hiding something and wouldn't tell me.  I know fear the worst.  I called her back again today to see if I could claify her status, but she has been unresponsive.

I am now second guessing that maybe the condom slipped off or ever worse my partner took it off during the sex and I didn't realize it because I was drunk.  I don't think that is what happened but I now fear that maybe I wasn't careful enough.

Knowing this, would you reccomend me going on PeP?  I am conerned with the cost as I don't really have the money, but I would rather come up with the money and not get HIV.  

Thank you for your help

[Edward W Hook, MD]

Most people tell the truth.  If a condom was used, you are not at risk.  Testing, using whichever test you used will likely prove this.  EWH

[worriedguy343]

Nevermind... I was able to make an appt at the local clinic and they are going to give me a viral load test in 2 weeks.

[worriedguy343]

So I spoke to the sex worker and she said the condom was intact the whole time.  I am now outside my 72 hour window as of early this a.m.  I called my local clinic yesterday and they didn't call me back.    If they call me back today and I can set an appointment does it even make sense to go on a Pep over 72 hours?

I am sure to be riddled with anxiety of the next 8 weeks to 3 months...
What are the percentages of people that show positive after 4 weeks, because I want to start getting tested at the soonest relevent time...

[Edward W Hook, MD]

Welcome to the HIV Prevention Forum.  For all practical purposes your questions needs to be decided on the basis of the answers to two questions- Did she have HIV and was a condom used during anal intercourse.  There is virtually no risk related to the oral sex.  Even if she had HIV, if a condom was used throughout the anal sex and it did not break, then there is nothing to worry about. On the other hand, if a condom was not used, came off or broke, the question comes down to whether or not she had HIV.  If she had HIV and a condom was not used, your risk of infection is about 1 in 100.

This, my preference would be for you to be able to have a talk with her. The sex is done, now you just want to know what precautions you need to take.  If that cannot be done, given her evasive behavior, you may choose to take PEP.

With respect to PEP, this is always a personal decision.  PEP is expensive and there are side effects although the current regimens have fewer side effects that they used to.  If you choose to go with PEP, please get it from a health care provider who will commit to follow you following starting PEP to answer questions and follow your progress.  All too often some physicians think their responsibility is done when they write the prescription. It is not.

I realize I haven't given you a straight up or down answer but I hope the questions I have posed with help you. If you choose to go the PEP, it should be started within 72 hours of exposure.  I don't mean to add to your pressure but the timing is important.  EWH

[worriedguy343]

Also, she did not cum during oral or anal.  It was afterwards on my abdomen.(if that makes any difference)