BASHH HIV PEP Guidelines for Community (Non‑Occupational) Exposure (PEP / PEPSE)
Overview
PEPSE (post‑exposure prophylaxis following sexual exposure) is a time‑sensitive intervention to reduce the risk of HIV acquisition after a single potential exposure. In the UK, BASHH guidance is the specialty standard for sexual exposures and is supported by national expert advice (EAGA) and government guidance.
Emergency departments (EDs) and Sexual Assault Referral Centres (SARCs) are frequently the first point of contact: rapid assessment, timely provision of a starter pack and urgent referral to sexual health services are essential (EAGA; NICE NG68).
Indications and timing
Offer PEPSE when risk assessment identifies a clinically significant chance of transmission from a single exposure. Examples include:
- Condomless receptive or insertive anal or vaginal sex with a source of unknown or HIV‑positive status.
- Sharing injecting equipment.
- Sexual assault with plausible exposure.
PEPSE must be started as soon as possible and no later than 72 hours after exposure; the sooner it is started the greater the likely benefit (NICE NG68). Do not delay initiation to wait for laboratory results if the presentation is within the window and PEP is indicated (EAGA).
Risk assessment - key elements Consider and document:
- Time since exposure (critical).
- Type of exposure (receptive anal intercourse carries the highest per‑exposure risk).