Condom Slippage

Hi there,

I generally tend to be a "worried well" gay man.   I am a gay male who recently started dating a new guy.   We both were tested for HIV and other STDs just as the relationship began (part of our own regular screenings which happen to be at the same time) and discussed our negative results with each other.

This weekend we had protected anal sex, with me being the insertive partner.   About 3-4 mins in, I realized that there was a condom slip, and I withdrew immediately, but could tell that I had been inside him without the condom on (albeit for a short amount of time, the condom remained inside).

He doesn't seem worried at all - but I can't help think that I should consider PEP?  Although he recently tested negative, and we've agreed to be monogamous, I still feel there could be a risk given window periods, etc.

Many thanks for any advice you can offer.

[Edward W Hook, MD]

Welcome to the Forum.  A little more detail regarding how long ago the two of you tested and when his last exposure other than you was will help me to provide a bit more detailed advice but overall this was a low risk exposure.  If he had HIV, your risk from a single unprotected exposure would be less than 1 in 200 however since your partner recently tested negative, the chance that you were exposed is essentially the likelihood that he is in the "window period" in the process of converting from a recent sexual exposure.  That likelihood is , in general, low.  The longer it has been since your partner's last unprotected rectal or genital exposure other than you, the less likely he is in the window period.  

Unless I misunderstand the information you have provided, in general this is not an exposure that warrants PEP.  

I hope this comment is helpful.  EWH