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Avatar universal

Risks/Broken Condom

Hi Doctors, thank you for your valuable insights. I've read a number of posts and would like your advice on my particular situation.

About 36 hours ago, I visited a transvestite CSW (male to female, pre-op). We engaged in unprotected oral and protected anal intercourse. I received protected anal and gave protected anal. Ejaculation was external.

However, while I was giving intercourse, the condom Broke. She felt it right away and we pulled out to replace the condom. We continued and about 15 min, the condom broke again and again immediately pulled out. We engaged in mutual masterbation until we both came.

I became worried about the encounter, and followed up to ask whether she was "clean." she assured me she was and after a follow-up phone call, offered to show me her "sample."

I'm extremely worried about catching an STD and/or HIV. I have had no symptoms thus far and would like to continue my sex life, which is always protected. This was in New York City.

I'd like to know my risks for HIV/Herpes in this particular situation.  Thanks in advance.

What are my risks in this situation for acquiring HIV and other STDS like HSV 2. Thanks in advance for your advice.
8 Responses
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  While I will not be able to provide you with precise estimate of your risk for HIV or STD, I will provide some information which I hope will be helpful to you.

The first determinant of risk is whether or not your partner had an infection.  I presume that you both were in favor of condom use and if this the case, the likelihood that she was infected is lower than if she did not since it suggests she would use condoms with other partners.  Further, she told you she was not infected an most people do tell the truth.  While none of this is a guarantee, it all seems to suggest that the odds are that she was at somewhat lower risk for infection than if that were not the case.  

In addition, even if your partner was infected, most sexual exposures to infected partners o not lea to infection. thus this too is in your favor.

Finally, while there are no specific studies which evaluate the effect of duration of exposure on likelihood of infection, common sense tells us that the briefer the exposure, the less likely infection is to occur and your exposure was brief since you separated when you felt the condoms break.

Putting all of these facts into consideration, while your exposure was not risk free for infection, chances are that you did not get infected.  You'll know if you got HSV-2 base on whether or not you develop lesions in the 14 days following your exposure. For other STDs, testing may help to provide peace of mind.  

Hope these comments help. EWH
Avatar universal
Thanks for the reply, Doctor. One follow-up question:

Would you recommend testing on the basis of this encounter? I am regularly tested for all STD's as part of my annual physical. I was test earlier this year. I've also scheduled an appt to get tested this week for the more common STD's (chlymadia, etc). Would you recommend testing for any additional STD's (HIV, HSV)? I understand the window period would larger than one-week post exposure, but would it still we worthwhile? Thanks very much.
300980 tn?1194929400
MEDICAL PROFESSIONAL
I think if you are getting tested for the most common STDs (i.e. chlamydia, gonorrhea, NGU)  this should be quite sufficient. EWH
Avatar universal
Thanks Doc, I've gone ahead and seen my doctor and submitted a urine sample. However, just in the last 24 hours, I've noticed that the back of my tongue has a strange, green coating on it and throat is slightly sore. Admittedly, I've been smoking (I'm a smoker) more than usual as a result of anxiety over this incident. Is this anything to worry about? Thanks again for your thoughts.
300980 tn?1194929400
MEDICAL PROFESSIONAL
No, nothing to worry about.  There are no STDs that give a person a green tongue and most STDs infecting the throat are asymptomatic.  EWH
Avatar universal
Hey Doctor, a few updates:

1) I submitted a urine sample approx. 6 days after this exposure. My doctor said that if anything came back positive, he would call (testing for chlymadia, gonorreah, NGU, etc). It's been two weeks and haven't heard from so everything is fine on that front.

2) It's been exactly 19 days, and I've not noticed any lesions, sores or anything out of the ordinary in and around my genital region. No discharge either. No generalized symptoms either. Just anxiety.

3) Today, almost three weeks since the exposure (about 19 days), I went to my local Planned Parenthood for an HIV rapid test (drawn via blood). It came back negative. The clinician told me that at about 3 weeks the test result is highly reassuring. At this point, it's really up to me if I want to get a confirmatory test at any point in the future.

Here are my final questions (I realize you want questions about HIV in the HIV forum, but hope you might humor me).

1) How reliable is a rapid HIV (via blood) test at approx. 3 weeks (19days)?

2) Should I re-test at any point in the future related to this individual (brief) exposure assuming no new partners?

3) My initial doctor gave me a referral to a Quest Diag Lab and told me to wait to get tested at least until 3 months. The test on the form includes
a) HIV-1/HIV-2 Ab, EIA w/ reflex to HIV-1 Ab, WB
b) HSV 1/2 IGG Herpes Select

4) How long do you recommend waiting to get the above quoted tests?

Thanks again Doctor. I do appreciate your input. The last few weeks have been the darkest in my life.
300980 tn?1194929400
MEDICAL PROFESSIONAL
Straight to your questions:

1) How reliable is a rapid HIV (via blood) test at approx. 3 weeks (19days)?
At 19 days an HIV antibody test will detect more than half of recently acquired infections. At 4 weeks the proportion of infections detected increased to over 90%

2) Should I re-test at any point in the future related to this individual (brief) exposure assuming no new partners?
As I said, your risk for HIV is low. To be completely sure, you would need an antibody tests at 8 weeks following your exposure.  I doubt that the results will change between now and then.

3) My initial doctor gave me a referral to a Quest Diag Lab and told me to wait to get tested at least until 3 months. The test on the form includes
a) HIV-1/HIV-2 Ab, EIA w/ reflex to HIV-1 Ab, WB
b) HSV 1/2 IGG Herpes Select

The HIV antibody test will provide definitive results on HIV.  You could get equally reliable results with the same test earlier if you wish, at 8 weeks following exposure.  Your doctor is following rather conservative recommendations.

As for the herpes test, this is a test for HSV antibodies.  In the absence of lesions we do not recommend testing for persons in your situations studies have shown that in the absence of lesions or other more pronounced risk, the likelihood that you will get a false positive test is higher than that you will find that you have acquired HSV.

this will need to bring this thread to an end. Take care.EWH
Avatar universal
Hey Doc -- no questions, just reporting my results.

6 week blood test negative, as well as my final 8 week test (57 days to be exact), also NEGATIVE, as you predicted.

Thank you so much for your time, expertise and insight. It's considerably helped me through this time, even if, from a medical POV, my risks were low.

All best to you.
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