Condom ripped - Risk of HIV

[julian999]

Hi Doctor,

Today I had protected anal sex with a working girl. The problem is that during the session I noticed that the condom ripped. When that happened I immediately washed my penis with water. Both of us where freaked out about it. I asked her if she was clean. She stated that she was. I also told her that I was clean as I just tested my self 3 months ago. I am still pretty worried about this. I Honestly don't know how long I was in there unprotected as I noticed that the condom ripped when I decided to pull it out. I hope that it wasn't more then a couple seconds. How high is my risk? Should I consider Post-exposure prophylaxis?

[H. Hunter Handsfield, M.D.]

So you had an episode of unprotected vaginal sex with a partner at risk. If she had HIV, the average risk of transmission is somewhere around 1 in 2,000 -- perhaps lower in this case, if the exposure time was short after the condom broke.  But she probably does not have it.  Host commercial sex workers are not infected, and people rarely lie about HIV status when asked directly.  The fact that she routinely has her customers use condoms, and that she was as freaked out as you, are good signs she isn't infected.  (Statistically speaking, she was at greater risk of catching HIV from you than you were from her.)

Overall risk:  Chance she has HIV, say 1 in 100 (tops).  If she had it, chance you were infected, 1 in 2,000.  That makes your risk somewhere around 1 in 20,000 -- and it's probably lower, since almost certainly she is not infected.  You definitely do not qualify for post-exposure prophylaxis.  Your risk of HIV really isn't even high enough to need HIV testing.  However, like most people on this forum, most likely my opinion won't completely settle your fears, so feel free to be tested if you wish.  If so, have a standard HIV antibody test in 6-8 weeks.  You can expect negative results.

Let's not get into a string of follow-up comments as in your last thread on the STD forum.  Of course add a comment if new, pertinent information comes up, like if your partner gets tested and you know for sure that she does or does not have HIV.  Based on the information provided so far, my opinion and advice aren't likely to change.

Regards--  HHH, MD

[julian999]

Just wanted to clarify that it was anal and not vaginal sex. As I understand anal sex is a higher risk then vaginal. I suppose that I still wouldn't qualify for POP.

thanks

[H. Hunter Handsfield, M.D.]

No, it does not.

[julian999]

Hi Dr. Hunter,

I just got a rapid HIV test and came back negetive its been almost 5 weeks since the encounter. The nurse claimed that this is as good as a blood test. The nurse used the OraQuick Advance rapid HIV-1/2 Antibody test. Just wanted to get your input on how accurate rapid hiv tests are.

Thank you

[H. Hunter Handsfield, M.D.]

The nurse is right. Rapid HIV tests have been discussed many times on this forum; you can use the search link to find many dicussions.