Worried possible exposure from condom failure

Dear Doctor,

About 5 weeks ago, I had sex with a female sex worker in Jakarta. During sex, my condom broke and I didn't realize it until it was over. Actually, I heard a pop sound during sex, but I just didn't realize that it was the condom breaking.  The condomless intercourse was about 5 minutes, maybe less. Anyway, I have been very worried since the encounter with the sex worker. I have been tired, getting muscle aches and stomach problems. Tommorrow I'm thinking of going for a test, but I'm not sure whether I am mentally ready for it. I actually went to a doctor right after the incident, but the doctor didn't mention anything about PEP. Maybe because PEP is not widely available in the country. The doctor just told me to get tested at 3 months. It has not been 3 months yet, but I'm dying from anxiety. What do you think are my chances? And what should I do? Thanks Doc.

[H. Hunter Handsfield, M.D.]

The risk of transmission of HIV averages one chance per 1000 episodes of vaginal intercourse, if one partner is infected--and most likely your commercial partner is not (although off the top of my head I do not know the epidemiology of HIV in Jakarta).  Most experts would not have recommended PEP in your situation, unless you knew for sure that your partner was HIV positive.

Your symptoms are not those of HIV, and in any case symptoms are never a reliable indicator of new HIV infection, especially in someone at the low risk that applies to you.  Over 90% of HIV infected people are positive within 5 weeks, so you can be tested any time. It will be negative.  Most experts would recommend a second test at 3 montns just to be safe, but it is rare for it to take that long.  (Search this forum for "time to positive HIV test".)

"What are my chances?"  Close to zero.  "What should I do?"  Stop screwing around and get tested.  It will be negative.

Good luck--  HHH, MD

[Concerned25m]

Doc-
I noticed a change in view on 'time to positive hiv test'.  Any reason that you are no longer mentioning that '4-6 weeks' gives an accurate result, compared to your updated mentioning of testing at 3 months?

[H. Hunter Handsfield, M.D.]

There is no change.  I continue to recommend 4-6 week testing as clinically sufficient in most cases, especially following low-risk exposure; and I have always promoted 3 month testing for peace of mind, given the recommendation of many websites and other authorities.  But it takes several lines of text to clarify the differences and reasons (just like now), so there's also the efficiency aspect of the amount of time I have to respond to questions.  I have also said many times that every response needs to be interpreted in the narrow context of the question asked and my response to it.

HHH, MD

[pbl]

Hi Doc,

I tested negative at five weeks after a condom break. And as you have guessed, I was negative. However, about 10 days later I'm getting sick with symptoms including sore throat, tiredness, slight fever (37C), runny nose, stomach wind, etc. I have been ill for about 3 days now.  Is it possible that this is the seroconversion period? Should I get tested again? Thank you very much Doc.

[Brian123]

It seems to me that you are seeking solace when valuable and more than adequate information has been provided to you by HHH MD.
In seeking reassurance for your risk in this forum,it best that you either seek medical assistance outside the realm of this system (presumaby by your own MD).

If needed, and probably adviseable, (I would suggest, and of course, always my opinion) to obtain another test at 3 months to seek the peace of mind you are not able to obtain on here; even though a leader in the field of HIV/AIDS has provided you with more than adequate information in regards to your risk/exposure.

Good Luck.

Brian