condoms efficacy when not broken

[amontec]

Hi Doctor!

I am a HIV-negative (tested 6 months ago) 30yrs old male. Here is a "risk" that triggered my HIV panic-mode: Yesterday I engaged in protected oral sex (5min, did not come) followed by a protected intercourse (5min, ejaculated) with a CSW. Showered after it (I know, a mistake). I am from Poland.

Me and my wife are desperately trying to get pregnant (in-vitro fertilisation is on the horizon) and I have no idea why I did it. Guilt kicks in and BAM! I'm on medhelp.

After doing some research (tried to use reliable sources, like WHO) I started to freak out. Each and every official/government site out there claims that the risk of getting infected is "greatly REDUCED if a condom is used properly". Numbers vary from 78 to 95%. I have not found a single sentence claiming that "one is 100% safe, if a condom did not break".

That said, from thinking "no tear, no fear", I converged to "80% better if it did not break, was not expired, correct lube was used and I was lucky". Given that risk for unprotected sex is 1/1000, and that condoms are 80% effective (which I did not know at that time...) I would have never took a chance.

Q1: Given a post-factum situation where condom did not break and was gently/correctly handled- is it considered 100% safe? Is tearing the only way that condom can fail (in othere words: can you tell when condom failed). Why there is no agency officially stating that if condom did not break, there is no need for testing? I'll test regardless of your answer since we'll need it for in-vitro but I do not want to risk infecting my wife in the meanwhile.

Q2: I am treating 2 plantar warts on soles of my feet with salicylic acid, so the skin there is a mess. Is taking a shower in a brothel something I should consider risky in any way (I know HIV is not an option here)?

Thank you for your patience :)

[Edward W Hook, MD]

Welcome to the Forum.  The exposure you describe has no appreciable risk for acquisition of HIV or, for that matter, most other STIs.  You are correct that here is substantial variation in how much condoms reduce risk for HIV., This is more a reflection of the difficulties of carrying out condom studies than anything else.  Remember, condoms can be put on incorrectly and since one cannot realistically observe condom use in persons who claim to be using them, persons may mis-state that they used condoms correctly.  Further, many people who think they are using condoms actually use them improperly, putting them after sex had been started, having them slip off during sex, and other errors in use.  For these reasons, estimates of how effective condoms are tend to be conservative.  Most experts agree that condoms are more than 99% effective for reducing risk for HIV.  The chances if getting HIV from the encounter you describe is less than 1 in a million.

As for your specific questions:

Q1: Given a post-factum situation where condom did not break and was gently/correctly handled- is it considered 100% safe? Is tearing the only way that condom can fail (in othere words: can you tell when condom failed). Why there is no agency officially stating that if condom did not break, there is no need for testing? I'll test regardless of your answer since we'll need it for in-vitro but I do not want to risk infecting my wife in the meanwhile.

Yes, your exposure was effectively completely safe., You really have no realistic reason to worry.

Q2: I am treating 2 plantar warts on soles of my feet with salicylic acid, so the skin there is a mess. Is taking a shower in a brothel something I should consider risky in any way (I know HIV is not an option here)?

No, there is no risk for any STI related to the fact that your feet  were irritated from the acid treatments.  Please don't worry, there is no reason for concern and no reason for testing related to the exposure that you describe. EWH

[Edward W Hook, MD]

Glad I could help. Take care. EWH

[amontec]

Thank you, doctor.
I'll focus on being sincere with my wife now, trying not to worry about this episode.