[Question #1889] Possible Exposure Insertive

43 months ago
Hello Dr,

Exactly 8 days ago i met another bi-sexual male and we had protected anal with me being insertive. We both disclosed being neg. He first lubed inside of himself and i then lubed the condom. He was tight so i pulled out after a min and lubed the condom more. We then proceeded for about 2-3 mins and i ejaculated. I pulled out and the condom did not look brokenand my head was covered. However, to me it seemed like there was very little semen inside the condom. I went to the bathroom and used toilet paper to pull off the condom and filled it with water. I noticed there were drops of water falling. I emptied and noticed about a .5 cm tear in the condom probaly about .75 inches from the tip of the condom. I was not sure if it happened during sex or when i used toilet paper to pull near tip of condom. I told the guy and he seemed unfazed and said he tested 5 months ago and was neg and only had unprotected giving oral since. I was worried and asked him to come test incase he was pos and i can take pep but he refused saying he had nothing for sure. 

1. What are my chances of catching hiv from this tear?

2. 5 days later i went for a gono and chlamydia test but 2 days prior my gp prescribed me amoxcillin for a bacterial throat infection and i wonder if 2 days on those meds would impact the gono test?

3. Gono and Chlamydia would raise risks of hiv and ive received unprotected oral but never had symptoms would this be a concern catching via oral without symptoms?

4. I feel i missed pep window. Would you have prescribed pep if you saw my case?

5. Can i test at 3 weeks?
43 months ago
I forgot to add that I am circumsized and ive read it makes a difference in transmission.

One other question.

6. Does it take a lot of fluids to catch hiv and if so would the tear being only .5 cm help?

7. Does hiv have to go in from anywhere on the head or strictly uretha as far as im sure the uretha are did not have the tear but was near edge of head based on where i saw it?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to our Forum and thanks for your question.  Before I address your questions, let me also congratulate you for using a condom.  While condoms do occasionally break, they remain the best way to prevent HIV and other STIs.  I hope you will keep using them.

As for your specific questions:
1. What are my chances of catching hiv from this tear?
My guess is that the condom broke after you had removed yourself from your partner rather than during sex.  I say this because when condoms break, they typically break wide open leaving no doubt that they have broken.  Having said this, of course I cannot be 100% sure that this is the case.  Nonetheless, your partner had tested relatively recently and was negative and this further reduces the likelihood that you were even exposed to HIV.  The risk of infection IF your partner was infected and IF the exposure would be about 1 in 200, on average.  Given your circumstances, I would put your risk far lower- probably less than 1 in 1000 and perhaps far lower.

2. 5 days later i went for a gono and chlamydia test but 2 days prior my gp prescribed me amoxcillin for a bacterial throat infection and i wonder if 2 days on those meds would impact the gono test?
Yes, 2 days of amoxicillin might make both your gonorrhea and chlamydia tests negative, if you had been infected, odds are you were not infected however. 

3. Gono and Chlamydia would raise risks of hiv and ive received unprotected oral but never had symptoms would this be a concern catching via oral without symptoms?
Chlamydia is very rarely acquired from oral sex.  Gonorrhea is sometimes acquired from oral sex but this too is rather uncommon.  When gonorrhea is acquired, it is symptomatic over 95% of the time. 

4. I feel i missed pep window. Would you have prescribed pep if you saw my case?
PEP is a personal decision but no, I would not have recommended PEP with this history.  (and yes, you are out of the window for effective PEP). 

5. Can i test at 3 weeks?
Testing for HIV with a 4th generation, combination HIV antigen/antibody test at three weeks would detect most but not all recently acquired HIV infections.  Test results at 4 weeks are definitive. 

6. Does it take a lot of fluids to catch hiv and if so would the tear being only .5 cm help?
The risk of getting HIV is proportional to the amount of virus a person is exposed to and that can be highly variable and unrelated to the volume of secretions one is in contact with.  As I said above, my guess is that your condom tore after you had removed yourself from your partner.

7. Does hiv have to go in from anywhere on the head or strictly uretha as far as im sure the uretha are did not have the tear but was near edge of head based on where i saw it?
HIV is acquired through the urethral mucosa.  Contact of infected material through non-mucosal, non-urethral skin does not put you at risk for HIV. 

I hope these answers are helpful.  If I were you, while it is reasonable to worry about the possible exposure you describe, it is most likely that you were not infected.  I would not be worried.  EWH


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43 months ago
Hello Dr. Hook,

I really appreciate the response and puts my mind at ease because i kept thinking maybe he was hiding something and thus not wanting to test.

A few follow ups below will be the last of my questions.

8. I had unprotected receptive oral 6 days prior to this event and if that caused me to catch gonohrea would i have been at a much higher risk to catch hiv if i was exposed from this event?

9. If he was positive 1 out of 200 is the risk and i know i should not read stuff on the internet from random sources but for some reason i recall a stat for anal insertive being in the range of 0.10. Was that inaccurate (just to clarify i was inserting my penis not receiving)?

10. Does being circumcized help me with prevention when exposed or is this all unproven?

11. So the head i assume is not a mucosa and only the uretha opening is correct?

12. I know i should probably not rely on symptoms but if i dont get any of the common ars symptoms such as high fever, throat pain and feeling like the worst flu between 10 days and 3 week mark would that add some re-assurance of me not catching hiv?

13. I want to test at 3 weeks completion using the rapid Insti test to put my mind at ease before a 4 week test. Is it correct to assume 75% detection at that time?

Thank you once again. I was just worrying quite a bit as i always ask hiv status and use condoms and it was the first time this happened. Your responses have put at ease while i wait for conclusive test.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
8. I had unprotected receptive oral 6 days prior to this event and if that caused me to catch gonohrea would i have been at a much higher risk to catch hiv if i was exposed from this event?
In most instances, if another STI is present at the time of exposure, the risk for infection increases slightly.  If you had gonorrhea in your throat and performed oral sex on an HIV infected partner your risk for infection would go from less than 1 in 10,000 to less than 1 in 3000.  Still very low.  With or withoput STIs, no one has ever been shown to acquire HIV from receipt of oral sex from an infected person. 

9. If he was positive 1 out of 200 is the risk and i know i should not read stuff on the internet from random sources but for some reason i recall a stat for anal insertive being in the range of 0.10. Was that inaccurate (just to clarify i was inserting my penis not receiving)?
. That is a bit low.  The risk is higher; 0.1 is about 1 in a thousand.  most experts feel that the risk for acquisition of HIV from insertive rectal sex with an infected partner is a bit higher- about 1 n 200 (i.e. 0.5)

10. Does being circumcized help me with prevention when exposed or is this all unproven?
Yes, being circumcised has been shown to reduce your risk for HIV by about 50%, on average.

11. So the head i assume is not a mucosa and only the uretha opening is correct?
Correct.

12. I know i should probably not rely on symptoms but if i dont get any of the common ars symptoms such as high fever, throat pain and feeling like the worst flu between 10 days and 3 week mark would that add some re-assurance of me not catching hiv?
Estimates of the proportion of people who get the ARS vary somewhere between 40 and 60% of infections. The best way to evaluate for infection is with a test at least 4 weeks after exposure. 

13. I want to test at 3 weeks completion using the rapid Insti test to put my mind at ease before a 4 week test. Is it correct to assume 75% detection at that time?'
Testing with a 4th generation test at 3 weeks would detect at least 75% of recent infections. 

EWH
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43 months ago
Thank you Dr. I guess this my last reply allowed so might as well ask it. You can close right after your response.

I am having a hard time waiting 4 weeks for a test. There is a site stdcheck.com which tests via labs in Canada and perform HIV RNA test which they claim can detect after 11 days. Is there such a test and what are your thoughts on accuracy?

If the .5 - 1.0 cm condom tear was during the sex act and uncertainty on my partners hiv status cause i can not be 100% sure as people can lie or never have been tested would you still put my risk at 1 out of 1000 or did you base that on if it was torn after the intercourse.

Thanks and have a great weekend. Hoping for this nightmare to end soon with a negative result.


Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
I  can understand your desire to have an answer sooner than at 4 weeks.  The best way to get this information would be if you could arrange for your partner to be tested.  If he is negative now, you can be confident that you were not exposed. 

The RNA tests are good and do appear to diagnose infections earlier than the 4th generation tests we recommend but, in general, they are more expensive and there is less experience with them.  In addition, we are not all that enthusiastic about the HIV RNA tests because from time to time, unlike the 4th generation tests, they give false positive results which are very upsetting for clients. 

My estimate of a 1 in 1000 chance was the case IF your partner was infected and was based on the idea that your risk of infection from unprotected incertive rectal intercourse is about 1 in 200 and my suspicion that there was a less than 20% (1 in 5) chance that the condom broke during sex.  If we include consideration that your partner probably did not have HIV, then your risk would actually be far lower.   I hope this convoluted, multi-compent reasoning makes sense.  The odds are very much in your favor that you were not infected.

I will keep the thread open for a few hours in case my explanation above is unclear.   EWH
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43 months ago
Thank you Dr. Makes sense and thanks for giving me some positive hope. I will avoid the RNA test as a false neg is not worth it.