Postexposure prophylaxis 385

The precautions listed below should be considered very seriously and applied conscientiously in order to achieve a reduction of risk. And, of course, the fewer sexual partners one has, the smaller the overall risk. The most important elements that can make otherwise "unsafe" sex somewhat less risky are condoms and certain spermicides and lubricants. Their use does not guarantee complete safety but, in general, condoms and spermicides can and will play an important role in reducing the risk of infection with the AIDS virus. The following practices remain only "possibly safe" or "possibly unsafe."

Condom use is considered only "possibly safe" and not absolutely safe, as they are often used incorrectly. To correctly use a condom, always use new condoms. Keep a ready supply of condoms where they cannot be damaged by moisture or heat. Never test a condom by blowing it up. Put a dab of lubricant into the tip of the condom to increase sensation. Prevent any air bubbles from forming that could cause the condom to break. Put the condom on the fully erect penis and roll it down all the way to the bottom of the shaft. Generally, lubricate the vaginal entrance or the anus before entry. Use only a water-soluble lubricant. Upon withdrawal, hold tightly onto the base of the condom. After use, throw the condom away. Use a lubricant that contains nonoxynol-9, a mild detergent that kills not only sperm cells but also all kinds of other organisms, such as amoebas, the herpes virus, bacteria that could cause gonorrhea and syphilis, as well as the AIDS virus.

Vaginal intercourse should be somewhat safe if the man uses a condom correctly and the woman uses a spermicide containing nonoxynol-9. This double precaution does reduce risk of infection and is strongly recommended whenever partners cannot be completely certain if either of them carries the virus.

Generally speaking, using a condom during anal intercourse does not offer the same level of protection as with vaginal intercourse. Nevertheless, a lubricant containing nonoxynol-9 should still be used as it does further reduce the risk. one should never use the same condom for both anal and vaginal intercourse.

French kissing, also called deep kissing or tongue kissing, is not considered completely safe, even though there has been no known case of HIV transmission in this way. The AIDS virus has been found in saliva, albeit in very low concentrations. An infection through kissing therefore is not very likely. If one of the partners carries the virus and the other suffers from bleeding gums or other injuries within the mouth, there could be danger. It seems wise, therefore, to consider long and intimate deep kisses to be somewhat risky.

oral intercourse with precautions is also considered "possibly safe" (oral intercourse with no precautions is definitely unsafe). Sucking the penis is also considered "possibly safe." One way of reducing the risk of infection is to avoid swallowing semen. One should also avoid swallowing the clear pre-ejac-ulatory fluid. A better practice is to suck the penis after it has been thoroughly covered with a condom.

Licking the female sex organs is also considered "possibly safe." Using spermicides containing nonoxynol-9 in and around the vaginal opening or licking it through the covering of a dental dam are two safer options.

Playing with urine ("golden showers") is also considered "possibly safe." As long as urine comes in external contact only with unbroken skin, there should be no risk of infection. It is sometimes difficult to be certain that the skin is intact everywhere. Slight cuts, bruises, or pimples are easily overlooked. Therefore persons playing with urine, even if only externally, need to be extremely careful.

post hoc analyses Analyses conducted after results that were not defined before the start of a clinical trial are available. Such analyses are particularly prone to false-positive claims or type I error.

postexposure prophylaxis (PEP) Administering of drug treatment to prevent disease after an individual has been exposed to an infectious organism. Sometimes referred to as the "morning-after pill" for individuals with unanticipated sexual or injection drug-related exposures to HIV, PEP is a compelling prevention intervention because it may prevent an exposure to HIV from becoming an established infection. Nonetheless, PEP is not as simple as swallowing a pill. The theory underlying the use of PEP is that antiviral treatment instituted immediately after exposure may abort the infection by inhibiting local HIV replication and by allowing the host's immune system to eradicate virus from the inoculum. Information about early HIV infection suggests that HIV can take several

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