[Question #2177] Broken Condom HIV risk

45 months ago
Hello Dr,

I saw a high-end escort for the second time in 4 days. Our first meeting we talked about STD testing and she said that she gets tested once a month because she cares about her health and wants to be around for her daughter and mother.  She also does not see clients who she can trace back to seeing escorts that don't use condoms.  

Today in our second encounter we tried anal sex and the condom broke and I was exposed inside of her for 2-3 seconds or it could have been 1-2 seconds. She turned around said "your okay" and put on a different condom for anal sex and we continued. We talked about the whole incident and she assured me again that she gets tested once a month for her own well being and I should get tested to "feel good" about the incident. 

What is the chance of getting infected with HIV in 1-3 seconds period time?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question.

My first reaction is to congratulate you for having safe sex in this situation. Good move -- even if the condom failed.

Second, in general a "high-end escort" is very unlikely to have HIV, or other transmissible STDs, partly for exactly the same reasons your partner gave you:  most understand the risks, care about their health, and take precautions to protect it. In addition, probably the large majority of their clients are at low risk -- that is, you probably are a typical client. Even among the highest risk female sex workers, fewer than 1% are infected and I would judge the chance your partner had HIV as under one in several thousand, especially if she is telling the truth about recent negative testing. (And few people lie about HIV status when asked directly.)

The average risk of HIV from insertive anal sex, if the receptive partner is infected, is estimated by CDC to be 1 in 909 -- you can round that up to 1 in a thousand. For only 1-3 seconds of unprotected exposure, it's undoubtly lower still. So if we guess your partner had 1 in 1,000 chance of HIV (probably too high, but let's go with it) and 1 in 1,000 chance of transmission, your HIV risk was something like 1 in a million (0.001 x 0.001 = 0.000001). And lower still because of the brief exposure, so more likely only one chance in several million.

So your risk too low to be tested on account of this particular event. Of course you are free to do that if you believe you would be further reassured by the negative result. Alternatively, ask her to be retested (and maybe pay for it) -- if she is negative at this time, you can be even more confident you were not exposed. In addition, everyone who is sexually active outside a committed monogamous relationship should be tested for HIV from time to time, like once a year. If you haven't been tested recently, maybe this is a good time, since it's on your mind. But not because of these particular exposures.

I hope that helps. Let me know if anything isn't clear.

HHH, MD

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45 months ago
Thank you, for quick reply DR.  HHH, MD

She will be leaving my city today and going back home to her city and I don't want to bother her taking a risk of me seeing her real identity on paperwork. 

I get tested once a year but planning on getting a 6-week test from this incident to put my paranoia to rest.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
I don't understand why you would need to ask to see her identity papers. What's the deal with that? In any case, it's fine for you to go ahead with a blood test (preferably an antigen-antibody test, i.e. "4th generation" or "duo" test).

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45 months ago
Online STD site  said, "Our standard HIV test is a 4th Generation HIV 1 & 2 Antibody/Antigen test that can detect HIV as early as 2-3 weeks after exposure."  

When is the ideal time for a 4th gen test?  Would 6 weeks 4th gen test be enough time frame for a conclusive test result?  

Thank You again for providing this service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
The 4th generation HIV blood tests indeed can be positive as soon as 2 weeks after exposure. They are usualy conclusive by 4 weeks and always by 6 weeks. 

That completes the two follow-up comments and replies included with each question, and so concludes this thread. You need not post your upcoming negative HIV test result. Best wishes and thanks for the thanks about our services. I'm glad to have helped.

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