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Condom Breakage - exposure for 5-10 mins
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Condom Breakage - exposure for 5-10 mins

Hi Doctor,

My friend, a 27 year old male, went to a massage parlor recently and ordered the full treatment (intercourse) as this was the first time doing so in a situation like this.  

During the encounter, the condom ripped (rip was big aparently) which he did not realize it had.  It had also fallen off.  
1) He was in her for 5-10 mins (not sure the exact time but that is close) before he realized it was ripped and fell off, therefore having unprotected intercourse for 5-10 mins max (assuming the worse case scenario that it ripped right away)
2) He did not finish.  Upon discovery he was panicking.  She on the other hand seemed very cool about it, and was more upset that this was the first time this happened and that she had a condom stuck inside.  
3) She said she got herself checked and is clean.  
4) She apparently was not very wet or anything like that in her vagina, though there might be some fluid inside naturally.  

He went and got himself checked the next day, though was told some of the results could take months before it is detectable and that he shouldn
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I'm not sure why you're asking about somebody else's risk.  Your friend should be asking himself.  Unless it's really you.

1) I cannot assess the STD risk.  The chance of an STD depends on the chance that your partner was infected with something, which I have no way to judge.  If she uses condoms routinely for all her commercial partners, the risk is low.

2) HIV risk always is very low for any single episode of unprotected vaginal sex, even if the massage lady was infected--which she probably wasn't.

3) I don't recommend STD testing unless symptoms develop.  If no symptoms within 2 weeks, he can assume all is well and probably can resume sex with other partners.  This approach isn't 100% protective, however.  Whether or not he gets tested in the absence of symptoms is a personal judgment.

Good luck--whether to you or a "friend".

HHH, MD
7 Comments
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I disagree with Doc.  A prostitute is very high risk for STDs.  Duh?  Did we lose our common sense?  Can you think of a higher risk category for heterosexual men?  5-10 minutes is enough time for this "masseus" to massage a shedding virus into your buddy's private part.  He now needs to do the right thing for himself and others, which is to abstain from unprotected sex for a few weeks until he gets tested for everything.  He will be glad he did.
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Thanks to apollo for that comment.  It raises a useful issue.  But I basically disagree.

If every person who had unprotected sex with a high-risk female partner got tested for STDs and HIV after every encounter, the health system could not handle the volume.  Not all commercial sex workers are at equal risk, and one who (apparently) uses condoms routinely may be at very low for carrying an active STD.  And even in high risk settings, the risk of infection for any single episode of unprotected vaginal sex is low.

So I disagree that every person in atb's situation should get tested.  In men, absence of symptoms after a 2 weeks is a good indicator against the common STDs.  Not perfect, but pretty good.  (Symptoms mean nothing in regard to HIV, but that risk is extremely low after a single sexual encounter.)  Rather than being tested after every such exposure, sexually active heterosexual men outside permanent, committed relationships should get tested for common STDs and HIV on a periodic basis, such as once a year.  But not necessarily after any particular exposure, unless there is direct evidence that the partner was known to be infected.

It's a judgment call, though, and one size does not fit all.  If atb102 remains nervous and wants the additional reassurance of negative test results, then I suggest he visit his local health department STD clinic 4-6 weeks after exposure and be tested for chlamydia, gonorrhea, syphilis, and HIV.

HHH, MD
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Avatar_n_tn
I remember seeing a documentary about a prostitute in a legal Nevada brothel who had slept with hundreds of men over many years and has never caught an STD proved by regular testing. She professes to being an expert at using condoms and recognising syptoms (symptoms) in others.

Thus I imagine there is a wide variety of risk in the world of prostitution - with some prostitutes being more risky than others.

There may be some strange implications in this - is it less risky to have sex with this woman compared to the average person whom you might have just met?

Same goes for acquiring herpes - statistically are you less likely to get herpes from a single encounter with someone who knows they are infected and takes appropriate precautions compared to an average person of unknown status? Bearing in mind that 25% of people have HSV-2 anyway.

I do not know the answers but suggest it is much more grey than you imply in your response.
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Alright.  In the absence of symptoms, he should at least get tested for HIV.
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I continue to disagree.  As a guess, you would have to test 100,000 people in the circumstance described by atb1002 in order to identify a single new HIV infection.  Millions of dollars to detect a single new case.  HIV testing generlly is not warranted after any particular exposure of vaginal sex, except in higher risk situations than this.  See my comments above about annual testing rather than testing after individual events.  

HHH, MD
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Is preventing one HIV related death worth a few million bucks?
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