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Condom Broke Tip Exposed
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Condom Broke Tip Exposed

Hi Doctor HHH,

This may be a long post, but i used effort to type this out so i really hope you spend your time, and thank you for your time, to read it!

I had protected vagina sex with a KTV/Sauna girl in China, in the Guangdong province. She is 18 years old.

So during our 2nd round of intercourse, the condom broke, and the tip of my penis is exposed. I noticed it exposed because earlier in the intercourse, it felt tight, but after it broke, my penis's sensation felt better. This lasted about 10-30 secs, but i am not sure so a safer bet is 1-2 minutes. I immediately withdrew, panicked, and went to the shower and washed with soap. After withdrewing, I looked at the condom and it seemed to have a "red" color?
Not obvious stains of blood but maybe minor tears in her vagina? I am uncircumcised.

I also asked her
- if she ever did intercourse without a condom, she said no.
- did she ever face a situation where the condom broke, she said no.
- She also told me she only did 20 guys.
- She is not working in that sauna/ktv anymore but she is being a "call girl" to cover up the loss in her fashion store business.
- She also told me that she checks up every month (but she didn't state what sickness she goes for checking), and she told me in a serious manner (because i asked multiple times) that she has no illness
- she did not seem to worry about herself since the condom broke
- when she helped me put the condom on, she put it on the opposite way, realized is wrong and continued to use the condom in the correct position.
- i told her i might need to use PEP and she said don't bother scaring yourself and don't waste money on that!

I cannot sleep, eat, concentrate on anything nor my goals. I am really worried, and spend my days just looking all over the web.
1. it's under 72 hours, do i need to use PEP?
2. I am really worried about HIV, this is the main thing! Do i need check up based on medical?
Welcome to the Forum. I'll be pleased to address your question.  The short answer is that you do not need PEP and this is a low risk exposure.  Below I will elaborate on why I say this.

1.  Any single exposure is rather low risk, statistically.  Even if your partner did have HIV (which is unlikely- see below) the probability of becoming infected is between 1 in 1000 and 1 in 2000 - quite low.
2.  You do not know that she has HIV and it is unlikely that she does.  Most commercial sex workers do not have HIV.  She told you she tests regularly and was negative the last time she was tested.   Most people tell the truth.
3.  There is no clear inside or outside to condoms.  That she put it on in a way other than how it was rolled as she took it out of the package does not change this.
4.  Most commercial sex workers use condoms to protect themselves.  Not their clients.  
5.  Even if there was blood present, this does not change the risk.  In fact, there is usually less HIV in blood than there is in genital secretions.

So, what can/should you do. Certainly low risk is not the same as no risk.  Therefore I would suggest the following:
1.  If you can convince her to do this (you may have to pay her), I would take her and have her tested.  If her test is negative, there is almost no chance that she is infected and you really need not worry.
2.  You should be tested for other, more common STIs, particularly gonorrhea and chlamydial these tests can be done any time more than 2 days after sex.
3.  You may wish to have an HIV test at a later date for your peace of mind. If so, a DUO test at 4 weeks or a standard HIV antibody test at 8 weeks will provide reliable results.
4.  Again, PEP is not recommended in this setting.  As she told you, it is a waste of time and money.

I hope these comments are helpful to you.  EWH
Thank you for taking your time to read my question. It is very descriptive and took a lot of weight off my shoulders. I asked her again and she said she takes hiv test every half a year, major stds every month, and minor stds every two weeks. Shes 18 and i do not know if its realiable information. She said her last time testing for HIV is around mid to end Jan. she said it was negative. Lets say she did about 3 guys each month, and since she checked at end of jan, end of dec until now is 6 months. 6 x 3 is 18, lets say 20, so in order for her to contract hiv, she need to have been with at least 1 of the 20 guys to be hiv positive, and at the same time, breaking the condom. I know this is in my favor. But how realiable is her response, i have no idea? Also, i read that blood doubles my risk of contraction though, how come its less risky then?

Lastly, how low is my risk? Do i need to test hiv if not based on peace of mind? I am in hong kong, what tests can i take here and when should i take it?

Thanks again doctor!
A friend of mine said becareful of hiv there, he said many of hiv carriers are in
Guangdong province. And china is loads of hiv carrier. This makes me really scared, what do you think of it doctor?
You are playing games and acting on misinformation.  I do not know where you heard that blood exposure increases risk but that is wrong. the science, and that is what we base our responses on, shows that there is no more, and often less HIV present in the blood of an infected person than in genital secretions.

As to placing a number on your risk, this too is imprecise as there are so many variables involved. From a mathematical perspective your risk from this single event is no higher than 1 in 10,000 and perhaps far lower (I suspect it is).

Finally, if you wish to believe your friend that is up to you and your problem.  You asked for my assessment and I give it to you as well as the reasons for it.  My assessment and recommendations are unchanged.  EWH
Your computation of the risk is not correct... At least 1 of the 20 guys needs to be HIV positive and have a condom break (Which is around 1 in 100)... And still, if that happens, the risk of infection is between 1 in 500 - 1000  for a female to be infected through vaginal intercourse. (Probably far lower due to period of unprotected intercourse)
Sorry if i sounded disrespectful EWH, its just the hiv paranoia that a lot of us have.

I understand doctor, how did you get the probability of 1/10000? Can you explain in detail?

In terms of the blood, i read on another condom breakage case and the girl was on her period, and i recall dr.HHH say is double the chance! And why is the hoghest risk of hiv is thru dirty bloody needles?

Not questioning you but to learn from your knowledge, doctor.

Fianl answer.  1 in 10,000 comes from a less than 10% chance your partner had HIV and a less than 1 in 1000 chance that you would have acquired HIV if exposed.  Both estimates are conservative.  

I think you are mis-understanding Dr. Handsfield's response.

Injection of infected material is more infections becasue when injected the virus is past the barrier provided by intact skin and mucosal surfaces, providing direct access to the target cells for infection.

This concludes this thread.  EWH
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