Advice Please After Condom Break

[Kykid30]

I am a 31 year old heterosexual white male from Kentucky. I've been sexually active with about 10 "high class" CSWs over the past 6 months. I have practiced unprotected oral sex (both ways) with all of them and always use condoms for vaginal sex. I have never had a problem with a condom breaking until today. I tried to penetrate my partner (she was African American) anally and when entering her the condom broke wide open. I'm not certain if I was inside her when the condom broke or if it broke on entry but we immediately stopped. I freaked out and asked her about her status. She swore to me she was HIV negative and even showed me her last test results from last August (she was negative for everything).

I'm going to test in 6 weeks for my own peace of mind, but I have the following questions:

1) As stated I'm going to test, but from a medical standpoint if I walked in your clinic with the above scenario would you advise testing?
2) Would this brief unprotected exposure warrant PEP? If so, how would I go about that?
3) Do my other exposures (all protected vaginal and unprotected oral) warrant testing?
4) Would you be highly concerned if you were in my shoes?

Thanks for the great work you do.

[Edward W Hook, MD]

I suggest that it is time for you to move on.  EWH

[Kykid30]

Dr. Hook,

I took a Home Access test at 4 weeks and the results were negative. While I realize that these results are not considered scientifically conclusive, it put my mind somewhat at ease. Given the brevity of my exposure, can I move on or would you suggest additional testing at 3 months? I've had no signs or symptoms of any other STDs to this point. Thanks for the work that you do -

KYKID30

[Edward W Hook, MD]

Welcome to our Forum. sorry to hear of your condom mishap. to put this into perspective, condoms break about 1% of the time.  

Let's analyze your risk related to this exposure.  Although your partner is a commercial sex worker, the fact that she can prove to you that she did not have HIV two months ago is good news and makes it quite unlikely that she has gotten HIV in the interval. Here’s the math- just for arguments sake, let's say there is a 1% (1 in 100) chance that she had HIV.  Then, if she had HIV, your risk from a single exposure is about 1 in 1,000 and perhaps lower. Factors such as the brevity of your exposure probably make it much lower but again, just for arguments sake, let's use the 1 in 1000 chance for transmission probability. Using these two figures, your risk of infection is mathematically 1 in 100,000 or, to put it more likely, you are more likely to get hit by lightening sometime that to have gotten HIV from this exposure.  It is not something to worry about.  

Now let's deal with your questions:

1.  Testing is always a goo idea for purposes of reassurance (for you) and because VERY rarely weird things happen (like people get hit by lightening).  It is critical, probably not.  If you get tested, as long as you’re at it, I'd suggest testing for other common STDs (gonorrhea, chlamydia) too, just to get complete peace of mind.
2.  No it would not. I would not recommend PEP in this situation. In my judgment it would not be needed and the risk of side effects would be greater than the potential for benefit (not to mention it tends to be quite expensive too).
3.  No they do not warrant concern. Condom protected sex is safe sex and the risk of HIV from giving or receiving oral sex is virtually non-existent.
4.  While I understand your anxiety/concern, I would not be worried.

I hope you find my comments reassuring.  EWH