Exposure Risk Assessment

[progers777]

Dear Drs,

I'm trying to get your professional opinion if I should start PEP therapy immediately or not.

Last night I was having protected vaginal sex with a call girl when I felt the condom snap. I withdrew immediately and saw that a part of the head of my penis was exposed with the tip of the condom still in place and attached. The condom didn't get get completely destroyed but it was definitely broken. I immediately went to shower and washed my genitals with warm water and soap, and peed a little.

The lady said she always practices safe sex and indeed, though at my request, we used a condom for oral prior to the mis-hap. I asked her if she would go take a full STD test with me and she did do it this morning. We have to wait for results till Tuesday or Wednesday, and I'm driving myself nuts.

Should I go to the emergency room and ask for PEP treatment? It's still been less than 24 hours as I'm writing this.

Thank you for your prompt reply,

progers

[progers777]

Thank you for your quick reply. I was tested for the whole panel of STDs last month, all clear. this was my first intercourse of any kind in over 4 months. Didn't expect it to turn into such a stressful experience. The lady wasn't a streetwalker, but rather a part-time call girl. She assured me she hasn't done drugs and always practices safe sex... Oh well, all I can do now is wait for her test results.

[H. Hunter Handsfield, M.D.]

This situation does not meet most authorities' guidelines for PEP, at least not if you are in the United States or other western industrialized country.  Few commercial sex workers in the US have HIV, and that's probably especially true if "call girl" means a relatively upscale CSW, i.e. not a brothel worker or streetwalker.  Further, it is likely she told the truth when saying she isn't infected with HIV or other STDs.  When a female CSW routinely insists on condoms for vaginal or anal sex, it's a pretty safe bet she is HIV negative and dedicated to staying that way.  After all, in general CSWs are at greater risk of infection by their customers than the other way around.  On top of all that, it sounds like your urethra remained covered by the condom, which is the important aspect of condom use.  You can't catch HIV through intact penile skin.

In fact, your risk from this event is that I don't even recommend HIV testing, let along PEP.  Sexually active people at potential risk but not at particularly high risk for HIV (like gay men, injection drug users, etc) generally don't need HIV testing after individual exposures, unless the partner is known to have HIV.  It's a smarter practice for those who are sexually active outside mutually monogamous relationships to just plan on routine HIV testing from time to time, like once a year.

So if you haven't been tested recently, it would make sense to do so 6-8 weeks after this event -- for peace of mind, not because the risk is high.  Or just do it if you will sleep better knowing you have had a negagtive test.  But don't seek PEP (you probably wouldn't be able to find a provider to prescribe it) amd don't lose a lot of sleep over this event as you wait for testing time.

Best wishes--  HHH, MD