[Question #10555] Condom broke anal sex with transexual
21 months ago
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Hi,
A few days ago I wanted to have sex with a transexual csw in Germany ( it was one fantasy ) and I feared about condoms so I was trying to be careful. When I wanted to insert the penis it was not hard and I tried a second time when I checked the condom and it was broke. It had a hole in it. I asked the sex worker and she said that I was not inside her. In Germany it's mandatory to have some card but when I asked she said that she can not find it. I asked her if she would take an HIV test if I pay her and she did not answer. She said that it's clean but without any papers I do not know. I went to a clinic and I took my first PEP dose after a little 3 hours of exposure. The doctors said that the chances are slim but I am terrified. I do not have any bruises on my penis.
What do you recommend?
Thank you!
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H. Hunter Handsfield, MD
21 months ago
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Welcome to the forum. Thank you for your question.
I agree with the doctor/clinic where you sought PEP: not only are the chances you were infected HIV slim -- I would have considered them zero or very close to it. Had you been my patient, I would not have agreed to prescribe PEP. That said, the local doctors you saw probably have a better understanding than I do about how likely a partner like yours might have HIV. All I can do is reassure you that most people do not lie about HIV status when asked directly, so it seems to me unlikely your partner has HIV. And the very brief exposure you describe -- with a condom with a "hole" -- probably carried little risk even if your partner in fact has HIV.
That said, I have no specific advice about whether you should continue or stop PEP. We do not provide direct medical care, only general advice -- any decision about continuing PEP should be between you and the doctor(s) who prescribed it. But my guess is that they would agree it's OK to stop.
As you consider your decision, keep in mind a potential downside of PEP that many people don't think about -- and many physicians don't think about it either. If PEP is take but fails to prevent PEP, it prolongs the time to conclusive testing. At a minimum, testing must be done 6 weeks after the last drug dose, and some experts and clinics advise three months. Without PEP, you can have nearly conclusive testing 4 weeks from now, with truly conclusive results at 6 weeks. With PEP, it will be at least 10 weeks and maybe 4 months from now before you could know for sure you weren't infected. Are you prepared for that duration of anxiety and worry about it?
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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21 months ago
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Hi Doctor,
Thank you for answering so fast! It is a great honor to be talking with you!
I kept talking with the escort trying to convince her to take a test with me or show me her papers and I got a negative. I am now sure that she is positive ...
Even if there is a small chance to prevent it I will keep taking it.
I am not sure if the penis was out of the condom or the whole was on a side but I am crazy scared ...
She said that I was not inside her but if I think back the maxium duration was a few seconds. If.
Does anything I said above change my chances?
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H. Hunter Handsfield, MD
21 months ago
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No, this information doesn't change my evaluation or advice. I think you should believe the escort both on her HIV status and that there was no penetration. But it's up to you of course.---
21 months ago
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Last reply for me. What are my chances if she is lying? I 100% believe that she is lying so I do not go to police. O therwise she would have accepted my offer or show me the papers.
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H. Hunter Handsfield, MD
21 months ago
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With insertive anal intercourse (typical duration a few minutes), if the receptive (bottom) partner has HIV, top has roughly one chance in 1,000 of catching HIV. With the very brief exposure you imply -- and maybe no penetration at all -- it must be far lower. And if your partner indeed has HIV but is on effective anti-HIV treatment, the transmission risk is zero even with entirely unprotected anal sex. I'm sure your own PEP prescribing doctors would agree.
That concludes this thread. Best wishes and stay safe.
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