I am a man, and received condomless oral sex from a transexual that I met on the internet. While she did so, I performed analingus on her. My lips were chapped at the time. The entire experience only lasted a few minutes. However, as I was leaving, I met another man coming into her apartment.
I was freaked out by this experience and went to the hospital the next day to receive nPEP. My doctor advised against it, but said that I could still receive it, and today is the end of my 72 hour window. I'm still very worried; can you advise me? Should I start PEP?
Thank you for your inquiry. From what we gather from the question, you were asking about going on PEP from performing analingus. From the information given, this scenario is determined to be Negligible Risk (There are no evidence or no documented cases of transmission). This scenario is deemed Negligible as bodily fluids can be exchanged.
In order for HIV transmission to occur bodily fluid containing HIV must have direct access to the bloodstream of an individual who is of HIV negative status through a high risk activity.
In this scenario bodily fluid can be exchanged, but no high risk activity occurred. High risk activities include unprotected sex, sharing needles, unsafe tattoos or piercings, or vertical transmission–from mother to child (1).
High risk activities of a sexual nature are either unprotected vaginal or anal sex. If you are engaging in high risk activities there are biomedical approaches such as PrEP and PEP that help lower your risk of acquiring HIV. Refer to your physicians for further information. Since this activity is not considered high risk it is not recommended to take PEP.
PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV (2). Some examples of emergency situations include possible exposure during sex (condomless sex or condom breakage), shared needles and harm reduction products, or if a sexual assault occurs (2). It is not a substitute for regular use of other proven HIV prevention methods, such as pre-exposure prophylaxis (PrEP), which means taking HIV medicines daily to lower your chance of getting infected; using condoms the right way every time you have sex; and using only your own new, sterile needles and works every time you inject (2).
Recommendation: There are no evidence or no documented cases of transmission refer to Physician for more personalized answers. PEP is not needed in this situation.
AIDS Vancouver Helpline/Online, Danielle