PEP Guidelines

Management of Co-Exposures

Sexually transmitted infections (STIs)

Individuals presenting for non-occupational PEP (NPEP) require appropriate targeted testing for chlamydia, gonorrhoea and syphilis as per Australian STI Management Guidelines at www.sti.guidelines.org.au

If symptoms of STI are present, further tests, empirical treatment and follow-up are required.

Hepatitis B (HBV)

All patients presenting for PEP should be assessed for HBV (see Table 4).

HBV-negative individuals

  • Individuals with evidence of previous immunity to HBV (anti-HBs ≥ 10 mIU/mL) ever documented following a complete vaccination course, or past cleared infection who are immunocompetent) require no further follow-up
  • Non-immune individuals (anti-HBs <10 mIU/mL and anti-HBc negative) require HBV immunisation and follow-up (as per Australian Immunisation Handbook)
  • If the person is non-immune (anti-HBs <10 mIU/mL and anti-HBc negative) and the source is known to have chronic HBV (HBsAg positive), a single dose of hepatitis B immune globulin (HBIG) should be administered and hepatitis B vaccination commenced. They will also need follow-up for subsequent serology as per the Australian Immunisation Handbook guidelines.

Hepatitis C (HCV)

All patients presenting for PEP should be assessed for HCV (see Table 4).

There is no current evidence to support any mode of PEP in preventing hepatitis C (HCV) acquisition following exposure to HCV.69 People presenting for PEP who may be at risk of HCV, either from prior risk exposures or from the risk exposure which prompted the presentation for HIV PEP, include:

  • people who have shared needles and other injecting paraphernalia70
  • occupational needle-stick or other sharps injury69
  • MSM71
  • people who have been sexually assaulted72
  • those currently or previously incarcerated.70

Patients potentially at risk of HCV acquisition require baseline and follow-up testing for HCV.

The incubation period for HCV ranges from two weeks to six months, and approximately 80% of people do not exhibit any symptoms. If symptoms develop, they may include fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, pale faeces, joint pain and jaundice. Patients should be informed about these symptoms of acute HCV, with advice to seek specialist review if these occur.70

Highly effective antiviral treatments are available, and early treatment is recommended if HCV seroconversion is detected.70

For further advice, see the National Hepatitis C Guidelines.

Tetanus

Individuals who sustain wounds or abrasions should have their tetanus status assessed and be offered immunisation as indicated.

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