Condom broke, what next? PEP usage with a partner of unknown status
December 3, 2014 3:34 PM   Subscribe

I'm a late-thirties bi man who's relatively new to having sex with men - like, total partner count under 5. Last night I went home with a guy I sort-of knew, which is not something I've ever done before. The condom broke while I was bottoming and he didn't notice until afterwards. What next?

He says he's clean and was tested less than six months ago, but he also said he was OK with me not wearing a condom when topping him when I said I was negative, and thought it was weird that I insisted on a condom when giving him head (and maybe that is?), so I don't entirely trust his self-evaluation. However, I kind of know him from the community we're both in and word about status does get around, and I haven't heard anything.

I've talked to my doctor, and he initially recommended not getting PEP (post-exposure Truvada), but then talked to the staff HIV expert and they said that "if I was calling, it was worth getting PEP". However, I've been out of work for a few months and have a really crappy health plan, so paying $1500 for the meds and dealing with side effects while I'm job hunting is going to be pretty difficult. However, I could do it.

Despite being pretty old, I'm really inexperienced going out with guys. I was a little bit outside my comfort zone anyway, but he was younger and really hot and hitting on me hard, and I'm at a point in my life where I wanted to step out a bit. I'm pretty sure I'm more concerned than average about this, and maybe more than I should be, and I don't really have anybody experienced that I can talk to about this.

So my questions after all that are: what's the typical way to handle a possible STI exposure with a partner who says they're negative but you're not entirely sure that you trust? Particularly within the gay community? Is getting PEP a super-common thing in a situation like this, or am I being overly paranoid?
posted by anonymous to Health & Fitness (17 answers total) 1 user marked this as a favorite

You mentioned the cost. Did you talk to their social work person? There is a copay assistance program for truvada as well as access for those without insurance.
posted by Ms Vegetable at 3:43 PM on December 3, 2014 [1 favorite]

I would say that PEP is pretty uncommon among the gay guys I know, but that you shouldn't let that influence your decision. As I'm sure you're aware, you need to start PEP as soon as possible for it to be effective. Are you in an urban area? Can you talk to your local Gay and Lesbian Center to see if they can help subsidize your Truvada?
posted by roger ackroyd at 3:44 PM on December 3, 2014

I know you are going through a lot right now, but if you are worried about the possible exposure and an make it happen financially* and are worried about the possible exposure, I think that the piece of mind would outweigh the side effects of Truvada. I'm not guaranteeing they'd be minimal, but they definitely are for some people.

* I too would recommend finding a copay assistance program -- I make enough money and have good insurance and still have my medications covered through one.

If you have any other questions, please feel free to reach out to me over MeFiMail or over the email address in my profile (anonymously or otherwise)
posted by MCMikeNamara at 3:52 PM on December 3, 2014 [2 favorites]

Can you find somewhere offering the rapid HIV test (mouth swab) and go with him to both get tested on the spot? You can get results in just a few minutes around here, not sure about your area.

Like the regular tests it won't pick up people who have become positive recently, but for something like this I think it would be very helpful.

I would also suggest asking him more details about his recent sex partners and condom use, if possible. Getting a negative result six months ago is great if you haven't had any sex partners in between, but not so helpful if there have been any since then, especially unprotected. He won't necessarily tell the truth, but it's worth asking.
posted by randomnity at 3:59 PM on December 3, 2014 [1 favorite]

If it were me, I would find a way to do the post-exposure prophylaxis. Why? It would give me some peace of mind. In my experience, grilling people about their sexual history and unknowns about their status just doesn't help. It doesn't give you any certainty or satisfaction. What he knows or understands about himself isn't conclusive.

If it helps to hear, you're likely going to be just fine. HOWEVER, I don't think your concern is outsized in the slightest. Many people I know would be greatly concerned, and would be in the ER getting PEP already. I would be. And talk to them about how you can't afford it and see what can be done.
posted by RJ Reynolds at 4:10 PM on December 3, 2014 [9 favorites]

Gilead, the maker of Truvada, has a website devoted to their co-pay coupon program. I think they cap the assistance at $300/month, but even that could help.
posted by roger ackroyd at 4:21 PM on December 3, 2014 [2 favorites]

In my state, there is an organization called RAIN that provides free testing and treatment services, as well as case management and care facilitation for individuals who need ongoing assistance after testing positive. There may be a RAIN in your state or something similar, I bet they could help direct you to a similar local resource if you give them a call, as well as providing some general advice on your next steps.
posted by rubster at 4:25 PM on December 3, 2014 [1 favorite]

If I were in this position, I would take PEP. It bothers me that he would have been okay with you topping him bareback, just because you'd said that you were negative. I know of at least a couple of gay men in my social circle who have taken PEP because they had unprotected sex with a partner of unknown status. I know of other people who have chosen not to take PEP and have been fine. I don't think it would be at all "overly-paranoid" for you to take PEP. And it would be awful if you chose not to take it and got a positive test back in a couple of months.

I know this wasn't really a part of your question, but it stood out to me that you seem to be a bit unsure about STIs and safer sex. I think it would be really good for you to do a bit of reading about this and, if possible, to talk to some kind of outreach organisation for gay and bisexual men, so that you can work out what your boundaries are and stick to them. For example, you might do a bit more reading and realise that you're actually comfortable with the small risk that accompanies uncovered oral. Or you become more certain that you want to keep using condoms for everything, and end up going home with someone one day who doesn't take well to a request for covered oral. Will you be able to stick to your guns, or will you feel pressured to give in?

Using condoms for oral is very rare amongst the majority of people, because as far as sex goes, it is a lot less risky than anal and vaginal sex. As far as I can tell from my previous reading, the likelihood of contracting HIV from oral sex is extremely, extremely low. But there is some risk of gonorrhoea and, I believe, syphilis.

Here is a page that you might find helpful.

And if you haven't had it already, I recommend getting the Hep B vaccine :)

posted by kinddieserzeit at 4:56 PM on December 3, 2014 [3 favorites]

I believe the Post-Exposure Prophylaxis (PEP) hotline is exactly for your situation. If you are in the US you can easily call them right now, (888) 448-4911, they are open until very late. If you're not in the US the site still has useful resources online. And if you can figure out how to dial a US toll free number from where you are I bet they'll be glad to help you.

I can't give you advice on your medical question, I'm mostly writing just to express my sympathy and support. I have several friends who are bi men and have come out later in life and I am sympathetic to the challenges.

It's normal to be paranoid and "more concerned than average" about HIV exposure and you're smart to seek out help. If the hotline doesn't help, I suggest you go right away to a local gay / HIV clinic and tell them your story and ask for their advice. You don't list your location, this website has a list of US HIV testing locations. Planned Parenthood is also a good resource. Often the free clinics are busy; tell them about your concern about recent exposure and PEP and you need to talk to someone rapidly.

You are totally in your rights to ask your partner to get tested again, but that probably won't help solve any immediate questions or decisions.
posted by Nelson at 5:00 PM on December 3, 2014 [6 favorites]

Oh and I will add: one of the guys I know who have taken PEP, let's call him Pete, asked the guy he slept with, let's call him Jay, to get tested. Jay got tested and the test came back negative, so Pete stopped taking PEP before the end of the course. But that was only because Jay and Pete had been exclusively dating for a couple of months, so Pete was quite certain that Jay's test was accurate and up-to-date.

Because of the window periods for the different tests (varying from as little as 9 days, I believe, for a test that looks for the virus, and at least 6 weeks for a test that looks for antibodies), if the guy you slept with has had unprotected sex recently, it's also possible that any test he takes now can't really be considered up-to-date. So I think that you should take PEP (or not take it), based on your own judgement of the situation. Don't change your mind based on any test he has or hasn't taken.
posted by kinddieserzeit at 5:14 PM on December 3, 2014 [1 favorite]

In addition to the great advice above, I'd note that one of the reasons one needs to be careful about taking people's word that they "tested clean" is that sometimes people indeed mean that they had an actual test at a real place and came back for their results which were negative ... and sometimes they mean something completely disconnected like they gave blood at their office blood drive and therefore they are "clean" because the blood gets tested, right?
posted by Dip Flash at 5:54 PM on December 3, 2014 [3 favorites]

Nthing calling a hotline--in addition to the PEP hotline, here is another list of a few resources in SF and nationwide.

The SF Sex Initiative hotline on that page might be a good starting point to talk with, generally. It's awesome that you're getting to explore another side of your sexuality, and as kinddieserzeit noted, it sounds like you have some questions that might be well-answered by non-judgmental experts. Feel free to memail me if you'd like more resources.

Another thing to consider about testing is that the results done on X day only show exposures that happened 6+ weeks ago, and not since then. That is, if I test you today for HIV, it will only show me if you were exposed 6+ weeks ago, not yesterday or last week. It can take 3-6 months (rarely, 12 months) for the virus to show up in testing, and this is why re-testing is recommended for high-risk exposures or patients.

Take care.
posted by stillmoving at 6:58 PM on December 3, 2014

Personally I would try and find some way to start PEP because "The condom broke while I was bottoming and he didn't notice until afterwards" sends up warning flags for me, especially considering he was OK with you not wearing a condom when topping. He might be a nice, honest guy, but Stealthing is a thing.
posted by FreezBoy at 7:31 PM on December 3, 2014 [3 favorites]

So... the problem is that the pool of people who say they're "negative" includes both the lowest-risk partners (actually HIV-, zero risk) and the highest-risk partners (recently seroconverted, inside the window period or just untreated). You're way less likely to get HIV from unprotected sex with an HIV+ but undetectable partner (the risk here may actually be near zero) than from someone who thinks they're negative but is actually positive: this is because 1. HIV meds reduce viral load dramatically and 2. people are most infectious right around seroconversion. Given that your sex partner seemed sort of cavalier about safe sex, I don't think your concern is unfounded, especially since unprotected bottoming is in the highest risk category.

You may take a little comfort in the fact that on a per act basis, even unprotected bottoming is not by any means a sure thing: it's around 1.5%, given that your partner was HIV+.

About your two medical opinions - I'd be more inclined to trust an HIV specialist than a primary care physician, especially if your PCP is not gay/bi/a guy who has sex with guys and doesn't specialize in those issues. The advice to call the hotline is good, too (you might also see if anyone at has answered a similar question).

If it were me, I would probably get PEP. I am also very risk averse when it comes to sex (maybe pathologically tbh) and I have good health insurance, and you should be aware that PEP side effects are no joke. However, one-off and unintended exposure with a partner of unknown status (which I think it's fair to call this guy, given his behavior) is a totally reasonable reason to get PEP, both IMO and according to CDC guidelines [PDF].

You also need to jump on this fast if you want it to happen: after 72 hours it's pretty much useless, and the sooner in that window you start, the more protection you get.

Good for you for taking your sexual health seriously! I wish more people did. I'm sorry you're going through this and I hope everything works out for the best for you.
posted by en forme de poire at 8:41 PM on December 3, 2014 [6 favorites]

thought it was weird that I insisted on a condom when giving him head (and maybe that is?)

BTW, wanted to respond to this - it's uncommon in my experience (having gay sex) for anyone to offer, much less insist, to use a condom during oral sex. But it's far from unreasonable, and I actually wish it were more common, since syphilis and gonorrhea can still spread to the receptive partner in oral sex. (There are also risks for the insertive partner, which condoms can help alleviate.) Dr. K at the SF City Clinic has a good chart here.
posted by en forme de poire at 8:50 PM on December 3, 2014 [2 favorites]

(BTW, just to follow up, if you need a gay dude (and former HIV and sexual health counselor) to talk to about this or anything else related, please email me at the address in my profile.)
posted by RJ Reynolds at 6:18 AM on December 4, 2014 [1 favorite]

In your situation, I would 100% do the PrEP, even if it meant taking out a loan or eating ramen to get it. HIV is far, far more expensive than truvada is.
posted by zug at 10:55 AM on December 4, 2014 [1 favorite]

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