[Question #11853] Condom broke during sex
12 months ago
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Hello, I had vaginal sex with a prostitute, condom broke. She is from Brasil, states that she is HIV negative and was tested 3 months ago. I got her tested with Oraquick hiv test which was negative. Should I start taking PEP?
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H. Hunter Handsfield, MD
12 months ago
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Welcome to the forum. Thank you for your question.
Congratulations for the wisdom in using a condom for this exposure. Too bad it broke, but your risk for HIV remained low anyway.
Decisions about PEP are best made by local health care providers who understand the details of local HIV epidemiology, such as the frequency of infection in sex workers. However, I see no need for PEP. First, even if your sex work partner has HIV, the odds of transmission from a single episode of unprotected vaginal sex are around one chance in 2,500. And with her negative Oraquick test, there is almost no chance she has HIV. Your risk is low enough that you really don't even need HIV testing -- although of course it would be understandable if you decide to test in a few weeks, for reassurance despite the zero risk involved. You also might want to consider testing for common STDs, i.e. a urine gonorrhea/chlamydia test (valid 4-5 days after exposure) and a blood test for syphilis in a few weeks -- although the risks of these also are very low, assuming no symptoms like urethral discharge, painful urination, or penile sores.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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11 months ago
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How accurate/reliable is that Oraquick test? Also I forgot to mention that she told me that she is taking Truvada is PrEP, which made me even more nervous first, but I guess it is a good thing and she told me that many escort providers do that nowadays…
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H. Hunter Handsfield, MD
11 months ago
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Oraquick is around 98% reliable, making it exceedingly unlikely she has HIV. And her taking PrEP makes it even less likely. That should not make you nervous at all -- it confirms she understands the risks of her sexual lifestyle, and that she cares about both her own health and that of her partners. If somehow I were in your situation, I definitely would not seek PEP. I wouldn't even be tested for HIV and would continue unprotected sex with my wife with no worry of infecting her. Your situation is truly zero risk for HIV.---
11 months ago
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Thank you for your response, truly appreciate your confidence. Since I’m entitled to one more follow up question, I will ask it. If the risk of infection is so negligible, how come so many people get infected? Or it is mostly other types of transmission (even though according to statistics even male to male transmission is fairly low, like 1-2%) risk per intercourse)? Do you see any female to male transmission in your practice at all?
Thanks again!
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H. Hunter Handsfield, MD
11 months ago
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The quick answer is that HIV isn't as common as you might imagine based on media stories. The total cases likely acquired by heterosexual exposure divided by the 40 years of the national HIV/AIDS epidemic comes to only 25,000 - 30,000 cases per year, a small number in a population of 330 million. And most of these are not in people with one-time or occasional risky exposures, but in the regular partners of persons at high risk. (Think of the closeted married gay man or injection drug whose wife becomes infected; and even this often doesn't happen until several years into the relationship, with multiple episodes of vaginal sex.) Stated another way, the proportion of the population at truly high risk of HIV is really quite small. Over the years I've personally had few or no male patients who acquired the virus from female partners.
As you anticipated, that concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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