Most people have heard of emergency contraception (aka the “morning after pill”) but many don’t realize you have a medical option for preventing HIV if you’ve had sex and are concerned about infection. It’s called PEP, and the Nurx medical team prescribes it. We talked to Emily Rymland, DNP FNP-C, Director of Clinical Operations at Nurx, to find out what sexually active people should know.
What is PEP?
PEP stands for post-exposure prophylaxis. It’s a medication you take to reduce your risk of HIV infection if you’ve had sex with somebody who you know has HIV and is not on treatment or whose status is unknown. You must begin within 72 hours for it to be effective, although the sooner, the better, and you take a pill every day for 30 days. PEP works by using antiretroviral therapy (ART) medications, similar to those in PrEP and HIV medication, to stop HIV from entering your cells and replicating. We typically prescribe a medication called Biktarvy for PEP.
What’s the history of PEP?
The first PEP formulations were developed in the 90s and tested in sex workers, then PEP was originally used for healthcare workers exposed to HIV on the job.
Does PEP have risks or side effects?
It is generally quite safe, without major side effects, but you do need to stay in contact with a medical provider while you are taking it. Some people experience some stomach upset for a few days, and you may also experience trouble sleeping. In rare cases people have an allergic reaction but, again, that’s rare.
Who should use PEP?
Anybody who has had vaginal or anal sex with a partner who has HIV but is not on medication and undetectable, or whose HIV status is unknown. PEP is for men, women, and trans people. You may need it when a condom breaks, or when you make a decision that you question in the morning. PEP is also given to sexual assault victims when they seek care at the ER.
How can somebody get PEP through Nurx?
Although PEP isn’t one of our main services and we can’t deliver it in the mail, we will help a patient get PEP if they need it. If you need PEP and think Nurx may be your best option for accessing it, request an STI Home Test Kit or a PrEP prescription through our website or app. You’ll see a question about whether you’re concerned you’ve been exposed to HIV within the past 72 hours. Answer “yes” then complete the process and order an STI Home Test Kit or a PrEP Home Test Kit, which you’ll need to confirm that you’re HIV-negative after you take PEP. We’ll get in touch to get you started on PEP if it’s appropriate, and will call the prescription in to a pharmacy near you. If you don’t have insurance we’ll help you apply for payment assistance through the manufacturer.
We have somebody on call to help with PEP every day, including weekends. This past weekend we prescribed it to three people.
How else can people get PEP?
You can usually get PEP at your local emergency department, urgent care, or STI clinic. If that’s the fastest way for you to get started on PEP, you should do that because, again, you need to start within 72 hours and the sooner, the better. But Nurx is here for patients in the states that we serve if they feel that we are the fastest or safest way for them to access the medication.
How is PEP different from PrEP?
PrEP is a medication HIV-negative people take to stay HIV-negative, it can be taken daily or on-demand, but in both cases it needs to be taken before a sexual encounter to be effective. Although PrEP and PEP work in a similar way, the combination of medications prescribed for PEP is different.
If somebody needs to take PEP is that a sign they should consider taking PrEP?
That is a complicated question, and we can help a PEP patient assess whether they should be taking PrEP. If it was an isolated incident then maybe not. But if you regularly have sex with people with unknown HIV status then, yes, you should probably consider taking PrEP daily to protect yourself. If you are finding that you need PEP more than what you thought then you should definitely consider a transition to PrEP. We have had patients who find themselves in situations where they were unable to consent and may need PEP related to that incident, but that does not mean they need PrEP moving forward. An honest and open discussion with your medical provider may help you determine your risk for HIV and whether PrEP is right for you.
How effective is PEP? How does a patient know if it’s worked?
People who take it need to stay in touch with their healthcare provider and get an HIV test three to six weeks after they begin taking PEP and again about three months later. PEP is not 100% effective but if you begin it as soon as possible within 72 hours, and continue to take your pill every day for 30 days, it’s quite likely to be effective.
When people get PEP through Nurx have they heard of it before?
Not always! We just prescribed it for a young woman who didn’t know it was an option. She had sex with a man who was wearing a condom but he took it off during sex without telling her — which, by the way, can qualify as sexual assault. She came to Nurx to order an STI Home Test Kit and when she answered “yes” to having possible HIV exposure within the past 72 hours we got in touch with her to offer PEP. She was very relieved.
Learn more about PEP and how to request it through Nurx.
For information and guidance related to sexual assault, you can contact the National Sexual Assault Hotline 24 hours a day at 1-800-656-4673. You can also contact the hotline via online chat.
About Emily Rymland
Dr. Emily Rymland, Clinical Development Manager at Nurx, has been a nurse practitioner working in HIV care in Northern California since the early 90s. She was originally drawn to medicine because of the HIV epidemic when many of her friends became ill. She has spent time working in Women’s Health at Planned Parenthood and runs the Buseesa Community Development Centre, a small bush clinic in western Uganda. Emily enjoys working in telemedicine because it increases access for patients, especially those who suffer from the stigma surrounding HIV.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.