Condom Failure - Risk Assessment

[Weenie Boy]

My condom broke during vaginal intercourse with a sex worker in the Midwest USA. Vagina intercourse lasted approx. five minutes. I believe the condom broke at climax - last minute or so. I did receive oral sex from her prior to intercourse, with condom. Upon withdraw, and realizing what had happened, I immediately went to the bathroom, urinated and scubed with soap and water.

It has been seven days since this happened, and I am exhibiting no visual symptoms or discomfort. I did get a nucleic acid amplifying test at 7 days for Gonorrhea and Chlamydia, and am waiting for the results.

Based on searching the forums here, I am making the following assumptions (please correct if I'm mistaken). Risk from contracting anything from the condom oral sex is, for all practical purposes, close to zero. Odds of contracting HIV or Syphilis from this one-off event are extremely low. Risk for Gonorrhea, Chlamydia and Herpes are much greater.

My questions:
1) I was told by a lab that the RPR test for Syphilis is 50% accurate at seven days and 92% accurate at 14 days. Is this true?

2) What is the risk for trich in my situation? Is there enough of a real risk that I should be treated before having sexual relations with my significant other?

3) Too soon to test for Herpes and HIV. Other than keeping a weather eye out for symptoms at this point, what other courses of actions should I be taking.

Thank you so much for you help doctor! Great Resource.

[H. Hunter Handsfield, M.D.]

The lack of symptoms is a pretty good indicator you were not infected, but of course not perfect.  But it will be surprising if you NAAT is positive for either gonorrhea or chlamydia.  You are right that oral sex is low risk.

1) The lab was wrong about RPR.  It typically takes at least 2-3 weeks to become positive, sometimes 4-6 weeks.  But absence of a chancre (syphilitic sore) of your penis is strong evidence you didn't catch syphilis.

2) There are no data on the risk of trichomoniasis in this situation.  I can't even make an educated guess.

3) You really don't need herpes testing; you risk was too low, unless you develop symptoms of herpes.  And the risk of HIV from any single episode of vaginal sex is never high enough to require HIV testing, unless the partner is known to be infected or at much higher risk than your partner.  The prevalence of HIV in American commercial sex workers is very low.

Keeping an eye out for symptoms is all you really need to do, and wait the results of your gonorrhea/chlamydia test.

Good luck--  HHH, MD

[Weenie Boy]

Thank you Doctor Handsfield for your answers.

"Keeping an eye out for symptoms is all you really need to do, and wait the results of your gonorrhea/chlamydia test."

I will follow your advice. Would you answer, or clarify, questions about Trich?

How common is Trichomonas? Is it true that men generally don't show symptoms, but can pass this on to their female partners? Is it true that men cannot be accurately tested for the infection? Would it be wise to receive treatment for Trich, since the odds of being able to test for, or show symptoms, is low?

Thank you so much for you help.

[H. Hunter Handsfield, M.D.]

The risk of trich from the exposure you describe probably is too low to worry about.  No, routine treatment for it is not recommended in your situation.  In general it is considered a trivial condition, even for women - and inconvenience more than a serious health threat.  That view is changing, but it's still considered a secondary problem.

It is true that accurate testing is not generally available for men.  The only test that works worth a damn is PCR testing, but there is no commercial PCR test for trich.  Some labs offer home-grown PCR tests, but they are not widely available, and the actual results for them may be highly variable from one lab to another.

I won't have any other comments.  Regards.

[jabu]

A related discussion, condom breaks was started.