[Question #12782] Condom broke HIV exposure
5 months ago
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Hi Dr Hunter Hansfield,
I had a potential exposure to HIV that I am concerned about. Im visiting Edinburgh and had sex with a prostitute in a brothel. I used a condom for vaginal sex, however as we went to change positions, I noticed that half the condom was completely ripped exposing the head. We probably had unprotected sex for 1 -2 minutes. Here are my questions:
- What are my odds of contracting HIV? Just so you know, I am uncircumcised and have genital herpes. I understand odds of contracting HIV are about 1 in 2500 but I've also seen that being uncircumcised increases odds by 2 fold and genital herpes by 2-3 fold. So if we do the math increasing 5 fold does that mean my chances are 1 in 500?
- As soon as I noticed we put another condom on and finished sex about 3-5 minutes after. Immediately after I went to the shower to wash my penis with soap and water and urinated. I saw studies saying washing with soap almost immediately after also increases odds of contracting hiv. What would that increase my odds of contracting to?
- Lastly with everything you know, would you recommend that I take PEP? I'm far away from home so that might be very difficult to get. My understanding is that Edinburgh prostitutes have a low HIV infection
rate which is good, though she is a brothel worker. The woman told me she was clean and got blood work 4 months ago but I cant say I fully trust her.
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Edward W. Hook M.D.
5 months ago
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Welcome to our Forum. Thanks for your questions I'll be glad to comment.
I'm sorry to hear of your condom mishap. This occurs about 1% of the time condoms are used. Despite this problem, I would still characterize your risk for any STI, including HIV is being low. Most commercial sex workers do not have STIs (and the likelihood of a CSW having any STI is lower amongst brothel workers than a CSW you might meet on a street on in a bar) , including HIV and most single exposures to an infected partner do not lead to infection. In the unlikely event that your partner had HIV, your risk for infection would still be less than 1 in 2,000. Thus, given that the likelihood that your partner had HIV is far, far less than 10%, conservatively there is a more than 99.99% chance that you would acquire HIV. I would not recommend HIV PEP in your situation.
Your risk for other STIs is likewise low. If you choose to test for the purposes of reassurance, a urine test for gonorrhea and chlamydia, the most likely STIs if any, would provide conclusive results any time more than 3-45 days following your encounter.
I hope this information is helpful. I would not worry. EWH
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5 months ago
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Thank you for your response. Can you please answer my question about my odds of contracting increasing by 2 fold with an uncircumcised penis, genital
herpes increased by 2-3 fold, and washing my penis almost immediately after sex? Do those factor into the 1 in 2000 chance or do they increase?
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Edward W. Hook M.D.
5 months ago
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The changes in risk are not additive and there is no formula for considering multiple possible contributors. When considering that you are uncircumcized and washed immediately after sex, your risk might increase to 1 in 1000 but if you really want to find out if you got HIV, you will need to test. My estimate is that your risk of infection, again in the unlikely situation that she had HIV remains substantially less than 1 in 1000. I would not prescribe PrEP for you if you approached me in my clinic. EWH---