[Question #13180] Broken Condom with Escort

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1 months ago
Hi,
I recently had sex with an escort a regularly see and during sex the condom broke when i cummed in her vagina. She said she is HIV negative and gets tested every 2 months. I mever caught anything from her and get tested every month. Does this exposure warrant pep?
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Edward W. Hook M.D.
1 months ago
Welcome back to the Forum.  Thanks for your continuing confidence in our service.  This question is quite similar to the questions answered by Dr. Handsfield 4 months ago when he stated "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.) " 


Most commercial sex workers do not have HIV or other STIs and tend to get tested regularly.  Your partner was probably telling the truth regarding testing and that makes the likelihood that she has acquired HIV since her last test quite low.  Personally, I see no meaningful need for PEP.

You seem to have a problem with condom breakage.  Do you know why?  Have you tried a different brand or type (such as polyethylene rather than latex? 

I hope this information is helpful. EWH

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1 months ago
If i starter pep within hours of exposure what would my odds be? I’m worried that the pep i got wont work
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Edward W. Hook M.D.
1 months ago
IN THE UNLIKELY CIRCUMSTANCE THAT SHE HAS HIV, The chances of you getting HIV from the encounter you describe less than 1 in more than 2000 (I.e. there is a more than 99.9% chance you would NOT get HIV.  If you start PEP within 72 hours of the encounter the chance would go to less than 1in 20,000 ( I.e. chances become 99.99% you would not become infected.

I think you are worrying more than you need to.  EWH
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1 months ago
Is this situation even worth testing for?
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1 months ago
Helllooooo????
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Edward W. Hook M.D.
1 months ago
Sorry for the delayed response.  I wasn't sure you wanted to use this somewhat repetitive question as your final follow-up.  Testing is always a personal choice.  Your risk of HIV is vanishingly low and in this situation, I probably would not bother to test.  Many clients however choose to test for additional assurance.  I've already told you that even without PEP there is a more than 99.99% chance that you did not get HIV from this exposure.

This completes this thread.  Take care.  EWH


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