Anal intercourse with escort - condom broke

I had sex with an escort on a recent business trip a week ago. We had unprotected oral sex, both giving and receiving. We had protected vaginal intercourse and protected anal intercourse. It was during the protected anal intercourse that the condom broke and I didn't notice for a couple of minutes. When I noticed it broke, I pulled out and mentioned it to her. She said she gets tested regularly. I immediately cleaned up with hot soapy water and an antiseptic wipe. We did continue for another round of unprotected oral and protected anal sex. She seemed very open and honest person and somewhat of germiphobe. Her practices were very clean, even the preparation for anal sex before our encounter. I'm am wondering what my risks or contracting HIV are in this instance. I was tested today for HIV, Syphilis, Gonorrhea, and Chlamydia. I realize that it is early to test for HIV and am also wondering when I should get tested again. Is there anything else I should test for as well?  Thanks in advance for any advice.

[Edward W Hook, MD]

Welcome to the Forum.  I'm sorry to hear of your condom mishap.  Sadly, even when used perfectly condoms do fail about 1% of the time with rates being a little higher for anal intercourse than for vaginal intercourse.  I also applaud your decision to go on and use a condom for your second exposure.  If she were infected, since every exposure does not lead to transmission, using a condom was a good idea.  Now let's discuss your situation.

For starters, chances are that your partner did not have HIV. While rates are a bit higher among commercial sex workers than the general public, in most countries the vast majority of CSWs do not have HIV.  your partner's statement to the effect that she is not infected is likely to be true, both on statistical basis and because she said so- most people tell the truth.  Furthermore, even in the unlikely situation that she had HIV, with anal intercourse the risk of infection is only 1 infection per 1-200 exposures.  Nonetheless, given her occupational predisposition to infection, testing is a good idea.  In general the right time to get tested after an exposure of this sort is at around 8 weeks.  At that time virtually all HIV infections which had been acquired 8 weeks earlier would be detectable.

I hope this comment is helpful to you and try not to worry.  The odds are very much in your favor. EWH

[karatemd]

Dr. Hook, Thanks so much for you prompt reply to my questions. My labs today all came back negative and I will, as advised, be tested for HIV 8 weeks post. Thanks again.

[Edward W Hook, MD]

Glad to help. EWH