The risk of transmission is low, the risk/ benefit balance is less clear.

The risk should be assessed on a case to case basis taken into account the more detailed knowledge of local HIV prevalence in the index case population and the following factors:

  • more detailed knowledge of the local prevalence in within the index case population
  • breaches in the mucosal barrier such as genital ulcer disease and trauma following sexual assault or first intercourse
  • multiple episodes of exposure within a short period of time e.g. group sex
  • sexually transmitted infection in either partner

 

When PEP is not offered (or offered and then declined)

  • Ensure emergency contraception and follow up pregnancy testing (if applicable)
  • Explore/administer Hep B immunisation
  • Take bloods for storage HIV, Hep B, Hep C and advice on follow up blood tests starting at 45 days post exposure
  • Refer to Sexual Health for testing for sexually transmitted infections commencing 2 weeks post exposure (see referral form within PEP pack)
  • Promote safe sex/avoidance of blood donation until all results at end of follow up are available and negative
  • Advice to seek medical assistance on the onset of any acute illness during the follow up period including any new rash or flu like illness