[Question #10953] Broken condom HIV scare

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18 months ago
Hello doctors,

I’m absolutely terrified right now. I just (less than a half hour ago) visited an adult theater and had sex with another man. I was the insertive partner. The duration was less than 30 seconds. After I pulled out, I saw the condom broke. I asked the guy if he was clean, which he said he was. But I don’t want to take any chances. Should I begin PEP today? What would be my risk in a situation like this?

Your insight is appreciated.
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Edward W. Hook M.D.
18 months ago
Welcome to the Frum.  Thanks for your questions.  I'm sorry to hear of your condom mishap however this happens about 1% of the time condoms are used.  I hope that this mishap will not keep you from using condoms in the future.

In all probability, your partner was not infected, both statistically and because data show that when asked most people tell the truth.  Even if he had untreated HIV (treated HIV is typically not infectious) your risk for infection is, on average less than 1 in 1000, i.e., if he was infected there is a more than 99% chance you were not infected. Whether this risk is high enough to seek PEP or not is, of course, up to you.  PEP is typically safe and effective although it may be costly and taking PEP will mean that you cannot test conclusively for HIV until at least 30 days after you complete PEP.  If you choose to use PEP, the sooner you take it, the better and PEP must be started within 72 hours of exposure.

I hope this information is helpful to you as you go forward.  In my opinion PEP is of borderline benefit for you but, as I said above, this is a personal choice.  EWH
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18 months ago
Thank you for your insight. Hearing the odds like that is very reassuring. Coupled with the fact that, after the initial shock wore off, I took into account the brevity of the exposure. 

I’ll sleep on the decision to seek PEP, as I want to be certain but also understand that 1/1000 stat is close to hetero risk numbers.
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18 months ago
If it makes any difference in risk, I remember the break happening at the base of the condom and only the base was present after I pulled out. So I’m not sure if the head was covered the entire time or not. 
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Edward W. Hook M.D.
18 months ago
Thanks for the additional information.  When condoms break at the base rather than the tip, the risk for infection is lower still.  If the head of the penis is covered, the condom will be doing its job.  EWH---