What is PEP?
PEP stands for Post Exposure Prophylaxis. It is a combination of medicines that can be taken after possible exposure to HIV to prevent someone getting the infection themselves
PEP is available from sexual health clinics and hospital emergency departments (EDs). It should be given as soon as possible after potential exposure to HIV (ideally within 24 hours) but can be given up to 72 hours afterwards.
PEP treatment is a combination of medicines (Tenofovir Disoproxil 245mg/Emtricitabine 200mg plus Raltegravir 1200mg) taken once daily for 28 days. It is only given in circumstances where there is a high risk of HIV transmission, and it only protects against HIV, not other sexually transmitted infections (STIs).
How to get PEP
If you think you have been exposed to HIV and would like to discuss PEP, we advise accessing care as soon as possible. Please call us on 01273 523 388.
Phone line opening times
If you need PEP over the weekend, on a bank holiday or outside of office hours, the best place to go is an ED and ask to start HIV PEP.
- Monday:
- 9.15am to 4.30pm
- Tuesday:
- 9.15am to 4.30pm
- Wednesday:
- 12.30pm to 4.30pm
- Thursday:
- 9.15am to 4.30pm
- Friday:
- 9.15am to 4.30pm
Who is eligible for PEP?
PEP and follow up testing are available for free from NHS services. You do not need to have a Brighton and Hove (B&H) address or to be already registered as a patient with us to attend our clinics for PEP. Similarly, if you need PEP when you are away from B&H, don’t delay accessing services until you return, you can attend any sexual health clinic or Emergency Department (A&E) nationwide to access PEP.
PEP assessment following potential sexual exposure (PEPSE)
PEP is not suitable in every circumstance, so the clinician seeing you will need to ask some questions about the type of sex you have had and the person you have had sex with to assess the level of risk. PEP is not needed if the sex was with someone living with HIV who is on effective treatment, meaning they have an undetectable level of virus in their bloodstream. If you do not have any information about the person you had sex with, a clinician will take as many details as possible to help decide if you need PEP. If you are attending following a sexual assault, we can offer other support and advice alongside a PEP assessment.
PEP is often given following:
- Unprotected receptive anal sex with someone of unknown HIV status.
- Unprotected receptive anal sex with someone who has HIV and is not yet on treatment, or who isn’t on effective HIV treatment (if you are unsure the clinician seeing you will be able to discuss this).
- Unprotected receptive vaginal sex with someone who has HIV and isn’t on treatment, or who’s level of virus in the blood isn’t yet undetectable (if you are unsure the clinician seeing you will be able to discuss this).
PEP is sometimes given following:
- Unprotected insertive vaginal sex with someone known to be HIV-positive with an unknown or detectable level of HIV in the blood.
- Unprotected insertive anal sex with someone known to be HIV-positive with an unknown or detectable level of HIV in the blood.
In other circumstances, including oral sex, PEP is usually not recommended, although it can be discussed with a clinician if you have any concerns.
What will happen when I attend the clinic for PEP?
On the day:
When you attend a clinic asking for PEP we will try to see you as soon as possible to make an assessment. If you are very close to the 72 hour deadline, please let reception staff know so they can alert a member of staff to this.
The clinician will ask a series of questions to assess the risk of HIV exposure. These will include the type of sex you had, any information you have about the person you had sex with, whether you consented to this sex, whether any condom was used. They will also need to know if you have any diagnosed medical conditions, if you take any medications and if you have any allergies. If you are at risk of pregnancy they will ask about any contraception you use and when your last period was. You may also be offered emergency contraception.
It is really important that you let us know if you take any medications, including those bought over the counter or taken recreationally as some drugs can affect the ability of PEP to prevent HIV infection.
Before starting PEP, we will need to do some tests. These will include a rapid point of care HIV test (to check that you do not already have HIV), some blood tests (to check for STIs, immunity to hepatitis A and hepatitis B, and to assess your kidney and liver function) and swab tests for chlamydia and gonorrhoea.
If you have not previously been vaccinated against hepatitis A and B we will offer these vaccines. We may also offer vaccination against HPV if you are eligible and have not had this in the past.
Follow up:
To ensure that the PEP has worked, and that you haven’t acquired any other infections, you will be offered some follow-up appointments for STI testing. These include:
- Chlamydia and gonorrhoea testing 2 weeks after you start PEP (this can be done in clinic or as a home testing kit).
- HIV and syphilis testing 45 days after you have finished your course of PEP.
PEP to PrEP
Starting PrEP after you have finished your course of PEP ensures that you have continuous protection against HIV. If you are planning to start PrEP after you have finished your course of PEP we will see you before, or on day 28 for HIV testing, and transition to PrEP. Depending on the type of risk you may also be advised to have a repeat test for syphilis after 3 months.
What if I am not given PEP?
PEP is not always required or recommended. If you are not given PEP following an assessment the reasons for this will be explained. We will help you make a plan to reduce your risk of acquiring HIV, and ensure you have space to discuss any concerns about STIs. We will also give advice about follow up testing and STI window periods.