condom broke

Hi Dr. I am 33 years old. Last night I went to a massage parlor. She put a condom on me and then procedded to get on top of me. After a minute or so i came. after pulling out of her i noticed that my condom had broken off the top part left inside her vagina i am assming with my semen and the bottom part attached to my penis. She said she gets tested egularly but I am not going to take her word. I am worried as hell. I have had trouble sleeping and eating and cant perform in the office. What are the chances of my contacting HIV and when should i get tested. Would apprecite feedback. Thank you very much.

very worried and sleepless.

[Edward W Hook, MD]

Welcome to our Forum.  Boy, don't we wish condoms never failed.  

I hope that the comments I am about to make will prove helpful to you.  To get to the bottom line, your risk of infection is low.  I will provide the facts supporting this statement and then make a suggestion or two as to next steps for you.  Your partner was a commercial sex worker in an area with moderate (not high) prevalence of HIV.  thus the chance that your partner had HIV, on average, is no greater than about 1 in 10.  If she had HIV, the risk of infection from a single episode of sexual intercourse is no greater than 1 in 1,000.  Thus, on a mathematical basis, your risk of infection is 1 in 10,000 or less.  Clearly the odds of getting infected from this encounter are low.

I realize however that even with the statistics in your favor, you are nervous about the consequences of the condom failure.  I should also point out that the condom failure puts you are somewhat higher risk of getting other STDs like gonorrhea and chlamydia than your risk for HIV.  Your partner said she gets checked regularly and in fact most CSWs in the Philippines do get checked so this is in your favor,  You could be even more sure if you can locate this person and convince her to go and get checked for HIV and other STDs (you might need to pay her for this too but it might be worthwhile to you).  If she does not have HIV, then your risk is negligible and you have no reason for concern about HIV infection.   In addition, you should be checked for other STDs in the next few days.  In addition, if you wish to be checked for HIV yourself, the results of a blood test for HIV antibodies at a time after 6-8 weeks will provide you with reliable information.,  If your tests are negative at that time, you can be confident that you did not get HIV.

I hope these comments are helpful to you.  

EWH

[nervousphilippines]

Thanks for your quick reply. I contacted the establishment and they said that they test regularly and that the last test was third week of january and of course were negative.  Question I am requesting that she take a test asap of course at my expense. If her results return negative are there still chances that she is still positive as I understand that the test only picks up a period of six weeks?  Meaning if she did have intercourse within the six week grace period?

Thank you.

[Edward W Hook, MD]

If her test is negative, even though she is a CSW, the chance that she is infected and the infection is not detected is vanishingly rare.  If I were you, if she has tests that are negative, I would not worry about HIV.  EWH

[nervousphilippines]

Thank you very much. will keep you updated.

[nervousphilippines]

Hi Dr Hook,

Its me again. Is there anything I can do in the meantime while waiting for the 6 week testing period? I am absolutely freaking out. I cannot eat and sleep. Can I take the test sooner like at 4 weeks? I apologize if I sound like im rambling.
Best regards.

[Edward W Hook, MD]

Again, try not to worry.  Your risk is very low.  At 4 weeks HIV tests would be expected to detect about 90% of infections acquired 4 weeks earlier and thus a negative 4 week test should go a long way towards providing you with re-assurance that you did not get HIV from the expsure you described.  EWH