[Question #12644] HIV risk from broken condom during anal sex

6 months ago

Hi this afternoon I had an anal sex with a sex worker and about after 10 seconds in the condom broke. I’ve had sex with the sex worker before and she’s always tested negative and I’ve always tested negative for everything. She says she doesn’t have HIV. Is it worth it for me to get on pep or stop worrying and move on with my life?

H. Hunter Handsfield, MD

6 months ago

Welcome back and thanks for your continued confidence in our services.

Looking at your two recent discussions with Dr. Hook, this event is the same as the previous two, and exactly the same as the second. (Perhaps there's something about the condoms you're using or your technique? Not necessarily -- condom breakage isn't rare. But still, two events in a short time raises these questions.)

In any case, HIV is rare in female sex workers in the US or most other industrialized countries, and people usually are truthful when asked directly about HIV status, testing, etc. So it seems very unlikely your partner has HIV. I definitely would not advice PEP and really don't even advise testing on account of this event.

Let me know if anything isn't clear.

HHH, MD

---

6 months ago

Thanks for the insight Dr Handsfield. I went to my local urgent care and the doctor there recommended that Pep would be a personal choice. She said the risk was pretty low but there was still a chance. Do you think me taking Pep would cause more harm than good in this circumstance?

H. Hunter Handsfield, MD

6 months ago

Of course PEP is always a personal choice. However, I would judge that the likelihood is high that the doctor making this recommendation is a lot less knowledgeable about HIV transmission risks, and also about the epidemiology of HIV in sex workers, than we are. The risk of a serious reaction to the PEP drugs, although very rare, still is a lot higher than the chance you acquired HIV. In addition, many persons at risk (and many health care providers as well) fail to consider an important downside to PEP. With anti-HIV treatment, it would be at least 8 weeks and perhaps 12 weeks from now before you could have conclusive testing to be sure you were not infected. Without it, you could be certain in as little as 11 days from exposure. Would you be prepared for the longer period of uncertainty and perhaps anxiety? (Be clear, I am not advising testing at all. Your risk was too low to warrant the cost, inconvenience, etc). But indeed the decisions are yours to make.)

All things considered, you need to get a grip on the true risks of HIV and likely other STDs. Your fears are way out of proportion to reality.

---
---
---

6 months ago

So I should go on and live my life?

H. Hunter Handsfield, MD

6 months ago

Yes indeed you "should go on and live [your] life". That was the whole point of my replies above. It is what I would do if somehow I were in your situation.

That completes the two follow-up comments and replies included with each question and so ends this thread. Also please note the forum policy against repeated questions on the same topic. This being your third about nearly identical and close-to-zero risk sexual practices, it should be your last along these lines. Repeated anxiety driven questions may be deleted without reply and without refund of the posting fee. We're not keen on collecting fees for questions with obvious answers; repeated replies often prolong anxiety rather than relieving it (there's so often a "yes but" or "could I be the exception" sort of thinking); and such questions have reduced education value for other users, one of the forum's goals. Thank you for your understanding.

I do hope this additional discussion has been helpful. Best wishes and stay safe.

---