[Question #1316] Broken Condom with CSW

46 months ago

Hi, All -

 

I'm based in Brooklyn New York. I had sex with a 21 year old prostitute a few nights ago. She charged $200 for the hour, so while she certainly wasn't high end I wouldn't call her a street walker either. 

 

Long story short She put a condom on me for vaginal sex. When I first penetrated her, I heard a pop (the condom breaking) and was inside of her unprotected for probably no more than 10 seconds’ total. I pulled out and went soft because I was worried about her not being clean. I asked her whether or not she got tested regularly and she told me that she is always concerned about her own safety and that I had nothing to worry about. She even said this was the first time in her experience a condom had broken.

 

Before she left she told me not to worry about anything and I even texted her that night expressing my concern to which she replied “I’m very clean :) ”.

 

She also told me she hasn’t been doing this work that long, I believe she said a few months which would correlate with what I found on the internet. Her ads only go back a few months (August 2016).

 

I’m still very worried about HIV, though. I even went down to the ER the next morning and started PEP. Was this an extreme action? Do I need follow up testing?

 

Thank you for the help,

Concerned in NYC 

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Welcome to our Forum.  I'll be pleased to provide some perspective.  Your risk for HIV or other STI from this encounter is lower than it would have been if you had picked up a new, casual partner if a bar.  Most commercial sex workers, particularly the higher end ones have HIV. They tend to take good care of themselves and test regularly.  Certainly less than 1% of the CSWs of the sort you describe have HIV.  Further, if she is committed to condom use, her risk of infection is lower still and, as she has said, condoms do break but only about 1% of the time they are use.  Finally, in the unlikely chance that she had HIV, HIV is spread in the course of vaginal sex on average about once in every 1,000 to 2,000 exposures.  Thus your odds of infection are tiny.

If she said she did not have HIV, I would also believe her.  most people do tell the truth when asked directly. 

So, what about PEP. this is, of course a personal decision.  I would not classify your risk as high but for some persons any risk is too high and this may be the case for you,  would I have taken PEP in your situation- no but we may have different tolerance for risk. 

I hope these comments are helpful to you. EWH

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46 months ago
That's very interesting. I would have thought for sure that this girl would have been a much higher risk than some girl I'd pick up at a bar. 

Given those odds, would you even recommend getting a test? Finishing Pep?

Thanks again, Doc. Your words have really calmed me down a-lot. 

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Many people think that CSWs are particularly high risk but if you think about it, particularly for high end CSWs they have a business interest in making sure that they do not pose a risk for their partners- very bad for business.  On the other hand, a "pick-up" may take a far more casual approach to her sexuality and not get regular check ups or be as cautions about condom use. 

Personally, I would not be worried with respect to a one time event but again, tis is a personal decision.  EWH

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46 months ago
Might as well get my money's worth and reply for the 2nd time :)

So to be clear, If I chose not to get tested for HIV, you think that would be OK?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Yes, personally that would be what I would do, relative to this exposure although I am not sure one would hesitate to test either.  As I said above, this is entirely up to you.

As you know, this was my third response and therefore this thread will be closed.  Take care.  EWH

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