• Post-exposure prophylaxis should be recommended, and immediate medical attention should be sought, when an individual reports a known or potential exposure to HIV within the past 72 hours.
• Situations that warrant an immediate referral
  for PEP include:
  • Condomless receptive or insertive vaginal or anal intercourse with a partner living with HIV or a partner whose status was unknown, including intercourse that involved condom slippage or breakage
  • Needle-sharing
  • Injuries with exposure to blood or other potentially infected fluids from a source known to be HIV-infected or HIV status is unknown (including needlesticks with a hollow-bore needle, accidents, etc.)
• For persons presenting with wounds or needlestick injuries
  • The site should be washed with soap and water, avoiding irritation of the skin.
  • The wound should not be “milked” or squeezed. Squeezing the wound may promote hyperemia and inflammation at the wound site, potentially increasing systemic exposure to HIV if present in the contaminating fluid.
• Lower risk exposures that require evaluation by a clinical provider on a case-by-case basis include:
  • Oral-vaginal contact (receptive and insertive)
  • Oral-anal contact (receptive and insertive)
  • Receptive penile-oral contact with or without ejaculation
  • Insertive penile-oral contact with or without ejaculation
• The level of risk in these situations increases with the presence of blood, genital ulcers, STD, or non-intact skin or mucus membrane.

According to CDC PEP guidelines, individuals who report an ongoing risk of HIV exposure (e.g., through injection drug use or condomless sex) or who have used more than one course of PEP in the past year should be provided with resources for HIV prevention, including an assessment for PrEP eligibility.