[Question #10753] HIV likelihood
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19 months ago
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I had protected vaginal sex with a woman for about 45 mins. The condom stayed on the head the whole time but it kind of was loose at the tip like a little bit was dangling when I pulled out. I checked the condom after to see if there’s any breaks in it and there weren’t. I even filled the condom with water after sex to see if any water would leak out and it didn’t. I was wondering what my risk is for this encounter and if I should even test from this exposure or even worry about the potential. The girl also told me she always has sex with condoms and even made me buy one so I think she practices safe sex. Considering that and that my urethra stayed covered although it was a little loose should I even be worried or even get tested?
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Edward W. Hook M.D.
19 months ago
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Welcome to our forum. Thank you for your questions. I’ll be glad to comment. As it happened, I was on the forum soon after your question arrived and therefore you are getting a response more quickly than typical. Any follow-ups may take longer to get to you.
The exposure that you described was a virtually no risk event. I say this with much confidence. Here are the reasons why I say this:
1. Most importantly, you used a condom, and there was no evidence that the condom broke. Condoms are highly effective for reducing the risk of STI when a person is exposed to a partner with STI.
2. Most people do not have STI. Irrespective of your partner’s history and prior activities, it is unlikely that she had a sexually transmitted infection. The additional information you provided regarding her insistence on condom use increases my confidence on this statement.
3. Finally, even if your partner did have an STI, and had you not used the condom, most single exposures to infected partners do not lead to infection.
Based on the information I provided, I would consider this encounter to be a no risk event. I see no medical or scientific reason for testing. On the other hand, I realize that sometimes following an exposure that a person has begun to wonder about, they may desire the additional Assurance that a negative test provides. If you choose to test, testing for the most common STI’s, gonorrhea, chlamydia, trichamonas will be entirely conclusive anytime more than 3 to 4 days after your exposure. Personally, I would not even bother to test.
I hope the information I have provided is helpful to you. Please don’t worry. EWH.
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19 months ago
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Okay, that is reassuring and I probably will not be testing unless I present clear symptoms of HIV transmission. I just have a few more questions to ask just for further clarification and reassurance.
1. Does the fact that my condom had front slippage but stayed on my urethra the whole time matter? It was kind of like almost at the base of my penis, but at the tip I had maybe like an inch dangling off, I did correct it kind of when I noticed. The condom also did not have any holes or tears. Where the condom was ending at the base it seemed to be securely held, and when I was taking it off it was very difficult.
2. What would my mathematical odds be if she were to have HIV? I understand without a condom the odds are roughly 1/2500, but the language around additional protection from condom confuses me a bit.
3. Should I consider PEP as it has not even been 24 hours since the exposure has occurred yet?
4. Have you or your colleagues personally heard of taken care of patients with similar situations as mine where they ended up being HIV positive?
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Edward W. Hook M.D.
19 months ago
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1. Does the fact that my condom had front slippage but stayed on my urethra the whole time matter? It was kind of like almost at the base of my penis, but at the tip I had maybe like an inch dangling off, I did correct it kind of when I noticed. The condom also did not have any holes or tears. Where the condom was ending at the base it seemed to be securely held, and when I was taking it off it was very difficult.
As long as the condom covers the tip of the penis, it protects from HIV, gonorrhea, chlamydia, etc.
2. What would my mathematical odds be if she were to have HIV? I understand without a condom the odds are roughly 1/2500, but the language around additional protection from condom confuses me a bit.
Your odds of getting HIV are substantially less than 1 in a million. Remember, following a single act of intercourse with a person with untreated HIV, the risk of infection is considerable less than 1 in a 1000 (actually it's close to 1 in 2500) then multiple that fact by the low likelihood that your partner had untreated HIV and the condom use and the risk approaches zero.
3. Should I consider PEP as it has not even been 24 hours since the exposure has occurred yet?
I would strongly oppose you taking PEP. If you approached me in my clinic for PEP I would refuse to prescribe it.
4. Have you or your colleagues personally heard of taken care of patients with similar situations as mine where they ended up being HIV positive?
Never.
Please don't worry. EWH
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19 months ago
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Hello again, I understand she is most likely not HIV positive, she even stated she got tested about a year ago so even more less likely. From my understanding if she were to be HIV positive then my odds are 1/2500 without a condom, but if a condom is 95% effective (I don't know if it is, the ranges are very different everywhere) this would make my risk 1/50000 or 0.002% IF she were HIV positive. Now, assuming that roughly 250,000 women have HIV in the United States and 13% (statistic of people who don't know they have HIV) wouldn't know they do that means 32,500 women are at risk of spreading HIV assuming that all who know take medication and those who don't take medication, but are aware would disclose it to partners. That would mean the odds of getting with an individual who doesn't know they have HIV is 32,500/167,000,000 which reduces to 1/5,100. So, my overall risk would be 1/50,000*1/5,100 which is 1/255,000,000 essentially meaning that statistically roughly only one individual in all of the United States would deal with this particular issue that I am in and get HIV? Also, my odds without the population statistic of 1/50,000 are the same as the theoretical risk of oral, so would my situation essentially be an undocumented case or has this type of exposure been documented in the past?
All in all, if the condom was in fact intact, just slipped forward to roughly half way my penis with some piece of the condom dangling at the tip I should be fine? Is it even possible to get HIV in this method?
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Edward W. Hook M.D.
19 months ago
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As I suspect you know, we provide up to 3 responses to each client's questions. I don't see a specific question here- rather a thought exercise to calculate your risk of HIV- I agree with your calculations. Could you get HIV from the exposure you describe -sure, in the same sense that you could be hit by lightening while reading this response. Is that worth any concern- no, it is not.
Once again, I urge you to have no concerns regarding this exposure.
This thread will be closed shortly without further responses. Take care. EWH
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19 months ago
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I'm basically just asking, are there any documented cases of someone using a condom that still covers the head of the penis and still getting HIV?
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Edward W. Hook M.D.
19 months ago
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No.
End of thread.
EWH
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