[Question #4262] Concerns over broken condom and STI risk

29 months ago
I was with a prostitute last night, first time in 4 years. Just after ejaculation, the feeling changed and I discovered the condom broke wide open at the end of my penis. Total time of exposure with broken condom was around a minute. Both the worker and her agency claims she has no STIs. I am experiencing high anxiety over this risk and what it it could do to my otherwise monogamous relationship. My plan is to avoid sex with my partner and get tested for gonorrhea and Chlamydia on day 5. I assume these are the primary risk infections. Some questions for a medical professional: 

1) Is there a way to quantify the risk of getting any STI from this encounter? 
2) Is day 5 appropriate for STD testing? Can I be screened that early for other STIs? 
3) Any advice for when to resume sex with my partner? 

Thanks in advance for ANY thoughts or advice. 

Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to the Forum.  Congratulations on your commitment to condom protected sex.  Unfortunately condoms do break about 1% of the time but they remain the best way to prevent STIs.  Since your condom broke, the exposure was unprotected and while it was brief, there is still a small risk for STI.  I should add several factors however:
1.  Most commercial sex workers do not have STIs
2.  Most unprotected exposures to infected persons do not lead to infection (about 1 in five exposures to an infected partner lead to infection)
3.  The short duration of your unprotected exposure likely reduces your risk for infection still sore although there are no statistics to provide more detail on this fact.
4.  As you point out, the infections you are at highest risk for are gonorrhea, chlamydia and perhaps trichamonas and that risk is low.  The risk for problems like syphilis and HIV are very, very low.

 I agree with your plan to test at five days.  Your results will be conclusive for gonorrhea and chlamydia at that time.  A urine test collected as you begin to urinate should be fine. if you can easily add a test for trichamonas that would provide an extra level of assurance. 

In answer to your specific questions:
1) Is there a way to quantify the risk of getting any STI from this encounter? 
Any guess would be just a guess.  If the CSW was a higher end CSW and given her assurances, I would estimate your risk for infection is in the neighborhood of no greater than 1-2% but admittedly that is only a guess.

2) Is day 5 appropriate for STD testing? Can I be screened that early for other STIs? 
Yes.  See my comment about trichamonas above. This can typically be done on the same urine specimen that can be used for gonorrhea and chlamydia.  If you choose to test for syphilis and HIV, these are blood tests which will provide definitive results at 3 and 6 weeks respectively.  As I said above, the risk for these infection is much, much less than the risk for gonorrhea, chlamydia or trich.

3) Any advice for when to resume sex with my partner?
After your urine tests for gonorrhea, chlamydia and trichamonas are back it should be safe to resume unprotected sex with your regular sex partner. 

I hope this information is helpful. EWH
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29 months ago
Thank you. All 3 tests (gonorrhea, chlamydia and trich) came back negative.  You mentioned in your reply that to test for Syphilis or HIV I must wait for 3 and 6 weeks respectively.  Would you recommend that testing? Is there any probability or statistical predictions on this? Thank you for your help. 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Glad to hear of your negative test results.  Definitive results on your syphilis tests will take a bit longer, as you mention but your risk for infection is very, very low- a small fraction of 1% for each infection.  That said, it is reassuring to know that you are not infected.  Testing is reasonable but by no means essential- I am confident you'll be fine.  EWH
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