Small Condom Tear/Brief Exposure

[Xtreme]

I had what was protected oral sex/sexual intercourse. As I was almost done with the woman on top, I heard a ‘pop’ and immediately withdrew knowing this was likely the condom breaking. To my surprise when I pulled off the condom it seemed pretty much intact. However on observation and filling water into the condom, a small (maybe ½ inch round) hole was evident on the top side of the condom below the reservoir tip. I washed my penis thoroughly, no more than about 5 seconds after withdrawing.   I was always under the impression that when a condom fails it essentially shreds and fails completely. In fact the only other time I had a real condom failure (over a decade ago), that is what happened.

In this instance there was clearly a ‘popping’ sound, and there is a definite (albeit it) small hole in the condom. But there was not a complete catastrophic rupturing of the condom, so it appears my penis was largely still protected – minus the hole mentioned above which I assume could have exposed the top (but) side of my penis head. The total time of ‘exposure’ from the ‘popping sound’ to my withdrawal from her vagina could not have been more than 1 second. And since the actual reservoir tip appears to have been intact I’m thinking my urethra was for the most part covered (although the hole was below the reservoir tip so I guess I can’t be 100% sure).

In your expert opinion is there an explanation as to how such a small hole could have developed without a complete rupturing of the condom (as I have always read that condom breakage means a complete rupturing/tearing of the condom)? And given that the condom did appear largely intact, including the reservoir tip top of the condom, along with a possible exposure time of no more than a second – would you think the isolated small hole in the condom REALISTICALLY puts me at risk?
  
Thanks you.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  But from 2005 to 2008 you asked a number of questions on the STD forum, if not this one, that prompted this response in December 2008:

"In your expert opinion is there an explanation as to how such a small hole could have developed without a complete rupturing of the condom?"

I haven't a clue why this condom defect appeared.  But since the condom remained largely intact, most likely you had substantial protection against HIV transmission, even if not quite perfect.  But you need to put things into perspective.  What is the chance your partner had HIV?  Assuming you are in the US or other industrialized country, probably no more than 1 chance in 1,000.  Even if she was a commercial sex worker, probably still no more than 1% (1 in 100).  And even with no concom at all, when a woman has HIV, the average transmission risk from a single episode of vaginal sex averages around 1 in 2,000. So if you had used no condom at all, the odds you would have acquired HIV were 1 in 200,000 to 2 million.  In other words, zero or close to it.

So my answer is a definite no:  REALISTICALLY, the condom defect did not put you at any measurable risk of catching HIV.

If you remain concerned, get tested.  But really, you shouldn't be worried.

Regards---  HHH, MD

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  Glad to have helped.

[Xtreme]

No follow up question (as promised!) - but I must say 'wow' to the information provided in your latest response! My partner and I are AA (east coast) so I guess that would account for a risk elevation on its face. However given the worst case statistical scenario described above (1 in 20,000) when factoring the limited/brief exposure, and your reply that I really shouldn't be worried about this episode - I'm thinking I should be able to finally get some sleep!

Thanks again!  

[H. Hunter Handsfield, M.D.]

Certainly such partial condom failures are rare.  But obviously not impossible.

As for the influence of your "minority" status and that of your partner, these factors may elevate the risk.  But not necessarily -- geography makes a difference (country; and in the US, east coast inner cities have a lot more HIV than elsewhere), and there is extreme variability within minority groups.  African Americans are at highest risk, Latinos lower, Asian-Americans at actually statistically lower risks than whites.  The reasons for all this are very complex.  Here is a thread that explains some of it, in relation to African Americans, but some of the concepts are similar for other minorities:     http://www.medhelp.org/posts/show/1261996

Turning back to your situation, in the worst case scenario, these factors probably elevate your risk.  But even if it were a tenfold difference, the odds remain very strongly in your favor, e.g. with a maximum risk calcuation of 1 chance in 20,000 you have HIV.  If I were in your situation, I really wouldn't be worried.

[Xtreme]

Thanks Dr. Handsfield:

I guess as a quick follow up - the woman was definetly from the 'inner city' (I myself am a minority btw), and I know it's been stated here that certain groups have had more exposure/risks (and possibly greater susceptibility?) etc. Please let me know if your assesment at all would change knowing this, or whether this was generally accounted for in your risk assessment above. I'm assuming this doesn't change your opinion but let me know if it does.  FYI she did tell me she is clean and she certainly at least attempted to practice 'safe sex'.

Also in your experience have you ever heard of a slight condom breakage as stated above but not a complete tear? I just didn't think this was possible.

No more follow ups after ths I promise! Thanks again.