Indiana University-Purdue University Indianapolis (IUPUI) Endodontic Regeneration Graduate Endodontic Department / Introduction: Regenerative endodontic procedures are used to treat immature teeth with pulpal necrosis in order to control infection, enable continued root development and enhance formation of a pulp like tissue in the canal. Canal disinfection is an integral part the regenerative endodontic process. Double antibiotic paste (DAP; i.e., equal parts of ciprofloxacin and metronidazole) has been successfully used for canal disinfection in regenerative endodontics. A comparison of the residual antibacterial effect of dentin treated with various dilutions of DAP pastes on biofilm formation has not yet been investigated thoroughly. Objectives: The aims of this in-vitro study were to investigate how concentration and time of treatment affect the residual antibacterial properties of DAP in preventing E. faecalis biofilm formation on human dentin. Materials and Methods: Extracted human teeth were used to obtain 4x4mm radicular dentin specimens. Each specimen was pretreated for 1 or 4 weeks with the 77 clinically used concentration of DAP (500 mg/mL), low concentrations of DAP (1, 5 or 50 mg/mL) loaded into a methylcellulose system, calcium hydroxide (Ca(OH)2), or placebo paste. After treatment, samples were rinsed and placed in sterile phosphate buffered saline (PBS) for three weeks. Samples were then inoculated with cultured E. faecalis and incubated in anaerobic conditions for three weeks to allow mature biofilm formation. The dentin samples were rinsed and biofilms detached. The detached biofilm cells were then diluted and spirally plated for enumeration on blood agar plates. The plates were then incubated for 24 h and the number of CFUs/mL was determined using an automated colony counter. Data was analyzed using Fisher’s Exact and Wilcoxon rank sum tests were used for statistical comparisons (α=0.05). Results: Dentin pretreatment for 4 weeks with 5, 50 or 500 mg/mL of DAP demonstrated significantly higher residual antibacterial effects and complete eradication of E. faecalis biofilms in comparison to a 1 week pretreatment with similar concentrations. However, dentin pretreated with 1 mg/mL of DAP or Ca(OH)2 did not provide a substantial residual antibacterial effect regardless of the application time. Conclusion: Dentin treated with 500, 50, or 5 mg/mL of DAP for 4 weeks was able to completely prevent the colonization of bacterial biofilm. Four-week treatment of dentin with DAP offers superior residual antibacterial effect in comparison to a one-week treatment. Intracanal application of DAP for 4 weeks during endodontic regeneration may offer an extended residual antibacterial effect.

Indiana University School of Dentistry Department of Endodontics / Introduction: Triple antibiotic paste (TAP, 1000 mg/ml) is composed of equal portions of ciprofloxacin, metronidazole and minocycline and is used as an intracanal dressing to disinfect the infected immature root canal during endodontic regeneration procedures. Lower concentrations of TAP have been recommended to minimize detrimental effects on pulp stem cells. TAP can be retained within the dentin matrix and its continual release confers an antibacterial effect to the dentin. Objective: The aim of this in vitro study was to investigate the residual antibacterial effect of dentin treated with various concentrations of TAP loaded into a gel system. Materials and Methods: Radicular dentin slabs were prepared from human teeth after obtaining IRB approval. The slabs were sterilized and treated with methylcellulose-based TAP of 100 mg/mL, 10 mg/mL, 1 mg/mL, 1.5% NaOCl, placebo paste with no TAP, or a positive control group with pure 1000 mg/mL TAP. Samples in each group were treated with the assigned TAP concentration for three weeks or immersed in 1.5% NaOCl for five minutes (n =18 per group). All samples were then irrigated with sterile water followed by 17% EDTA and incubated in phosphate buffered saline for either 2 or 4 weeks. Samples were then inoculated with Enterococcus faecalis and incubated for an additional 3 weeks. Biofilm formed on each sample was then dislodged and spiral plated to evaluate the bacterial colony-forming units. Data were analyzed using Fisher’s Exact tests and Wilcoxon rank sum tests (α = 0.05). Results: Dentin treated with 10, 100, or 1000 mg/mL of TAP demonstrated significant residual antibacterial effects up to four weeks. However, only 100 mg/mL TAP was able to completely prevent bacterial colonization after four weeks. No considerable residual antibacterial effect was observed in dentin treated with placebo gel, 1 mg/ml TAP or 1.5% NaOCl. Conclusion: At least 10 mg/mL of TAP loaded into a methylcellulose system is required to achieve a substantial residual antibacterial effect for four weeks.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13166号 / 論医博第2153号 / 新制||医||1029(附属図書館) / (主査)教授 一山 智, 教授 松原 和夫, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: År 2020 efterlyste Statens beredning för medicinsk och social utvärdering, (SBU), en uppdaterad litteraturöversikt gällande effekten av kontrakturprofylax. Kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet utgör populationen där kontrakturprofylax är en del av den fysioterapeutiska interventionen och då oftast i form av passivt rörelseuttag.  Syftet: Denna systematiska översikt syftar till att undersöka effekten av kontrakturprofylax som förebyggande och behandlande åtgärd för vuxna individer med kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet. Syftet utöver det var att sammanställa resultatets vetenskapliga kvalitet och tillförlitlighet. Metod: En systematisk översikt över RCT-studier producerade mellan 2013 och 2023, där interventionen syftar till att förebygga eller behandla kontrakturer. Artiklarnas kvalitet granskades med PEDro skalan och det sammanvägda resultatets tillförlitlighet granskades med den studentanpassade versionen av GRADE. Kvaliteten var genomgående hög medan det sammanvägda resultatet har en låg sammanvägd tillförlitlighet. Resultat: Sju artiklar med ett totalt deltagarantal på 367 granskades. Kvaliteten varierade bedömt utifrån PEDro mellan 7 och 10 poäng, samtliga studier inkluderades i den sammanvägda bedömningen av tillförlitlighet. Sammanvägt hade studierna låg tillförlitlighet, detta på grund av bristande samstämmighet och överförbarhet, precisionen ansågs acceptabel.  Slutsatser: Det går inte att dra slutsatser gällande enskild effekt av kontrakturprofylax i form av passiv rörelseträning. Samtidigt framkommer inte något underlag för att kontrakturprofylax skulle negativt påverka andra interventioner. Det behövs mer forskning inom området och mätning av ledrörlighet och definition av kontrakturprofylax bör även standardiseras för ett mer överförbart och samstämmigt resultat. Denna studie kan således inte konkludera om en fysioterapeut bör använda kontrakturprofylax, vare sig som förebyggande eller behandlande åtgärd. / Background: In 2020, the State's preparation for medical and social evaluation, (SBU), called for an updated literature review regarding the effect of contracture prophylaxis. Chronic neurological conditions that have caused a reduction in active mobility make up the population where contracture prophylaxis is part of the physiotherapeutic intervention and then usually in the form of passive range of motion. Aim: The aim of this systematic review was to investigate the effect of contracture prophylaxis as a preventive and treatment measure for adults with chronic neurological conditions that have caused impairment of active mobility. The purpose, in addition to that, was to compile the scientific quality and reliability of the results. Method: A systematic review of RCT-studies produced between 2013 and 2023, where the intervention aims to prevent or treat contractures. The quality of the articles was reviewed with the PEDro scale, and the reliability of the combined results was reviewed with the student-adapted version of GRADE. The quality was considered high, while the summarized result had a low reliability. Results: Seven articles with a total number of participants of 367 were reviewed. The quality varied as assessed based on PEDro between 7 and 10 points, all studies were included in the combined assessment of reliability. Summarized, the studies had low reliability, this due to a lack of consistency and transferability, the precision was considered acceptable. Conclusions: It is not possible to draw conclusions regarding the individual effect of contracture prophylaxis in the form of passive movement training. At the same time, there is no evidence that contracture prophylaxis would negatively affect other interventions. More research is needed in the field and measurement of joint mobility and definition of contracture prophylaxis should also be standardized for a more transferable and consistent result. This study cannot therefore conclude whether a physiotherapist should use contracture prophylaxis, either as preventive care or as treatment.

Antibiotika är ett viktigt läkemedel vid behandling av orala infektioner orsakade av bakterier. Läkemedelsverkets riktlinjer ska fungera som stöd och vägledning för tandläkare angående ordination av antibiotika. I behandlande syfte rekommenderas antibiotika till patienter med påverkat allmäntillstånd och/eller tecken på infektionsspridning. Vid dessa tillfällen ordineras främst fenoximetylpenicillin (PcV). När det gäller antibiotikaprofylax ordineras det med syfte att minska risken för fjärrinfektioner. Förstahandsvalet vid profylax är amoxicillin. Syfte: Syftet med denna studie är att kartlägga tandläkarnas antibiotikaordination för vuxna patienter vid Tandvårdshögskolan i Malmö år 2015-2017 genom att undersöka och analysera på vilka indikationer en ordination gjorts och ifall den överensstämmer med aktuella rekommendationer från Läkemedelsverket.Material och metod: Studien utfördes genom att granska patientjournaler där antibiotika har ordinerats. Journaler togs fram genom en term-sökning i journalsystemet T4. Sökningen omfattade en treårsperiod (2015-2017). Data sammanställdes och analyserades i tabeller och diagram.Resultat: Resultatet visar att majoriteten av antibiotikan ordineras i profylaktiskt syfte och främst i samband med implantatinstallationer. I behandlande syfte ordineras antibiotika till största del till patienter med svullnad, med eller utan abscess, och smärta. Under perioden 2015-2017 är resultatet med behandlande antibiotika nästan oförändrat medan profylaktisk ordination ökat med 44,5 %. Slutsats: Till största del följer Tandvårdshögskolan i Malmö Läkemedelsverkets rekommendationer gällande antibiotikaordinationer men brister när det gäller lokal infektionsbehandling i samband med antibiotikaordination. I framtiden kan det behövas liknande studie vid Tandvårdshögskolan för att undersöka om det skett någon förändring gällande antibiotikaanvändning och journalföring. / Guidelines from the Swedish Medical Products Agency serve as guidance for dental practitioners regarding prescription of antibiotics. For treatment purposes, antibiotics, mainly phenoxymethylpenicillin are recommended for patients with affected general conditions and/or signs of spreading infection. Regarding patients with a risk of remote infections, antibiotic profylaxis with amoxicillin is advised.Aim: The aim of this study is to investigate dental antibiotic prescriptions to adult patients at the Faculty of Odontology in Malmö between 2015-2017 by examining the indications behind an ordination and if it is in accordance with current guidelines.Methods: The study was performed by examining patient records where antibiotics have been prescribed by dentists. Charts between the years were obtained through a term search in the dental practice software T4, with resulting data compiled into tables and charts.Results: Results show that the majority of antibiotics prescribed, is for prophylactic purposes and mainly for implant installations. For treatment purposes, antibiotics are largely prescribed to patients with symptoms of swelling, either with or without abscess, and pain. Prescription of antibiotics with treatment purposes are consistent between 2015-2017, while prophylactic prescription has increased with 44.5 % between the years. Conclusion: The Faculty of Odontology in Malmö are most of the time following the guidelines regarding antibiotic prescriptions although inconsistent regarding local operative infection treatment in association with prescription. In the future, a similar study may be needed at Faculty of Odontology in Malmö to investigate whether difference occurs in prescription of antibiotics and in the quality of patient record documentations.

This work examines the surprisingly negative reactions among gay men to the introduction of pre-exposure prophylaxis or PrEP. PrEP refers to a medical regimen where HIV negative people take a drug designed to treat HIV to prevent the transmission of HIV. PrEP has proven to be at least as effective as condoms in preventing HIV transmission (if not more so), but those who take PrEP and engage in more condomless sex (commonly referred to as barebacking) are still viewed by some as dangerous and immoral. Although some scholars have claimed that the negative reactions to PrEP comprise a sex panic (a type of moral panic), I argue that sex panics are those that occur among a general population and this panic is limited to gay men. Drawing on Cathy Cohen’s concept of indigenous panics (2009), I argue that the negative reactions to PrEP among gay men is an intracommunity panic, but not a sex panic among the general population. Given the centrality of the public sphere to moral panics, I support this claim with a qualitative content analysis of 76 mainstream news articles and 294 queer news articles that focus on PrEP or barebacking. I also conducted interviews with 43 gay men regarding their experiences with and attitudes towards PrEP and its users. I found that there was not a general sex panic due to the relative dearth of mainstream articles on PrEP along with its framing as a medical tool rather than a sexual one and the framing of PrEP controversy as an intracommunity issue relevant only to gay men. Queer media produced a similarly medical framing of PrEP which helped limit the extent of the panic. However, moral shocks that set off the panic came from and were targeted against gay men, and queer news media produced a plethora of articles repeating these claims, concerns over increased barebacking, and framings of bareback sex as inherently problematic. Interview data revealed some gay men who embraced the bareback pleasures made possible by PrEP, but others reified the demonization of barebacking, even while claiming they did not intend to do so or glossing over their own barebacking. I argue that the main ways in which this panic was perpetuated are more subtle than other panics in the literature and that this may make the panic harder to resist. I conclude by arguing that the US is on the verge of a widespread sex panic over PrEP and barebacking which could be particularly dangerous given the current vitriolic anti-queer climate.

Orientador: Adriana Polachini do Valle / Resumo: A infecção de sítio cirúrgico é uma das complicações mais importantes e frequentes no cuidado do paciente, gerando grande ônus ao mesmo e à instituição. A profilaxia antimicrobiana é uma das principais ferramentas no combate à essas infecções, contudo, estudos apontam elevadas taxas de erros em seus processos, aumentando o risco de infecção de sítio cirúrgico e o prolongamento da internação e gastos hospitalares. Este estudo objetivou desenvolver e validar um aplicativo para auditoria e controle da profilaxia antimicrobiana em sítio cirúrgico para dispositivos móveis, baseando-se no protocolo adotado pela Comissão de Controle de Infecção Relacionada à Assistência à Saúde (CCIRAS) do Hospital das Clínicas de Botucatu e pesquisas recentes da instituição. O desenvolvimento do aplicativo foi realizado utilizando a ferramenta Xamarin, que permite o desenvolvimento de aplicativos de maneira multiplataforma. A validação foi realizada por meio de entrevistas com 10 especialistas de áreas que trabalham diretamente com profilaxia antimicrobiana, onde foram avaliados a usabilidade, apresentação e informações do modelo proposto. Nestas entrevistas, utilizou-se do Índice de Validação de Conteúdo (IVC) e Coeficiente de Kappa para avaliação da concordância entre os juízes, sendo definido como valores mínimos ideais de 0.75 e 0.61, respectivamente. A validação do sistema demonstrou excelentes resultados, onde os itens avaliados apresentaram uma boa classificação, com IVC igual ou superior a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Surgical site infection is one of the most important and frequent complications in patient care, generating a great burden on the patient and the institution. Antimicrobial prophylaxis is one of the main tools for the prevention of these infections; however, studies indicates that there are high error rates in this process, which can increase the risk of surgical site infection, prolong hospitalization time and increases hospital expenses. This study aimed to develop and validate a mobile application to audit and control antimicrobial prophylaxis in surgical site process, based on the protocol adopted by the Infection Control Committee related to Health Care (ICCHC) of the Hospital das Clínicas de Botucatu, and recent researches at the institution. The development of the system was carried out using the Xamarin development platform, which allow the development of multiplatform applications. The validation process was conducted with interviews from 10 experts that works directly in areas related to antimicrobial prophylaxis, evaluating the usability, presentation and information of the proposed model. In those interviews, the Content Validity Index (CVI) and Kappa Coefficient were used to evaluate the concordance between the judges, having defined as ideal minimum values of 0.75 and 0.61, respectively. The system’s validation showed excellent results, where all the evaluated items received a good classification, with a CVI equal to or higher than 0.90 and Kappa Coefficient equ... (Complete abstract click electronic access below) / Mestre

Objetivos: Avaliar os resultados obtidos com a utilização do protocolo de antibioticoterapia profilática do HRAC-USP em cirurgias bucomaxilofaciais. Material e Métodos: Para a realização do presente estudo foram analisados 649 prontuários de pacientes com fissura labiopalatina, devidamente matriculados no HRAC-USP submetidos à cirurgia bucomaxilofacial entre os meses de outubro de 2008 e outubro de 2009, aos quais foi ministrado cefazolina e metronidazol para os pacientes não alérgicos e clindamicina e gentamicina aos pacientes com alergia à penicilina. Resultados: 410 pacientes (63,1%) eram do sexo masculino e 239 (36,9%) eram do sexo feminino, com idade média de 18 anos. Somente 13 pacientes (2%) apresentaram infecção pós-cirúrgica. Conclusão: A utilização do protocolo de antibioticoterapia do HRAC-USP em cirurgias bucomaxilofaciais em pacientes com fissura labiopalatina demonstrou ser eficaz, resultando em baixo índice de infecção. / Objectives: To evaluate the outcomes achieved by utilization of the antibiotic prophylaxis protocol of HRAC-USP in maxillofacial surgeries. Material and methods: The study comprised analysis of 649 records of patients with cleft lip and palate, registered at HRAC-USP and submitted to maxillofacial surgery in the period October 2008 to October 2009. The prescriptions comprised cephazolin and metronidazole for non-allergic patients, and clindamycin and gentamicin for patients allergic to penicillin. Results: 410 patients (63.1%) were males and 239 (36.9%) were females, with mean age of 18 years. Only 13 patients (2%) presented postoperative infection. Conclusion: Utilization of the antibiotic prophylaxis protocol of HRAC-USP in maxillofacial surgery in patients with cleft lip and palate demonstrated to be effective, resulting in a low rate of infection.

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.

Introdução: As representações coletivas que alicerçam os ideais de masculinidade hegemônica distanciaram os homens heterossexualmente ativos das respostas à epidemia de HIV ao longo das últimas décadas, o que resultou no aumento da vulnerabilidade desses indivíduos em diversos países do mundo, inclusive no Brasil. Entretanto, a partir do paradigma da prevenção combinada, a Profilaxia Pós-exposição Sexual (PEPsexual), bem como outros métodos baseados no uso de antirretrovirais, torna possível novas formas de gerir os riscos de infecção pelo HIV, ao mesmo tempo em que traz novas questões a serem enfrentadas. Objetivos: O objetivo desta pesquisa é caracterizar os homens heterossexualmente ativos e seus comportamentos sexuais, considerando risco e prevenção à infecção pelo HIV, e explorar os significados atribuídos ao risco de contrair HIV e às formas de gerenciamento de risco entre homens heterossexualmente ativos que buscaram a PEPsexual em serviços em cinco cidades brasileiras. Metodologia: O perfil e o comportamento dos homens foram descritos utilizando a abordagem quantitativa, com dados obtidos das consultas iniciais de PEPsexual registradas em prontuários clínicos. Foram analisados todos os homens atendidos nos serviços nos anos de 2014 e 2015, sendo realizada análise descritiva. O significado do risco e o gerenciamento das vivências foram analisados utilizando a abordagem qualitativa, por meio de entrevistas em profundidade (16) com usuários dos serviços, com foco na situação que levou ao uso do método, bem como as experiências com o uso da PEPsexual. Para a análise dos dados empíricos empregou-se o método de interpretação de sentidos, de acordo com os princípios hermenêuticos-dialéticos. Resultados: Com base nas características descritas no eixo quantitativo, os participantes são, em sua maioria, adultos jovens, com idade média de 31 anos, altamente escolarizados, brancos e sem uso prévio da PEPsexual. A maioria das exposições aconteceu com parceria casual. O uso da camisinha foi mencionado pela maioria dos participantes, no entanto, a falha do preservativo foi o principal motivo pela busca da profilaxia. A maioria dos usuários relatou não conhecer a sorologia da parceria envolvida na exposição sexual, além disso as frequências de testagem sorológica para HIV, Hepatites B e C, Sífilis e Anti-HBs anteriores ao episódio da exposição sexual foram baixas. A análise dos dados qualitativos mostra que a camisinha é o principal e mais acessado método de prevenção à infecção pelo HIV, mas sua efetiva utilização foi condicionada a diversos fatores subjetivos e contextuais. As relações sexuais com parceria estável oferecem maior sensação de proteção, enquanto que a percepção de risco aumenta quando as relações são com parcerias casuais ou em ambientes associados às populações mais vulneráveis à infecção, como profissionais do sexo ou casas de swing. Evitar ou reduzir, ao máximo, o número de relacionamentos extraconjugais, utilizar mais consistentemente o preservativo e buscar informações especializadas emergiram como estratégias amplamente utilizadas pelos participantes. A PEPsexual consistiu numa oportunidade de reflexão acerca da forma de pensar e fazer prevenção não só ao HIV, mas também às outras ISTs. O estigma relacionado ao uso de antirretrovirais e a necessidade de esconder a medicação dos amigos e familiares foram elementos disparadores de autorreflexão acerca das vulnerabilidades pessoais frente à epidemia. Os participantes que planejaram ações concretas e detalhadas de prevenção após uso da PEPsexual foram também aqueles que relataram maior autopercepção do risco individual. Conclusão: As características dos usuários PEPsexual nos cinco serviços investigados revelam que os homens heterossexualmente ativos brancos, altamente escolarizados e jovens são maioria entre aqueles que buscam a profilaxia. No entanto, grande esforço deve ser direcionado às ações de prevenção à infecção pelo HIV entre diferentes segmentos dos homens heterossexualmente ativos, considerando os marcadores sociais de classe, cor, raça e geração. Os ideais de masculinidade hegemônica permearam os discursos de percepção e gerenciamento de risco à infecção pelo vírus. Ações de sensibilização devem ser direcionadas para que tais padrões de masculinidade sejam ressignificados a fim de diminuir a vulnerabilidade dos homens em geral e, mais especificamente, entre os segmentos dos heterossexuais / Introduction: The collective representations that support the ideals of hegemonic masculinity have distanced the heterosexually active men from the responses to the HIV epidemic over the last decades, which has resulted in the increased vulnerability of these individuals in several countries around the world, including Brazil. However, from the new prevention paradigm, Sexual Post-exposure Prophylaxis (PEPsexual), as well as other methods based on the use of antiretrovirals, make possible new ways of managing the risks of HIV infection, while bringing new issues to be addressed. Objectives: The objective of this research is to characterise heterosexually active men and their sexual behaviours, regarding risk and prevention of HIV infection, and to explore the meanings attributed to the risk of contracting HIV and the forms of risk management among heterosexually active men who sought PEPsexual in services in five Brazilian cities. Methodology: The profile and behaviour of the men were described using the quantitative procedure, with data obtained from the initial consultations of sexual PEPs documented in clinical reports. All the records from the men who have searched the services in the years 2014 and 2015 were analysed, and a descriptive analysis was performed. The meaning of risk and the management of the experiences were interpreted using the qualitative approach, through in-depth interviews (16) with users of the services, focusing on the situation that led to the use of the method, as well as the experiences with the use of PEPsexual. For the analysis of the empirical data, the sense interpretation approach was used, according to the hermeneutic-dialectic principles. Results: Based on the characteristics described in the quantitative component, the participants are mostly young adults, with a mean age of 31 years, highly educated, white and without previous use of PEPsexual. Most of the sexual HIV risk behaviours happened with a casual partnership. The use of condoms was mentioned by most of the participants; however, condom failure was the main reason for searching the PEPsexual prophylaxis. Most participants reported not knowing the serology of the partner involved in the sexual encounter and the frequency of serological testing for HIV, Hepatitis B and C, Syphilis and Anti-HBs before the episode of sexual exposure was low. The analysis of qualitative data shows that condoms are the main and most widely used method of HIV prevention, but their effective use has been conditioned by diverse subjective and contextual factors. Stable sexual relations offer a greater sense of protection, while the perception of risk increases when the relationships are with casual partnerships or in environments associated with populations most vulnerable to HIV infection, such as sex workers or swing houses. Avoiding or minimizing the number of extramarital relationships, using condoms more consistently, and seeking specialized information emerged as strategies widely used by participants. PEPsexual consisted of an opportunity for thinking on how to prevent not only HIV but also other STIs. The stigma related to the use of antiretrovirals and the need to hide medication from friends and relatives were self-reflexive triggers about personal vulnerability to the epidemic. Participants who planned concrete and detailed prevention actions after using PEPsexual were also those who reported greater self-perception of individual risk. Conclusion: The characteristics of PEPsexual users in the five services studied reveal that heterosexually active white man, highly educated and young are the majority among those who seek PEPsexual prophylaxis; however, great effort should be focused on actions to prevent HIV infection among different segments of heterosexually active men, regarding the social markers of class, colour, race and generation. The ideals of hegemonic masculinity permeated perceptions and risk management discourses to HIV infection. Preventive actions should be undertaken to replace such masculinity patterns in order to reduce the vulnerability of men in general and, more specifically, among heterosexual segments