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TheBugDoctor
TheBugDoctor, Doctor (MD)
Category: HIV and AIDS
Satisfied Customers: 1731
Experience:  I am a Board Certified Infectious Diseases physician with many years experience treating a broad range of infectious diseases.
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45 hours ago I had unprotected oral sex with a bi male

Resolved Question:

Hello and thank you in advance. 45 hours ago I had unprotected oral sex with a bi male. This encounter was brief (3-5 minutes) but fairly rough. I did not know the person. I went to see my doctor after 24 hours and explained the situation. He was not well versed on the subject of PEP and had to make a call to another Dr. He prescribed antibiotics that would blanket cover stds and also valtrex for possible herpe contact. He then prescribed me Truvada as a PEP medication. He said the risk was minimal that HIV would have been transmitted this way but also said "why not, for peace of mind, take the Truvada as there are no side effects". Essentially saying that there wasnt a risk but since the medication had no ill-effects its best to go ahead and do the 28 day program. I have done significant research online since then and found his assessment to be completely inaccurate. I love my Dr. He is one of the greatest guys I have ever met. Caring and attentive. He knows im a hypochondriac(sp?) and im sure just wanted to put my mind at ease. But his lack of knowledge on the drug is making it hard for me to begin the program. I know i have 72 hours before it is not effective anymore and im starting to panic. So, should i take the Truvada?

The situation again:
5 minutes of rough oral sex given to a bi male who was a heavy precummer. I have no oral/dental problems (i occasionally bite my lips).
Thank you so much for any advice!
Submitted: 5 years ago.
Category: HIV and AIDS
Expert:  TheBugDoctor replied 5 years ago.

My recommendation would be to not take PEP.

 

Oral sex is fairly low risk overall- while I would not say the risk is zero, it is quite low if all you had was oral sex. The benefit of PEP is fairly low in these situations, so that most would not advise it to be necessary.

 

Truvada is in fact fairly safe. It is well tolerated. There are some side effects we see with long term use ( affects on bones, or kidneys) but for a 4 week PEP course, these risks are minimal. Nonetheless, I doubt it would help you.

 

I assume you have been tested for HIV at baseline, to make sure you are negative before this episode- If you are already positive, as well, then Truvada by itself can lead to resistance ( usually we treat with at least 3 medications to someone who is infected).

 

Good luck.

 

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Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

 

Customer: replied 5 years ago.
Thank you again. I fully intend on accepting your response. I just wanted to add a quick follow up. Being saturday, my regular Dr is not in his office. I saw him yesterday as the last appointment in the day so there was little time for consultation once he heard back from the person he contacted in regards XXXXX XXXXX he should prescribe. With that said. I did not have a baseline test. Im scheduled Monday morning for that. Would there be any harm in taking Truvada today and tomorrow then following up with my Dr after the blood test for further discussion? I know the question is redundant considering you have already said the same thing he did. Low-no risk. So im sorry. The fact that this gentleman was "bi" is what is putting me on edge. Also, he ejaculated on my face. There might have been some eye/nose contact (dont know if that makes a difference?) And finally, if your recomendation is to still not take the PEP, is there something i can do with the medication? Its very pricey and I would hate to through it away when someone may be able to benefit from my overreacting... Thank you again so much.
Expert:  TheBugDoctor replied 5 years ago.

If you are on the fence- there is nothing wrong about starting it, until you decide one way or another. There is nothing wrong with taking PEP here. I just meant to say the benefit is likely very low with a low risk exposure. Given the already low risk of oral sex, I still generally do not use PEP in situations like you describe.

 

The estimated risk of infection while performing oral sex , with a KNOWN infected partner is about 1 in 10 000 per the CDC. That's if we know he is infected. Now, if he is not infected, then the risk is zero for HIV.

Then if you think that the risk reduction from PEP is about 80%, the statistics just make this is an intervention where one would be treating a huge number of people to have any benefit at all... The risk is just quite low.

 

As for what you can do with Truvada if you don't take it- That is harder. Yes all HIV meds are quite pricey. And hopefully you will not have use for them in the future.

Once a bottle is dispensed , the pharmacy will not take it make for safety reasons. In my office I sometimes do take samples from patients who no longer need them to potentially give to patients with insurance issues, or those who need immediate access and have some other financial probelms. You may want to talk to your doctor- but his policy may be not to accept it, again out of theoretical safety concerns, since he cannot know that pills were not tampered with ( that's the reality of our world...).

 

Good luck.

 

Always ask if you need clarification/more information.

If I have answered your question, please click the ACCEPT button so I can get credit for my work.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

 

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