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Avatar universal

condom failure HIV risk

Dear Doctors, you probably annoyed by this question, but I'm just anxious and need to ask you: I had sex with CSW yesterday (vaginal with condom), condom broke and I felt it and removed condom right away and washed exposed area with soap and water. I dont think exposure was too long, may be  a minute or so.  Main question is: would you recommend to start post exposure treatment (Truvada)? Girl told me she is clean, but I'm not sure if I can trust that. I was out for a conference in that city and came back home today and very nervous. Thank you very much!
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Forget it.  There are at least 10 reasons it cannot possibly be HIV.  You have a cold.  See my advice above.

This thread is over.  No more comments, please.
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Avatar universal
but what about sore throat? Could it by itself be the sign of ARS? Thing that worries me is that I have it for more than a week already
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Acute HIV infection doesn't cause stuffy nose; you caught a cold.  You really shouldn't be worried about it.  But if you remain concerned you should contact the doctor who prescribed the PEP.
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Avatar universal
Dear Doctor, to follow up on that: I did see ID specialist and he recommended PEP which I started within 48 hours after exposure. Now I'm little over 3 weeks post exposure and having pharingitis for about 10 days, stuffy nose, no fever, no lymphadenopathy, no other symptoms. I'm very nervous that it could be ARS - I know that is very unlikely considering I'm still taking PEP, but still freaking out. It is too early to get tested and I'm scared to do it anyway. What do you think: is that possible that my sore throat is due to ARS?
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239123 tn?1267647614
MEDICAL PROFESSIONAL
That's an excellent question but the answer isn't simple; it's a complex issue. First, the premise is wrong that "so many people get infected".  In the US and other industrialized countries, heterosexually transmitted HIV remains rare except in select circumstances and population groups.  The large majority of new HIV infections in the US continue to occur in men who have sex with men, because anal sex carries far higher risk of HIV transmission than vaginal intercourse.  Second, combinations of factors like low rates of male circumcision, higher rates of other STDs especially HSV-2, a higher proportion of infected people with high viral loads, and certain sexual behavior patterns (high rates of "concurrency", i.e. overlapping partnerships) explain the much higher rate of heterosexual transmission in some societies, e.g. southern Africa.

And by the way, even including men having sex with men, HIV isn't all that common in the US.  It is estimated that there are about 60,000 new infections per year.  That number is terrible in some ways and certainly far too high, but it compares with millions for most STDs (herpes, HPV, chlamydia, trichomonas), and with far higher rates for any number of cancers, deaths from accidents, etc.  As for new heterosexually transmitted infections, I think the number in the US is well under 5,000 per year -- a small number in a population of 320 million. And most of those occur not in one-time exposures to new parnters, including commercial sex workers, but in people who are the regular partners of people known to have HIV.  Heterosexually acquired HIV from one-off exposures is very rare.
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Avatar universal
Another question I wanted to ask: you always say that risk is 1:2000, so if that so low why so many people get infected? My understanding is that the main route of transmission now is heterosexual. Also do you think that duration of exposure plays role in probability of transmission?
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question, which is not at all annoying.  

Recommendations for post exposure prophylaxis (PEP) after potentially risky sexual exposures are highly variable from place to place and in different circumstances.  PEP might be warranted if HIV is especially common in CSWs in the area where this occurred, or if other circumstances suggest a high risk she is infected (e.g. a street walker or brothel worker, compared with an upscale/expensive escorts, or an injection drug user).  Her race/ethnicity also might enter into the equation.

Because of these varables, and because recommendations vary from place to place, we don't give specific advice for or against PEP on this forum.  And no online forum can give specific treatment advice.  My advice is that you immediately visit a doctor or clinic locally for personalized advice.

Having said all that, the odds are your partner doesn't have HIV; even in the highest risk settings, most CSWs aren't infected.  Furhter, most people don't lie about HIV status when asked directly.  And even when a woman is known to have HIV, the average transmission risk for any single episode of unprotected vaginal sex is around 1 in 2,000.  Your risk would be even lower, given the brevity of exposure after the condom broke.  So the odds are strongly in your favor.

I'll be interested in hearing the outcome if and when you are professionally evaluated.  You'll need to see someone within 72 hr of the sexual exposure; after that, it's too late for PEP.

I hope this helps.  Best wishes--  HHH, MD
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