[Question #2205] Condom breakage and std precautions

90 months ago

Thanks for the great service you provide. I have looked at recncent question but still wanted to ask for myself.

Last night I had protected vaginal and anal sex but the condom broke at the tip during vaginal sex I then changed the condom. This was with a female I had just met from the Philippines. I am mortified as I now use condoms for everything and I am panicking about HIV HSV and Hep b mainly and anything else I can catch. I have been to a urologist in the country I am in and explained the situation and I have been given 2 weeks of 2 antibiotics one of which I know is doxy not sure on the other. Would this treat any infections he also said I had white blood cells in my urine and did a PCR std test which I think is a waste of time 12 hours after sex. Do you think I should have further testing given this exposure? I will be traveling home in 1 week and will be meeting with a girl I have been seeing for some time and worried about going back to normal sexual relations with her.

Edward W. Hook M.D.

90 months ago

Welcome to the Forum. I'll be pleased to comment. I presume that your partner was a commercial sex worker. While the prevalence of STIs, including HIV, is relatively high among CSWs, most CSWs are not infected and most exposures do not lead to infection. By virtue of your condom breakage you may be at risk for infection. While I am not sure what the other antibiotic you took is, the doxycycline you are taking will prevent chlamydia, syphilis and probably gonorrhea IF you were exposed.

The presence of WBCs in your urine at 12 hours is rather early for this to reflect something you caught 12 hours earlier. Similarly at 12 hours you might too early for an STI test to be accurate. It is difficult to say whether the PMNs detected were somehow related to your exposure or have some other cause. Irrespective, as I noted above, the antibiotics you are taking should address the possibility of a bacterial STI.

As far as viral STIs, if you acquired herpes (statistically unlikely) it is most likely that you would develop lesions or signs of infection within 10-14 days. If you do not develop lesions in that interval, my advice would be to move forward without concern. We recommend AGAINST blood tests for HSV in situations such as this- the tests are not good enough and do not differentiate older, previously unnoticed infection from recent infection.

Finally there is the issue of HIV. We only recommend post-exposure prophylaxis with anti-HIV medications in situations where it is much more likely that your partner had HIV. Testing for HIV is probably appropriate to plan. The vast majority of HIV infections would be detected by testing with a combination HIV antigen/antibody test at 4 weeks after your exposure although a very small proportion of HIV infections may take up to six weeks to be detectable.

I hope this information is helpful. Overall your risk for infection is low but not zero. The safest approach for now would be to abstain or use condoms for exposures to your regular partner for at least two weeks after your condom mishap. I am less worried about HIV than other possible STIs. EWH

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90 months ago

Thanks for your quick answer. Do you feel thats PEP would be recommended in this case as i do not know her HIV status although i can ask her Also i have seen you can have a HIV test post ten days using HIV RNA PCR test is this also a recommended test.

RNA PCR Testing

Edward W. Hook M.D.

90 months ago

I would not recommend PEP in this situation. If you can ask her about her HIV status, that would be a good idea. It would be even better if she could be tested for HIV at this time. If her test is negative, you realistically have nothing to worry about.

HIV PCR does become positive before other tests and would likely give you a definitive answer by 10 days HOWEVER HIV PCR tests also have a considerably higher false positive rate than other tests for HIV and for this e typically do not recommend it for most clients. EWH

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