HIV - Prevention Expert Forum
Help doctor!!
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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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Help doctor!!

Hi drs, I've bet you've heard this before bit here we go,

4 days ago I was with a csw, and as I was putting it in and the condom popped. I and she noticed right away, and it was from behind so I instantly stopped and pulled away, if I was in in her vagina I was for at most 2 seconds, and I say if because I'm not sure, we placed another condom and finished 3 minutes later by oral with condom. I then went to the sink and washed myself with soap. After that, I asked her if she was clean, and her response was, " I didn't even blow you without a condom, I got to my doctor all the time, I'm a very clean person". She seemed upset that I even asked. So I didn't ask again, I check everyday to see if her ad is still up online just in case she disappears and so far it's up.  I'm freaked out!! She was Black but had no accent so I'm assuming she is Canadian and from what I recall she didn't have any marks on her arms from needles but she was smoking marijuana after.  

I've been doing the math, so I wanted to see what you think.
2012 hiv population in woman in Toronto - 13000
2012 population of women in Toronto - 1.5mil
Odds of contracting female to male - 1/2000

So (13000/1500000)x(1/2000)= 0.0000043* or 1 in roughly 200000.

A) do you agree with my numbers?
B) I want to get tested at 2 weeks insti rapid test, how reliable is that percentage wise?
C) in your 30+ years how many hetrosexual men with no history of IV drug use and no other std have you seen become positive from a single exposure vaginally?
D)Seeing as it was 2 seconds am I blowing this out of proportion?
E) can I resume unprotected sex with my wife? ( I know I'm an idiot )
F)at what point can I put this behind me?

Thank you.
Tags: HIV
300980_tn?1194933000

Welcome to our Forum.  I'll try to help.  In general, I think your calculations are on track and, if anything, overly conservative and that your risk is actually lower than you calculate..  

Let's work through your questions:
A) do you agree with my numbers?
Yes, although I think if anything, they are overly conservative. The bri3ef duration of your exposure, if anything, makes your risk probably lower than the 1 in 2000 chance of infection if she was infected.  Similarly, her adamant denial of infection and that she was as upset as you were when the condom broke also suggest that she too was worried about infection from you and thus, not infected.

B) I want to get tested at 2 weeks insti rapid test, how reliable is that percentage wise?
At 2 weeks this test will detect at least 50% of recent infections and probably more.

C) in your 30+ years how many hetrosexual men with no history of IV drug use and no other std have you seen become positive from a single exposure vaginally?
No, I have not.

D)Seeing as it was 2 seconds am I blowing this out of proportion?
Given the circumstances, as i said above, I think your risk is lower, and probably far lower than you have calculated.

E) can I resume unprotected sex with my wife? ( I know I'm an idiot )
Personally, in your situation, I would not be worried.

F)at what point can I put this behind me?
I would suggest now.  Of course it is up to you however.

I hope these comments are helpful. EWH
9 Comments
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Avatar_m_tn
Thank you doctor for your reassurance. It is very much appreciated. I had one more question. I read somewhere that about 80% of new infection would seroconvert and have symptoms within 2 weeks, is that true? And if so would a 2 week negative hiv result be almost conclusive in its own right if that would be the case as I also read that if you are suffering those symptoms than any HIV test would prove positive because if you are suffering symptoms than you must have a high viral load?
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Avatar_m_tn
The reason I ask this, is because if the above statement where true than than the it would out the odds in the millions, so if that's were the case it would make it, if not impossible, at least improbable. Would you agree?
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300980_tn?1194933000
Trying to be precise about the timing of seroconversion following HIV infection is difficult-the data are just not that good.  Trying to figure out what proportion of people have symptoms is more difficult still.  We can be sure that at least 50% of persons would have a positve tests at 2 weeks and probably more but just how many more is hard to say.  That said, a negative test would furtehr reduce your risk for infection a great deal beyond the already low risk that we agree upon.  EWH
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Avatar_m_tn
Thank you doctor for taking the time to answer my questions. You have succeeded in giving me the reassurance I was looking for. I will follow your advice and place this behind me, if I test negative in 2 weeks, I will forget this ever happened.
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Avatar_m_tn
Hi doctor, I was doing well with all this up until yesterday, as now I'm experiencing chills, stomach pain, nausea and constipation, which I understand are symptoms of ARS. Is it possible for it to start 5,6 days post exposure?? I hope you can answer this for me as I'm freaking out!!
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300980_tn?1194933000
No, this is not ARS and does not change my assessment or advice.  Please do not worry. EWH
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Avatar_m_tn
Hi Doctor, I am really trying my best to keep calm but 4-6 weeks seems so far maway for something that is potentially life threatening/altering. It ie affecting all the other aspects of my life as its all I can think about. I found this post by Dr. H of someone who is exactly same situation, and his assessment is that the risk is too small to measure. If that is the case what is the sense of testing?

http://www.medhelp.org/posts/HIV---Prevention/Worried-about-broken-condom/show/255690

I want to get tested  tomorrow at 10 days just to give me some support. How accurate would a rapid test be at that point?

I apologize in advance for my annoyance, but I'm quite worried.
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300980_tn?1194933000
Last answer, from an answer to prior clients:

"As a generalization for both you and other readers, you must realize that we VERY frequently get questions asking if different types of exposures or prevention measures are 100% effective.  The answer to that is that this is scientifically impossible.  For a variety of mathematical reasons far too complex to go into here, all one can do with well conducted scientific studies is estimate probabilities.  By definition, any estimate, cannot ever be 100% certain because of the incredibly low possibility that someone will get HIV through a previously undescribed mechanism tomorrow.  On the other hand, when Dr. Handsfield or I say that something is too small to measure, virtually zero, very close to no risk, or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained."

As you point out, you are testing to address your anxiety.  

There will be no further answers.  EWH
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