[Question #1768] broken condom pulled out immediately

45 months ago
To Dr. Handsfield kindly help and advice,  I am 29 old guy and currently in Sweden last Saturday I met a girl in a club then we spent the night together. It was just one-night stand I had protected vaginal sex, no oral or anal sex but during the intercourse, I heard my condom burst, immediately I realized  and pulled out directly in few seconds (2-3 seconds) then after was no intercourse  just kissing and masturbation to each other, but next day morning she worried me a lot as I asked about her std check-ups and I realized she didn't do it from long time ago and she had unprotected sex with many others. I got paranoid about the incidence and went to the emergency to get pep within the first 24 hrs but they told me no need at all and your case is not indicated to pep according to the Swedish health guidelines as there's not prove she is HIV positive. I booked std test after a week from now and will repeat the HIV after 4 weeks again.
currently, i am really annoyed and scared from what happened, so I am looking forward to know what's my risk probability to catch any STDs especially HIV if I consider her high-risk grp?
what's the mechanism of viral transmission from her to me in that case? as the dr. here told me it's nearly zero risks to be infected but still, i am confused and extremely worried almost can't sleep or eat since Saturday and feel I have destroyed especially it was my first vaginal intercourse after breaking with my gf from a long time ago.
so I want to hear from you as an expert in details about the incidence, please. 
thanks                         
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question. FYI (mostly for other users), it is by chance I am replying rather than Dr. Hook. He and I take questions randomly, without regard to requests for either of us.

Congratulations for using a condom. Too bad it failed, but your intentions are correct and wise. 

In general, STD rates are low in Sweden. Despite the country's reputation about sexual lifestyles, gonorrhea, chlamydia, syphilis, and especially HIV remain much lower than among similar popoulations in the United States. That you might "consider her high-risk" doesn't change anything. The chance any particular sexually active younger woman in Sweden has HIV is nearly zero.  In other words, I understand and agree with the Swedish PEP guidelines and would not have treated you. Even if you had had entirely unprotected sex, I'm not sure I would even recommend any HIV or STD testing at all; the risk is that low. And still lower because the duration of exposure was so brief after the condom broke.

That said, of course I understand your desire to be tested, and you should go ahead with a urine test for gonorrhea and chlamydia (valid any time more than 3-4 days after exposure), and with a 4th generation (antigen-antibody) HIV test at 4 weeks and perhaps a syphilis blood test at 6+ weeks. But really, you should be entirely relaxed in the meantime. The odds are overwhelmingly in favor of negative results for all of them.

Another approach would be to contact your partner, if you are able to do so, and ask her to be tested. If negative, you will know for sure you were not at risk and might even decide to forego testing. If you contact her, do it with caring and sensitivity. You may find she is just as fearful about your risks to her. Maybe an opportunity for flowers and a nice dinner!

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD

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45 months ago
Thanks for the response,  I already had contacted her and she promised will be tested and get me back with the results but I don't wanna show push otherwise she can not contact me hence she left back to Stockholm and I am in another city so difficult to reach her, for more details  she looks very healthy and energetic without any obvious medical problem.  but from your experience what is my risk percentage in that case as I am confused to recognize it protected or unprotected at all ?
considering her also as high risk from her many previous night stands which are very common in Scandinavians. what's my risk percentage statistical?     
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
As I said above, "STD rates are low in Sweden. Despite the country's reputation about sexual lifestyles...." I was referring exactly to things like "previous [one] night stands which are very common in Scandinavians. That's exactly what I assumed about your partner. So this information does not change my opinions or advice, and it obviously did not impress the emergency physician you saw, which is why s/he did not prescribe anti-HIV treatment.

For a risk calculation, let's assume 1 chance in 10,000 your partner had HIV. (It might be even less.) Chance of transmission for a single episode of vaginal sex, if the woman has HIV, 1 in 2000 (according to an estimate published by the US Centers for Disease Control and Prevention, CDC). Since the exposure time without the condom was very brief, let's say the risk was one tenth what it would be if entirely unprotected. With these figures, the chance you caught HIV calculate as 0.0001 x 0.0005 x 0.1 = 0.000000005. That's 5 in a billion, or one chance in 200 million. I hope you'll agree that's zero for all practical purposes. (And if we increase the chance she had HIV tenfold, i.e. 1 in 1000, your risk still is only one chance in 20 million. Still of course not something to worry about.

Really, mellow out. There is no realistic chance you have HIV from this event. It's really not something that should be occupying your mind. The chance of other STDs is somewhat higher, but still very low.


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