Safer Sex accident / PEP

Sometimes things do not go as planned during safer sex. Condoms can tear or slip off, for example. In the heat of the moment, they might also simply be forgotten.

Immediate Steps After Unprotected Sex

After unprotected sex with HIV-positive individuals, the risk of HIV transmission can be slightly reduced through the following measures:

• For unprotected anal or vaginal intercourse (high risk): Wash the penis under running water with soap. Retract the foreskin and gently clean the glans and the inside of the foreskin without applying pressure to the mucous membrane.
• If semen enters the mouth (low risk): Spit it out immediately and rinse briefly with water four to five times.
• If semen gets into the eye (low risk): Rinse thoroughly with water.

Important: Do not perform vaginal or rectal douches. They can increase the body's absorption of HIV.

Caution: These immediate measures only reduce the risk to a small degree. They cannot replace protection from condoms or, if needed, PEP!

What is PEP?

PEP (Post-Exposure Prophylaxis) is an emergency measure for people at substantial risk of having been exposed to HIV. Panic has no place in moments like this: An HIV infection can still be prevented with a high degree of likelihood. To do this, HIV medications are taken for four weeks. These medications prevent HIV from taking hold in the body. PEP can be considered a "post-risk prevention".

When is PEP recommended?

• PEP is typically performed if you have had unprotected sexual intercourse (anal or vaginal) with a person who:
  • is very likely HIV-positive
  • is HIV-positive and has a detectable viral load (this is not the case with well-managed, successful HIV treatment)

Other situations where PEP may be recommended:

• Healthcare personnel have experienced a needle-stick injury or been cut by an instrument that was previously in contact with the blood of an HIV-positive patient.
• While injecting drugs, someone used a syringe that had previously been used by an HIV-positive person.

When is PEP not recommended?

• Vaginal or anal intercourse with a condom
• Oral sex with or without a condom
• Unprotected vaginal or anal sex with known HIV-positive sexual partners who are undergoing successful HIV treatment and whose viral load is below the limit of detection, because they cannot pass on the virus. Undetectable means Untransmittable (U=U)

Whether PEP is appropriate is determined after a consultation at a clinic or doctor's office.

In the event of a sexual mishap, it can be helpful for partners to attend this consultation to provide information regarding their HIV status, any potential HIV treatment, and possible drug resistance.

Important: PEP must be started as soon as possible after a potential HIV exposure. Ideally, it should begin within two hours, or if that is not possible, within 24 hours, but no later than 48 hours. Whether starting PEP up to 72 hours (three days) after exposure is still effective remains debated. Please do not hesitate to directly contact the appropriate clinic in your area. The medical staff there will go through your options with you and discuss whether PEP is the right step for you.

Where is post-exposure prophylaxis (PEP) available?

Only specialized hospitals and medical practices are experienced with PEP (an overview of suitable locations can be found here). The listed outpatient clinics are open around the clock. During the day, PEP is also available at specialized HIV medical practices.

When in doubt, you should choose the practice or clinic that you can reach the quickest.

If you have questions, the counseling service of the AIDS-Service organization in Germany can help.

In Heidelberg, your main point of contact is the Immunological Outpatient Clinic at the Dermatology Clinic. You are also welcome to visit this clinic outside of regular consultation hours to explain what happened and let them know you would like PEP. They will then direct you to the right place. ▶️ You can find a list of all places that offer PEP here.

What are the side effects of PEP?

PEP is a four-week course of HIV medication. Side effects such as headaches, diarrhea, nausea, and vomiting can occur.