Small condom tear/possible brief insertive anal exposure

Hello Drs,

I have some concerns; I was the insertive partner for anal sex with a TS SW in Thailand. I kept pulling out to see if the condom was intact which it was. One time I went to insert and heard a pop and withdrew very quickly (probably less than 1 second). At an absolute maximum the head was in but certainly not more. I ran into the bathroom and inspected. There was about an inch in the end of the condom that was not taken up by my penis. I think me being paranoid and anxious is playing tricks on my memory but I remember asking my self 'is that even broke?' because it appear to still be covering the top of the head. When I took the condom off and filled it with water there was indeed a small hole (0.5mm) in the region where I imagine the side of my penis head was. I asked her about HIV and in a slightly offended manner said she didnt have it and asked me if I had anything. She seemed to have been educated to a degree; she knew sucking was not a risk unless sores are present and she mentioned a visit(s) to the Dr who said she is good. Not sure what that means? However you never know when people are lying and I suppose it is not in the best interests of a sex worker to admit to clients she has HIV. Or maybe she had it but didnt know.

My concerns are if the Urethra was exposed; albeit for 1 second max! Although I do not think it was however memory playing tricks on me as metioned before.
In the absense of cuts or tears in the penis lining is the urethra the only entrance for the virus? how does it get into the blood stream from there?

I think the small hole is indicative of the how quickly I pulled away and that further penetration or thrusting did not occur as this would have led to a full rupture. Logically my risk if any, is reduced because of how shallow and briefness of the penetration. Dont recall any secretions being on my penis.

I will test but want to do it with confidence. Will it be mostly for peace of mind?

Thanks doctor!

[Edward W Hook, MD]

Welcome to the Forum.  In reading your post several questions arose.  When condoms fail, they typically break wide open rather than developing a small hole.  In addition, when condoms are filled with water it is almost impossible to determine the size of the hole since the condom distends with water.  Taken together, these two facts make me quite doubtful that your condom failed- they just don't fail in the way you describe, even if the failure is detected almost immediately.  This makes me wonder if your questions is not based on a true experience but is asked as a “what if” question.

If your condom really did fail, there is some risk and precisely how much cannot be calculated since studies of condoms for HIV prevention simply distinguish between whether or not the condom failed.  Logically, as you point out, the risk of infection if your condom had failed would be low. It would be low for a number of reasons including:

1.  Your partner probably was not infected.  HIV rates in Thailand are lower than in much of Southeast Asia, even among commercial sex workers.
2.  The duration of your exposure was quite brief.

Testing is reasonable if you relay think the condom failed.  If you have access to a DUO (combined P24 antigen/HIV antibody) test, results will be definitive at 4 weeks.  If not, and you choose to test with a standard test for antibodies only, the results will be definitive at 8 weeks.

I hope this comment is helpful.  EWH

[joebo1990]

Thanks for the reply dr hook! Allow me to clarify a few things! The condom did have a hole in it! This was evident when water came out the side of the condom about 1.5-2inches up from the tip! I then riggled my finger into the condom with no water in and I could see the hole! It was less than half an inch in diameter! As I said I think the immediate retreat and lack of further penetration caused not to propagate further to give a typical condom rupture. How does this change things in your opinion?

That being said with this hole if my urethra was covered is there any risk? Can the virus pass through foreskin or the penis head with no apparent lesions/cuts/abrasions etc?

If the urethra was exposed surely 1 second, no thrusting, very shallow penetration makes the chance of the virus very slim? I don't mean to pose that as a what if' dr but I would appreciate your thoughts on it

Finally does my clarification change your view on testing? Do you still think it reasonable from a risk perspective or just to give absolute reassurance and piece of mind

Thanks dr

[Edward W Hook, MD]

Your clarifications do not change my assessment or recommendations.  There are simply no reliable data to allow my to promise you there is no risk. At the same time, as I've said, the risk is quite low.  EWH

[joebo1990]

Here is the similar post dr

http://www.medhelp.org/posts/HIV-Prevention/Small-Condom-Tear-Brief-Exposure/show/1516942

[joebo1990]

Ok dr hook thanks! Could you however address the question about transmission through intact penile foreskin or the head please?

[Edward W Hook, MD]

Have you signed on as Xtreme in the past?  The question is identical?

Your question about "transmission through intact penile foreskin or the head" is unanswerable as there are other variables involved.  We know however that when persons involved in mutual mastubation are not at risk from HIV even when they get each others' genital secretions on one anothers genitals.  PErhaps that will help.

EWH

[joebo1990]

No Dr Hook that post has nothing to do with me! I'm a white male from the UK he is a minority from the US by the sounds of it! I read it before I posted so maybe it influenced how I worded my question. But yes the situations are very similar. I get the feeling you think I'm making this up Dr can I assure you that this did actually happen it was a small failure and not a typical catastrophic rupture. As I said I think if intercourse had continued even a for a couple more thrusts then a typical failure would have prevailed. And seeing as most condom failures go unoticed from the very instance of breaking logic would suggest thats why they usually fail in a catastrophic way!

Can you briefly clarify these variables? I had no apparent cuts or abrasions washed my penis afterwards. Last post Dr...Thank you!

[Edward W Hook, MD]

Sorry, I am not going to further reinforce this "what if" exchange.  My advice, once more is that, if your condom faile as you suggest,  your risk of infection is very low but not zero.  The best thing you can do is get tested for HIV as suggested.

This will end this exchange.  EWH

[joebo1990]

Dr Hook I had a seperate 3rd gen ab and ag test (NOT a Duo/Combo) on the 4 week mark. Can I move on from this now? I am a bit worried as just after 6 weeks (a few days ago) I began to feel some irritation/scratchiness in my throat! Am I in the clear? Thanks