Condom Slippage - very worried

[dripperjack]

I had sex with an escort [whose HIV status is not known to me] with condoms on. Before putting the condom on my penis , there was some lubrication applied to my penis.

When I was taking her from behind, suddenly our act was interrupted as her phone rang and I withdrew from her. Then I realized that my condom is no longer in my penis.
I got worried and told her. She then pulled the condom from her vagina. I didn't see if it was hanging or way inside her vagina. But she seemed to have taken out without any effort as she was holding her phone with one hand and taking out the condom with the other.

I got scared and didn't continue sex after that. Now I am dead-worried if I had chances of exposure to HIV.
I am not sure if the condom slipped off during withdrawal or during the act.
But I didn't 'feel' that I was penetrating her bareback. So my feeling is that it got slipped off during withdrawal.

Doctor, can you please assess my situation ? Shall I go to a clinic for PEP ? It is not yet 48 hours since I had the exposure.
Can you also advise me if I would know had the condom slipped off during the act by feeling ?
The penetrative sex lasted less than 3-4 minutes.

[Edward W Hook, MD]

Thanks for the information.  EWH

[dripperjack]

Thanks Dr Hook for your reply.
I didn't have to pay for the full amount of the medication - Just $ 40 as co-pay.
As per the pharmacy receipt, insurance paid $ 872. Hence I would assume the total cost would be $912

Today is my 6th day of the PEP medication, and still haven't got any side-effects. I truly hope I would be able to complete the course without any side effects.

[Edward W Hook, MD]

If you have not experienced side effects you probably will not.  I suspect that you will not have problems completing the course of therapy from here on out.  

Just as a point of information, did you have to pay for the medication yourself and if so, would you mind sharing how much it coust.  It helps to keep meup to date with what treatment costs in other areas.  EWH

[dripperjack]

Dear Dr Hook

I could get an appointment with a doctor in a HIV clinic after around 40 hours of the potential exposure. She told me my risk is low to moderate and advised to start PEP. She also had me do a Rapid HIV test which came negative. The treatment prescribed is TRUVADA for 28 days.

I have started my first dose at around 47 hours of the potential exposure. Today is the 4th day of the treatment, and I am yet to experience any side-effects.

I don't know whether you would reply to my question as it is posted on the wrong forum.
But if you're kind enough to do :
1. When can I expect the side-effects to start?
2. What are the chances that anyone can complete the 28 day course of TRUVADA?

[dripperjack]

Thanks again , Dr Hook.
There was no alcohol involved in my case and the act was quite short - may be less than 3 mins. and I am sure I didn't have any difference in 'feeling 'feeling'

I hope and pray I am safe.
Many many thanks to you and God bless you!

[Edward W Hook, MD]

I  wish I could give you an absolute answer on this.  In general, had the condom come off, you probably would have noticed it and a difference in feeling but there are exceptions, particularly if alcohol was involved.  EWH

[dripperjack]

Thanks a lot Dr Hook for your quick and kind reply.
I am very sorry that I had put my question on the wrong forum.

I have one last question :
Can you please tell me from your wide range of experience of dealing with such patients - if I would have 'felt' that the condom is no longer between my penis and her vagina. I am a very inexperienced guy and very worried. Hope you would help me with your kind advice.

I didn't really get a different 'feeling' from what I felt when I inserted her first with the penis. So I want to be sure if it was only during withdrawal that it slipped off.

Thanks in advance!

[Edward W Hook, MD]

Welcome to our Forum.  In terms of HIV, you have posted on the wrong site.   Questions about HIV belong on the HIV prevention site. Your question actually has to do with both HIV and STD risk however.  I will do my best to answer your questions with this reply but, if you have additional questions or follow-up regarding HIV  they must be on the HIV Prevention site.  Sorry.

First some background information.  Mast CSWs in the Massachusetts area do not have HIV (particularly if your partner was not an IV drug user), your condom probably did protect you (see below) and even if you were without a condom and in the unlikely circumstance that your partner had HIV, your risk of infection is less than 1 infection per 1,000 exposures.  Putting all of this together, your risk of infection is low.  Whether or not you seek PEP is up to you but if you are going to pay for it yourself, it also costs over $1000 in most locations.  Personally, I do not think you need it and I suspect your risk of side effects from the drugs used for PEP is higher than your risk of HIV.  IN addition, for PEP to be effective it must be started within 72 hours of exposure and preferably sooner.  

The condom.  condom protected sex is safe sex.  Your condom did not break but came off.  When this happens, it the condom is usually "left behind" (no pun intended) in that the penis comes out of the condom as a person exits their partner. In these situations, the condom is still doing its job and providing protection.  It sounds as this is most likely what happened.  If it did not, I just gave you the figures regarding risk.  

I hope these comments provide some perspective.  EWH