condom break , safe practices , my risk

[accidental]

Last night I was the insertive partner during anal sex. I was wearing a condom, but I accidentally re-lubed myself with massage oil instead of lube (there were two bottles on the nightstand and it was dark and they looked the same). I felt something and pulled out and the condom had broken.
I had not ejaculated, I washed off immediately, I am circumcised and I don't have sores.
I talked with him and he said he's negative and had been tested this year and never has had unprotected sex.  I have read that the risk for a single condom break is ~0.065%, though I can't square this in my head since so many people in the world have HIV. I am scared as I've never had a condom break before.
I haven't been tested this year but I am a 25 yo gay male and I have NEVER had unprotected anal sex (first exposure was protected, this was the first time a condom broke on me), though I am worried that I might have been infected by oral (even though I avoid ejaculate and ask status).

1) Is PEP warranted for either of us? Would we be turned away

2) If I have never had unprotected sex is it irrational for me to worry about infecting him?

3) If I did manage to dodge the bullet what's the best way for me to lead a safe lifestyle w/ sex? My practices are (a) ask status with a new guy (b) avoid ejaculate with oral sex, and always close my eyes before ejaculation, (c) wear condoms for anal sex. Do I have a good chance of avoiding HIV if I do this or is there anything that I could do better?

[H. Hunter Handsfield, M.D.]

Others (below) have already responded, and I agree with their comments and advice.  Your experience reveals why all gay men should routinely know and share their HIV status, even when safe sex is planned.  Safe sex doesn't always work, for any number of reasons, including condom breakage.

1) Since both of you are HIV negative - with low risk either of you has been infected recently and is in the window period - most experts and most or all authoritative guidelines would agree that PEP isn't warranted.  Most providers probably would not agree to prescribe it.  I wouldn't do it if I were your doc.

2) Be clear:  A gay man with multiple partnerships is at relatively high risk for HIV, even if he always engages only in safer sex.  That's because sometimes unsafe situations may occur unnoticed, e.g. a condom rupture that isn't recognized at the time.  I stress 'relatively':  most men in that situation will go a lifetime without ever catching HIV, and your risk for being infected is low.

3) As suggested above, following those practices (well, practices a and c) you probably will never catch HIV.  Logically, not ejaculating in the rectum might reduce the risk for the receptive partner, but there are no data on this; and there is no reason to believe this protects the insertive partner; and if a condom is used, what difference can it make anyway?  I haven't a clue what you're getting at with the comment about closing your eyes before ejaculation.  Is that a serious comment?  What difference can it make??

Best wishes--  HHH, MD

[Protective]

Me and my boyfriend were thinking about having sex. Although were only 15 and 17 we figured if we use a condom we will be fine. I'm scared that the condom will break and things might happen.I also don't think he shares the same fears as me.

[twentyand8]

and I am a bit HORRIFIED. I pulled out, and did not notice the condom broke until I came... and it was a little obvious. I talked to the guy who I was with and he claims that he gets tested once every 4 months, but that does not make me feel any better. I can feel the anxiety hang over me today as I walk around with this not coming off of my mind. I already called a doctor (waiting for a call back) to see if I need any kind of PEP? treatment.

It does not make me feel any better that this individual was so lax about it, and would have let me have sex with him without a condom. He just got tested the day before we had intercourse, and now I have to wait a week to see whats up with him. I am negative as far as I know :(

I am assuming I still have low risk but this kills me. I am making an appointment to see a doc tomorrow.

[peekawho]

I suppose you could wear goggles?

*giggles uncontrollably*

[peekawho]

Thanks.  I feel better today, so perhaps if I employ my usual methods of ignoring everything, it will all go away.    

[monkeyflower]

Well, the sight of your partner wearing little turtle or crab goggles might not be all that inspiring... or maybe it would, who knows :-)

Equally off topic (my apologies to the original poster), but did I read something about you having an enlarged heart? On top of your pneumonia? Man. I'm sorry you've been having such a rough time lately. I hope you feel better soon. Hugs...

[MiamiLat]

Accidental, I had the same exposure as you recently. In my case, I didn't notice the condom had failed until after I ejaculated and pulled out.
I tested NEG at 3 wks and will be testing again this coming Saturday for my 6 wk result. Feel free to contact me for support on america online screenname: crcollazos...
Good luck!

[H. Hunter Handsfield, M.D.]

I get it.  The eyes closed business is for oral sex and you're worried about semen in the eyes.  Interesting:  in 30+ years in this business, this is the first I have ever heard that someone might consider closing the eyes as a safety measure.  I cannot imagine it makes much difference - and certainly there are no data to suggest that it does.

HHH, MD

[moose21]

Ok I'm not a doctor obviously, but I have to say that its hard to be much safer than you are already.  As Dr. HHH routinely says, most people don't lie about their status when confronted directly.  So the odds are already in your favor that he was not positive to begin with.  Secondly you were the insertive partner, which puts you at very low risk to begin with.  Thirdly, by all accounts you pulled out immediately when you suspected condom breakage.  This reduces your risk even further.

True, there are over 40 million people in the world who have HIV, but the disease is much harder to transmit than originally thought.  If it were as easy as people thought in the 80's and 90's, well over a billion people would probably be positive.  You have nothing to worry about buddy.  Testing is obviously always available for anxiety relief, but I don't really see anything to worry about.  Get on with life, and keep up your safe sex practices and you'll be fine.

[monkeyflower]

I agree with the other poster. The CDC estimates about 1 million people in the US have HIV. I know that sounds like a lot, but there are over 300 million people in the US, so it's really a pretty tiny percentage. And I think it's safe to say that most people by far who have contracted HIV have had repeated exposures, not just a single condom break. So while I don't know the statistic you quoted, it sounds reasonable to me.

Also, I agree that you're having about the safest sex you possibly can have while still involving another human being. I did want to add that the risk of contracting HIV from giving a blowjob is only about 1 in 10,000, so it seems to me that avoiding swallowing ejaculate isn't all that important. But that's a personal decision, and it sounds like it makes you feel safer and allows you to enjoy sex all that much more. So if you're not going to allow your partners to come in your mouth, you're right on the money about closing your eyes, though maybe not just for the reasons you think ;-) Semen *burns*.