Background: Prompt post-exposure prophylaxis (PEP) with proper antiretroviral drugs (ARVs) is effective in reducing HIV transmission after occupational exposures and might be effective following sexual exposures. The National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) provides exposure management consultation to clinicians managing occupational and non-occupational exposures based on Public Health Service guidelines. We reviewed calls to the PEPline to characterize current management of sexual exposures.

Methods: All sexual exposure calls to the PEPline for the period 1/1/04 to 8/30/05 were reviewed. We analyzed characteristics of the exposure, exposed, source, and treatment recommendations for calls concerning specific sexual exposures.

Results: Of 12,895 total PEPline calls, 944 (7%) involved sexual exposures. 64 calls were general questions; 880 concerned specific exposures.  Of the 880 exposure calls, 485 and 283 involved consensual and non-consensual contact, respectively. 113 calls concerned exposed persons already on treatment; the remainder were not on treatment at the time of the call. Calls came primarily from emergency physicians (168) and family physicians (183). Exposed persons were as likely to be men as women, while source persons were predominantly men (76%). 95 exposed persons (11%) were 19 years old or younger; 7 (8%) were younger than 13.  Of the 880 specific exposure calls, nearly all calls concerned exposures that met criteria for PEP. 283 calls (32%) came in within 24 hours of the exposure, 259 (29%) between 24 and 72 hours, and 248 (28%) more than 72 hours after the exposure.

Conclusions: Time from exposure to PEP decision was longer than current guidelines recommend among the majority of exposures for which the PEPline was consulted. Prompt consultation with experts, including the PEPline, can be essential to ensure that treatment, when indicated, occurs within a time frame recommended by the guidelines.