HIV Risk

[harman74]

Hello Doctors

Two nights ago I had penetrative sex with another guy ( I was the insertive ). After about 30 seconds I pulled out as I felt the condom slipping I realized the condom broke. I did not notice blood on the head of my penis. I used a new one and we continued. I this was our second time to do this and I have always asked him if he is neg. He mentions that his last anal sex was oct of last year and last jan was when he took the test and according to him its negative. He also mentions since the test , hes never been with someone else besides me.Of course he could be lying.

When the incident about the condom breakage happened, I asked him again and he gave the same answer. So my questions are as follows:

1) What is my risk for HIV considering  the amount of time (30secs or so ) that I was in him unprotected and no blood when I pulled out?

2) Risk percentage as the insertive partner?

3) its probably too late now but would you have recommended PEP?

4)Is the p-24 antigen test the same as RNA test? I am asking just in case I want to take the duo test.

This has never happened to me before so you can imagine I am really scared about what happened. I appreciate your answers. Thanks

[Edward W Hook, MD]

Even if he has HIV the odds are less than 1% that you would get HIV from this exposure.  On the other hand, if his test is negative then the odds of infection are a very, very small fraction of 1% (e.g. much lower still).  EWH

[harman74]

Thank you Doctor.  I will follow your advice and ask him to take a test with me. If you don't mind me asking tho  based on your experience and expertise in this field , if the odds are in my favor that this would have not given me HIV. This would be my last question and thank you again

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  I can understand that condom breakage can be worrisome.  At the same time, the answers to your questions really come down to a matter of trust,  If you partner's history of other exposures and testing is correct there is virtually no risk to you of having been exposed to HIV.  If there are trust issues and he is willing to have a rapid HIV test today (you could be get tested), you can also assure yourself that the risk from the broken condom is neglible.  

With this as background, let's go to your questions:
1) What is my risk for HIV considering  the amount of time (30secs or so ) that I was in him unprotected and no blood when I pulled out?
If he had HIV, the average risk for infection of the insertive partner in unprotected sex is about 1 in 200.  There are no studies to tell us how longer or shorter duration of exposure influences risk but logic tells us that shorter exposures should be less risky.  

2) Risk percentage as the insertive partner?
See above- 1 in 200.

3) its probably too late now but would you have recommended PEP?
PEP can be effectively started for up to 72 hours after an exposure although sooner is likely better.  From what you tell me, I see little reason for PEP.  Most people tell the truth.  

4)Is the p-24 antigen test the same as RNA test? I am asking just in case I want to take the duo test.
No, the RNA test is a PCR and has higher false positive rates than the DUO tests.  

I hope these comments are helpful.  The path of least resistance is for the two of you to go get tested today with a rapid test.  EWH