Broken Condom CSW - Risk Assesment.

[worriedinpty12]

Hi Doctor,
I´m a 27 y/o Heterosexual white male from Panama City, Central America, during my bachelor party (March 15th 2013) we went to a strip club/brothel in the city, quite famous and visited, neither the expensive or the cheapest one, "to get a girl for me" (what an idiot).

During that I had an encounter with a colombian girl, she put the condom on and started performing oral, she used lubricant on her vagina when I got half erect we engaged on vaginal sex for 5-8 minutes before I pulled out and she noticed that the condom was broken and told me to stop, i was ontop

I really dont know for how long it stayed that way, I think it was for the last half of the intercourse since it was very brief (less than 8 minutes),or the last 2minutes. She seemed very calm about the situation and offered to change the condom and asked me if I ejaculated inside her, which I replied no, I didnt ejaculate at all.
I totally freaked out and checked on the condom which I noticed had a small hole on the tip. My glans was still covered in part but I´m afraid my urethra was exposed, Since I freaked out I didnt really asked her about her status and just got dressed and left the room in panic.

I´m fully aware that this places test their girls for STD´s/HIV, just don´t know how often, also these girls can sleep with10 people in one night so having a condom failure on these kind of places is pretty scary. I´m also aware that they use condom on ALL the people they have sex with and regularly don´t do anal, here IV drugs are extremely expensive so I would rule out that.

Having described my situation I would like to
1)Asess my risk w/u (chances of being infected w/HIV)
2)When can I get tested for other STD´s (urine test for gono,chlamidya and vdrl) - has been 3 days, no symptoms
3)When can I have an HIV test done? on the medical standpoint you think its necesary? (i will do it anyway just want to know your opinion)
4)unprotected sex w/fiancee is a NO right?
Thanks a lot!

[H. Hunter Handsfield, M.D.]

It's not an issue of payment -- just a lot of superfluous information.  The important tests are negative and you can move on with your life without any more testing and without giving another thought to the low risk event in Panama.  

[worriedinpty12]

Wow, my last post got deleted... ok, just going to report my results. @6 weeks.

HIV - NEGATIVE
HSV II (Igg) - NEGATIVE.
SYPHILIS - NEGATIVE.

Had some other questions regarding further testing but apparently I will need to pay again.

[H. Hunter Handsfield, M.D.]

1) That test is fine.

2) HBV vaccine isn't being recommended because of your past exposure.  It will protect only against future exposures.

3) I don't understand the apparent lack of availability of testing for chlamydia and gonorrhea, and the dose of azithromycin is far higher than normal.  (The usual is 1 gram in a single dose.)  But most likely these treatments won't do any harm.

4) I'll bet this symptom is just anxiety making you more alert to normal body sensations or trivial symptoms you wouldn't otherwise notice.  
Certainly it is not herpes.

That will end this thread.  I would suggest that any additional questions or concerns be directed to your ID specialist.  Best wishes.

[worriedinpty12]

Thanks Doc.!

I know I said my next post was going to be a 6-week follow up but I wanted to share with you my findings with the infectologist.

He said that the risk of exposure was very low as you said for both the serious ones, very, very low for HIV and low for HSV2, but to be on the look for symptoms just in case, because a risk it´s still a risk!

I also called the brothel and talked to the manager which said that these girls cannot work unless having a "green flag" issued by the Healthcare System from the Panama Goverment, and that they do their tests every week.
(this is reasurring, however I have to yet go there and see their negative tests, maybe will go today)

Anyways, the doctor set me up for HIV PROVIRAL DNA which I think it´s the PCR test on April 22nd (5 weeks post posible exposure, because here in Panama there´s only 1 lab who does it and couldnt be any sooner), and an Antibody ELISA Test 3rd Generation @6weeks post possible exposure, we dont have 4th generation here.

Also unfortunately told me that tests for Gonorrhea and Chlamydia are not done in private laboratories, so we needed to go as if I have been infected and he prescribed.:

1 Intramuscular Injection of Ceftriaxone(1g) - Took on Wednesday Night
1g Azythromicin - 2 tablets of 500mg - Took Yesterday
2g Tinidazole
Hepatitis B Vaccine.

I have yet to take the 2g Tinidazole and the Hepatitis B Vaccine, most likely will do today.

My questions would be.:

1)What do you think about his assesment on the medications? and ¿is the HIV PROVIRAL DNA @5weeks and the ELISA 3rd Generation @6 weeks conclusive for my incident?

2)Is this Hepatitis B Vaccine any good now after 7 days post possible exposure? what are my chances on this one? should I get vaccinated?

3)Another thing I wanted to ask you about is that he prescribed 14 more days of azythromicin (500mg @day), as "prophylaxis", he mentioned "Chlamydia & Ureaplasmas"... in your experience, this is necessary? (I dont want to rule out my infectologist prescription but I really think it´s too much and wanted to have a 2nd opinion)

I already took the 1g Azythromicin for Chlamydia, and he really didnt explained to me why he did this prescription, I even dont know if I was infected with anything on the first place.

4)But, I´m also starting to feel a burning sensation on the tip of my penis, not when I urinate at all, maybe after that and it stays a while, could this be HSV2?

I have no blisters or sores or anything like that on my penis, neither fever, malaise or swollen lymph nodes at day 7, just this little burning sensation on the tip, which is not highly uncomfortable but its there, also no discharge or anything else "suspicious". at least yet, this is not typical right? at 7 days post exposure should I still be on the look for symptoms of HSV2?

Thanks a lot for taking the time to respond to my questions, I will make a follow up post after I get the results from the HIV Proviral DNA and Elisa 3rd Gen, If I dont have any HSV2 symptoms I´ll just move forward.

Thanks in advance for doing this incredible service to the community.

[H. Hunter Handsfield, M.D.]

The chance of catching HSV-2 from any single unprotected exposure is very low, well under 1 in many thousand (maybe one in a million).  I don't recommend testing for it.

I already answered the question about timing of HIV and syphilis blood tests.

I'm not sure about the frequency of syphilis in Panama in general, or in CSWs there.  But the chance of infection from any single exposure is quite low.

[worriedinpty12]

Thanks a lot Doctor. that really eases my mind..!!!  

I´ve been reading a lot through this forum, and also on the poz/aidmeds forum lately only to find out that most (if not all) condom breakage incidents with CSW reported on both forums end up with the person testing negative! -this is very reasurring for me.

Anyways I will be going to see an Infectologist to know transmission rates here in Panama City among CSW as he might have some info regarding this brothel too since its quite famous.

Also I will have him set me up for a chlamidya/gonorrhea test, the more informed I am, the less anxious I´ll be regarding this incident.

Now, what about HSV-2 (Genital Herpes)? I´m surely at risk for that one too, what are the odds for me on this condom breakage incident based on your expertise?? It´s been 5 days and I haven´t developed any symptoms, I know it could be too early to know , but when do you advise testing for this one?

Also after 6 weeks test with the syphilis and HIV? or can I get tested before?

And (if you dont mind answering this) what are the odds for me catching the Syphilis? (on the worst case scenario, which I probably know its not my case but just out of curiosity)

Thanks a lot for all your wonderful help!! -Next post will be a 6 weeks follow up on my status.

[H. Hunter Handsfield, M.D.]

To the user whose inappropriate comments were deleted:  there has never been a question we are "uncomfortable" answering.  It's just that thread jumping isn't permitted; we respond only to follow-up comments/questions by the original questioner.

[H. Hunter Handsfield, M.D.]

Only by a little bit -- not enough to make any difference in my advice above.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Based on your description of the HIV and STD testing policies of the place where your commercial partner works, it seems you can be confident she doesn't have HIV, and probably none of the main STDs (gonorrhea, chlamydia, syphilis).  Even if she has HIV, a single unprotected exposure carries an average transmission risk of HIV of only about once for every 2,000 events.  To your specific questions:

1) The chance you caught HIV is extremely low, probably on the order of one chance in a million, maybe lower.  The risk of other STDs is higher, but still quite low.

2,3) You can be tested for gonorrhea and chlamydia (a urine sample) whenever you want; any time more than 2-3 days after exposure is fine.  HIV testing is valid at 6-8 weeks for an antibody test, or at 4 weeks, if you have a "4th generation" or "combo" test for both HIV antibody and antigen.  For syphilis, 6 or more weeks after exposure.

4) If I somehow found myself in your situation, I would resume unprotected sex with my wife once I knew my chlamydia/gonorrhea test was negative.  However, if you want absolute 100% certainty against HIV and syphilis as well, you'll have to wait a few weeks until those tests are done.

Best wishes--  HHH, MD

[worriedinpty12]

I´m also uncircumcized, do this increase the risk.?