Broken Condom

[yokoshiho]

I am a male who gave a female CSW unprotected oral sex, followed by vaginal sex with a condom. Immediately after feeling a "pop" I pulled out of her. This is the first time I had a broken condom (which I always use for vaginal sex, occasionally when I am getting oral and I give unprotected oral occasionally). I sprayed the tip of my penis with alcohol. 24 hours later I noticed a little bit of whitish material coming out of the tip. The next day I went later went to a clinic and they suggested I use antibiotics. I am allergic to penicillin and they said I should use 2 grams of azithromycin (again). My questions are: 1. what infections (if any) are likely? I was told there was a chance of gonorrhea and chlamydia. 2. I have read that azithromycin does not work against gonorrhea, but was told it will. which is correct? 3. From this episode, what is my risk of HIV? How soon should I get a test for this? Thanks

[Edward W Hook, MD]

Whether or not you get tested is up to you.  As I said, your risk is very low.   I have very little concern about your risk for HIV and see no need for you to refrain from sex until after your 6 week test result.  EWH

[yokoshiho]

Do you think I need a follow-up test and would you recommend getting the HIV test? Do I need to refrain from sex until after teh 6 week HIV test?

[Edward W Hook, MD]

Welcome back to our Forum.  Condoms, when use correctly, still break as much as 1% of the time. Even so, your risk that this was an STD is relatively low.  Most CSWs do not have infection and most exposures to infected partners do not lead to infection.  For an STD to appear within 24 hours of exposure is rather early.   On the other hand, the alcohol you sprayed on yourself could certainly be irritating and might have caused this.  I say this mostly as background since your questions are related to the treatment you had but thought it might be helpful information to you and other readers.  As for your questions:

1.  See above. The STDs most often acquired from your exposure would be chlamydia, non-gonococcal urethritis (NGU) and gonorrhea.  This risk however is rather low.
2.  The dose of azithromycin used to treat NGU is not reliably effective against gonorrhea but the 2.0 dose, which is twice the dose used for NGU or chlamydia is effective and recommended for gonorrhea treatment.
3.  Very, very low.  Most CSWs do not have HIV and even if she did, your risk for getting HIV is 1 infection in every 1000-2000 exposures.  In your case a test for HIV at 6 weeks following exposure will provide proof that you did not get HIV.

Hope this helps.  Take care.  EWH