Started Prep But I Screwed Up!

[Pitt1988]

So finally after getting insurance, abstinence and getting everything set up; i started Prep March 30th, promised myself id wait till this Tuesday april 5th id wait to try having sex again; then i started talking to this guy on grindr; ended up going to his place last night just to meet and greet, one thing led to another and i ended up just "poking" him; we did not have lube and after i pull out i discover the horror of blood on my dick; at this point i was on pill #4 and shy of 3 more pills to have high levels of protection; he claims he's neg, and i washed off with soap and water very quickly; but im very worried and stressed, and mad at myself for not being more careful considering i only had 3 more days to go!! Anyone can advise me what my ridk level would be? Im just concerned about the 7 day waiting period, thanks

[simpleguy305]

I would take two pills today... 

 

And you are probably fine unless you have an open sore on your dick....

[Pitt1988]

I didnt have one, i never have actually, and i stopped fucking right away after i noticed the blood and washed off, i will consider the double dosage, thanks for the advice

[fillmyholeftl]

Don't "DOUBLE DOSE" ...  Just keep taking your regular dosage.  You'll be fine.

[Pitt1988]

Are you sure lol? I wonder what percentage of protection i have with 4 pills, i looked online and its between 75% - 92% but having blood contact really scared me; i should have brought lube just in case....

[bearbandit]

It's just possible that his last test was negative - being poz doesn't automatically turn you into a liar  . But assuming he's poz and has a high viral load, then even without PrEP, your chances of infection are considerably less than 1.4% which is the rate for having someone with a high VL cum in your ass. However, the four days you'd already taken truvada for, it strikes me, would be equivalent to the event-based dosing that some European studies propose (a double dose two hours beforehand and one at 24 hours and another at 48 hours). 

Yes, what you did falls outside of the maximum protection bellcurve; hell, one poor guy seroconverted despite being completely adherent, which is why you never claim anything in medicine is 100%. Although the doctors drum it into you "never miss a dose", that along with "seven days to maximum protection" can be taken with a dose of salt. For people with HIV the doctors are happy if you're 95% adherent, which suggests that the drugs are effective at a lower adherence rate, though I wouldn't like to experiment to find out...

In real life terms, you've run across a road without looking properly, but you're still here to write about it. What happened falls outside of the doctors' idea of what's safe, but they're considerably more cautious than the rest of us. Don't double dose: what happened wasn't risky enough for that - in the UK if the prescribing doctor thinks the risk that's been taken isn't high enough truvada only (no supporting drug from another class) will be prescribed for PEP. Instead, use this as a lesson: if, for any reason you have a break from truvada, wait the full seven days before letting yourself get into anything sexual. To be honest, I think you've done yourself more harm by stressing over the incident... Just keep taking the pills!

[nastybottom]

^ bearbandit: Just wanted to say thanks for all your valuable contributions to this board. You're always helpful and informative, and it's appreciated.

[Pitt1988]

Thanks for all the info and insight bearbandit; appreciate it

[6811283]

But assuming he's poz and has a high viral load, then even without PrEP, your chances of infection are considerably less than 1.4% which is the rate for having someone with a high VL cum in your ass. 

I think actually 1.4% is the *average* risk bottoming for an HIV+ top without protection, not for high VL specifically. In case of acute HIV infection (from a recent, untreated infection) the CDC calculates that risk is increased by a factor of 7.25. See: https://wwwn.cdc.gov/hivrisk/about_the_data.html

Edited May 7, 2016 by 6811283

[bearbandit]

Thanks guys, and especially 6811283 for pulling me up on my statistical error: I got as far as sums at school and never progressed to maths. I usually avoid statistics 1) because I'm lousy at the maths involved and 2) one thing I do understand is that 1 in 1000 does not mean you can do whatever it is 999 times in complete safety. By the "law of averages" I should have died sometime in 1993, and I should have been able to take considerably more tenofovir than I did without damage. Living cannot be reduced to a set of numbers