HIV - Prevention Expert Forum
Condom break with Jamaican stripper
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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 break with Jamaican stripper

Hi,

I had an unfortunate event yesterday. I visited a stripper yesterday in Jamaica. (She is Jamaican)

Before we started having sex, I asked her if she ever gets tested and she said that they always come and give them tests at the Strip club, and that they have to do it. She also mentioned that last time she was tested negative back in November, and that she always has protected sex.

Sex was mostly protected. However, during one instance, the condom totally broke and we both did not notice and we kept intercourse for several minutes without realizing it.
After I saw that I am totally bareback, I freaked out... So minutes later I put another condom (Without washing my penis) and had another session.
We also had unprotected oral sex (Giving and receiving)

I am mostly freaked out because I understand Jamaica has high prevalence of HIV, and I'm not sure she is telling the truth about her HIV status. (If she says she's positive, then she would lose her job).

As a note, I am circumcised male.

My questions:

1- Should I ask for PEP?

2- Does washing penis after condom breakage reduce HIV risk?

3- What are my risks and when do you recommend testing? (Sorry for the typical question)

Thank you for your help on this.
300980_tn?1194933000

Welcome to the Forum.  I'll be happy to comment.  First, while you are correct that the prevalence of HIV is relatively high in Jamaica, the fact is that still less than 10% of CSWs would be expected to have HIV and the risk for infection if she was infected is less than 1 infection per 1-2000 sex acts, thus your overall, mathematical risk for infection is in the neighborhood of no more than 1 in 10-20,000.  

PEP is typically recommended for persons known to be exposed to an infected partner and would not typically be recommended for you.  That said, I am sure that you could get it if you wanted to.  If so, PEP should be started within 72 hours of the exposure and, in general, the sooner the better.  

A better course of action, if you are still in Jamaica would be to go and see if you can arrange for her to be tested for HIV using a rapid test (widely available in Jamaica).  If her test is negative, then there is no reason at all for concern,.

Either way, in addition to your concern about HIV, you should also be concerned about other STDs, particularly common ones such as chlamydial infection or gonorrhea.  Testing for these would be a good idea.

With respect to your specific questions:
1- Should I ask for PEP?
See above.  I would not.

2- Does washing penis after condom breakage reduce HIV risk?
No, it makes no difference and in one study there was actually a suggestion that washing the penis might increase risk.

3- What are my risks and when do you recommend testing? (Sorry for the typical question)
See above.

I hope my comments help. EWH
16 Comments
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Avatar_m_tn
Thank you for answer.

I will forget about PEP, and hope I can convince her to get tested.
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300980_tn?1194933000
That's the best appraoch.  

Even if you need to pay her to go and get tested, it will be much cheaper than PEP and can help you to avoid haivng ot take expensive meds that you most probably don't need.  Please let us know if she'll go and the results.  EWH
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Avatar_m_tn
Yes, as a matter of fact, I offered her money earlier tofay for that. She said she'll do it but I feel she was kind of evasive, and this why Im concerned.

Supposedly, she should go get tested tomorrow. If she avoids that, then I know I am in deep trouble.
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300980_tn?1194933000
Agreed.  she should let you go with her when she goes to get tested.  EWH
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Avatar_m_tn
I tried to contact her plenty of times, talked to her this morning she said she was getting tested, but with a pissed off mood (saying that I'm putting her under pressure, etc...), but she is no longer answering my calls since morning, and it's almost end of the the day, even though I told her I would give her whatever she wants (money)

I am not sure if she is lying because she is feeling offended, or because she really has HIV. But I am in deep depression now.

Several notes:

1- I did not ejaculate inside of her.

2- I am circumcised

3- The sexual encounter was from behind and it was a bit dry

Sigh... I guess I'm just trying to make myself feel better.
I am still going to skip PEP and pray.

It is quite a shame, as I am really not sexually active, my few sexual encounters are protected and this is my first condom break.
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300980_tn?1194933000
I'm sorry she is behaving this way.  The odds remain very much in your favor.  I would not take PEP either.

Please feel free to follow-up with additional questions over time. EWH
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Avatar_m_tn
It could be that she just knew that she is HIV positive and does not want to tell me. In that case, that means she is probably in early HIV phase with no medications.

Do you think that would increase the risk to something like 1 in 50 ?
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300980_tn?1194933000
I think you are getting carried away.  I she has HIV and knows it, she would have had it for a while.  

I recommend against playing "what if" games however- it's no good for you.  EWH
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Avatar_m_tn
All right, finally some good news.

I convinced her to go to the clinic today, she had a fingerprick test and results came "Not detectable" for HIV 1/2.

Results came back 30 minutes later.

Do you think the results are totally reliable?
Do you suggest I get tested several weeks later to rule out if she is in possible acute stage? Glad I didn't take those PEP!
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Avatar_m_tn
Just as a note, I was with her at the clinic and saw the results myself.
Not sure what kind of test it was, but I'm hoping it's reliable as it was a respectful Jamaican clinic.
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300980_tn?1194933000
Great.  The time course is reasonable and her result makes it very,very unlikely that she has HIV.  In my opinion, you need not worry further and really don't even need further testing.  Take care.  EWH
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Avatar_m_tn
Hi again,

Sorry for bothering you again. Even though I feel much better after knowing she is negative, Im planning to marry the girl I love you pretty soon and one particular scenario concerns me.

Im mostly concerned if she somehow got infected in the 4-6 weeks window before she the HIV test, that would mean she had high viral load and I know that would significantly increase my chances of contacting it in this single exposure.

For that reason, i plan to get tested in the 6 weeks mark. What other STDs should I test for? Only symptom I have so far (2 weeks post exposure) is frequent urination...

Thanks again
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300980_tn?1194933000
Frequent urination is more often a manifestation of anxiety than anything else.  If you wish to test for peace of mind and want to rule out other STDs, far and away the most common STDs are gonorrhea and chlamydial infection.  You may be offered a blood test for syphilis as well and that too is fine.  I would recomend against blood tests for herpes- in your situation your risk of getting afalsey postive result is higher than your risk for herpes.

This will end this thrad. Take care. EWH
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Avatar_m_tn
Dr. Hook,
I know that you want to end this thread, and I understand and agree with the reason.
But I'm posting my test results.

I got NEGATIVE at 4 weeks. The person who drew my blood told me this is only Antibody test, so I understood this was around 90% accurate.

However, the report says "HIV-Ag/Ab". When I Googled I found this is 4rth generation DUO? Am I correct?

This would be my last inquiry. I just need to know because if this really DUO then this would be the right time for move to totally move on.

I sincerely apologize and thank you for your time and your help on this matter Dr.
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300980_tn?1194933000
Correct.  EWH
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