PEP overview

Overview

PEP stands for post-exposure prophylaxis. It is a short course of medicines taken as soon as possible after a possible exposure to a serious infection, such as HIV, hepatitis B, or rabies, to try to stop the infection from developing.

PEP is not a common treatment for the general population, but it is a standard medical response for people who may have been exposed to certain serious infections through events like needlestick injuries or high-risk contact.

Anyone who has had a potential exposure to a serious infection, including healthcare workers, people who have had unprotected sex with someone who may have an infection, or someone bitten by a potentially rabid animal, may be offered PEP.

Symptoms

Common symptoms

• There are usually no symptoms from the exposure itself. The decision to start PEP is based on the type of event, such as a needlestick injury or unprotected sexual contact with a person whose infection status is unknown or positive.

Symptoms in children

• Children may need PEP after an animal bite that breaks the skin or after a needlestick injury from a discarded syringe.

Symptoms in older adults

• Older adults may need PEP after a needlestick injury during medical care or after an animal bite.

Causes

Main causes

• PEP is started after a possible exposure to an infection through events like a needlestick injury, unprotected sexual contact, or an animal bite that carries risk of rabies or hepatitis B.

Risk factors

• Working in healthcare or laboratories where exposure to blood or needles is common.
• Having a weakened immune system.
• Living in or traveling to areas where certain infections are more common.
• Engaging in activities that increase the chance of bites from potentially rabid animals.

When to see a doctor

See a doctor urgently if:

• If you think you have been exposed to a serious infection, see a doctor or go to an emergency department as soon as possible, ideally within a few hours. Do not wait for symptoms.

Book a routine appointment if:

• If you are at ongoing risk of exposure (for example, you frequently come into contact with needles or work with animals), talk to your doctor about pre-exposure measures like vaccinations or PrEP (pre-exposure prophylaxis) for HIV.

Diagnosis

PEP is not a diagnosis but a decision made by a healthcare professional based on evaluating the risk of infection from the exposure event.

Tests that may be done

• Blood tests may be done to check for existing infections (like HIV or hepatitis) before starting PEP.
• The doctor may also take a sample from the wound to test for rabies or other infections if relevant.

What to expect at your appointment

The doctor will ask about the event, such as when it happened and the details of exposure. If PEP is recommended, you will be given a course of medicines to start right away. The doctor will explain how to take them and schedule follow-up tests.

Treatment

PEP involves taking a course of medicines for a set period (often 28 days for HIV, or a series of vaccines for rabies and hepatitis B) to prevent the infection from taking hold.

Self-care at home

• Take all medicines exactly as prescribed, without missing doses.
• Keep all follow-up appointments for blood tests and additional doses if needed.
• Report any side effects to your doctor, but do not stop the medicine unless told to.

Medical treatments

The specific medicines depend on the infection risk. For HIV, a combination of antiretroviral drugs is taken daily for 28 days. For hepatitis B, a vaccine and sometimes an injection of antibodies are given. For rabies, a series of vaccines is started soon after exposure, along with a shot of rabies immune globulin in some cases.

When is surgery considered?

Surgery is not part of PEP treatment.

Living with this condition

While taking PEP, you will need to stick to a daily medication routine. You might experience side effects like nausea, fatigue, or headache, which usually improve over time.

Lifestyle tips

• Avoid alcohol and recreational drugs, as they can affect the medicines or your liver.
• Use barrier protection (like condoms) during sex to avoid passing any possible infection to others until you are cleared by tests.

Diet and exercise

Eat a balanced diet and drink plenty of water. Gentle exercise is fine, but rest if you feel tired. If you have nausea, small frequent meals may help.

Mental health and emotional wellbeing

It is common to feel anxious, stressed, or even guilty after a potential exposure. These feelings are normal. Talk to your doctor, a counselor, or a trusted friend. If you feel overwhelmed, seek support.

Prevention

PEP itself is a prevention measure. To reduce the chance of needing PEP, take precautions such as using protective equipment (gloves, goggles) in healthcare, practicing safe sex, and getting vaccinated where vaccines are available.

Vaccines

Vaccines are available for hepatitis B and rabies. Being vaccinated can reduce the need for PEP or change the treatment plan after an exposure.

Screening programmes

Routine screening for infections may be recommended if you are at ongoing risk, such as regular HIV tests for people who are at higher risk.

Complications

If left untreated

• If PEP is not started in time or not completed, the infection may develop, leading to serious illness such as HIV/AIDS, chronic hepatitis B, or rabies (which is nearly always fatal once symptoms appear).

Long-term outlook

When started promptly and taken correctly, PEP is highly effective at preventing infection. Even if infection occurs, early diagnosis and treatment can lead to good outcomes. Most people who complete PEP do not develop the infection.

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