[Question #4610] Condom breakage due to wrong lube

28 months ago
Hello doctors, 

Id like to begin by thank you for all the help youve provided here and on medhelp. 

Im a 25yr male from canada and 4 weeks ago i had intercourse with a csw. I dont know what i was thinking and i guess i will have to come to terms with whatever the outcome is. 

Heres the breakdown: 

Oral: her on me protected
             Me on her unprotected 

Penetration: protected, halfway through we changed the condom. 

About 10 min before finishing she added some coconut oil. It caused the condom to breakdown but it was all stuck to my penis (kind of like an added layer of skin) 

The sensation was great but I didnt know at the time that oils can break condoms so i didnt make anything of it. 
I like to think the condom didnt break but it probably did. I know the majority stayed though because as i pulled it off, it hurt the tip some sensitive skin of my penis because of how stuck on the skin the condom was. (Kind of like ripping tape off of a hairy arm if that makes sense) 

I texted her a few days later asking if she has anything and she said shes clean and gets tested. (My fingers are crossed) 

I got tested about 8 days after and both gonorrhoea and chlamydia came out negative so that made me more optimistic. 

Im now worried about hiv because im basically assuming i was exposed for about 10 min.


The symptoms i have right now are 2 tiny soars in mouth, uvula feeling swollen ( i had this on and off prior to the encounter but it seems a little worse now) and i had some instances of a pulsing feeling near a lymph node at the back of my neck. I get the feeling it could be attributed to the high stress and anxiety i have right now. 

My province only tests for hiv and syphilis as of 8 weeks. Should i cross the border to get a 4th gen test for earlier results or should i wait it out? 

Thanks for all your help! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome to the forum and thanks for your question.

First, congratulations for using a condom. Failures can occur, bu tyour intent was good and it indicates a responnsible approach to sexuality. Good show. And by the way, oral sex is sufficinetly low risk that most experts don't recommend routine condom use. The oral sex wasn't completely risk free, but low chance of ineciton.

It's important to remember that most CSWs [have no active STDs. And it sounds like your partner is a responsible CSW who uses protection and pays attention to her health and sexual safety. (If she was an escort, i.e. a high priced sex worker by appointment, the chance she had an active STD is even lower.) Also, STDs are not very efficiently transmitted. Even without protection, and with a known infected partner, most people don't catch anything during any one exposure.

For those reasons, the odds were strongly in your favor even before you were tested. Of course testing was a good idea, and the news is good:  the tests for gonorrhea and chlamydia are highly reliable and you can be completely sure you caught neither of them. And by the way, your oral symptoms don't bother me at all. It is unlikely they have anything to do with the sexual exposure -- unless, as you suggest yourself, they are related to anxiety over the event.

The chance of syphilis or HIV in this situation is extremely low; it is statistically very unlikely your partner had either of them. FYI, there are no laws or reglations in Canada, either at the provincial, municipal, or national leve, about when syphilis and HIV testing can be done; individual doctors and clinics can test their patients whenever they wish. That said, 8 weeks is a reasonable interval. Six weeks actually is sufficient for both. OTOH, the chance you caught them is low enough that it really doesn't matter. There is no realistic chance you'll have a positive result. I really don't think it's worth the time, energy, or border-crossing hassle to cross over for testing.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
28 months ago
Thank you for the reassurance doctor. My thoughts are kind of getting the best of me and i just want to be able to stop super analyzing everything little sensation i feel on myself.  

I may be in the states and near a clinic that can do the 4th gen testing. Do you think its alright to get tested around 4 days before the 6 week mark and then get tested again around the 9 to 10 week mark?

Also the doctor basically told me that they dont test before 8 weeks since it can be attributed to a false negative and that the standards do not allow them to confirm anything prior to that period (i understand that they want to be safe). I also asked if their tests were the 4th gen testing methods and they didnt seem to know unfortunately.

Thanks again doctor! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Actually, there is no statistical difference in AgAb test reliability at ~5.5 vs 6 weeks. I thinik it would be fine to ge tessted now. You could even skip the 9-10 week test, really not necessary, especially in this low risk situation.

If the clinic's test is for both antigen and antibody, it's 4th gen; if antibody only, it's 3rd. Interestingly, for the 4th gen tests, one of the world's main proponents of ocnclusivity at 6 weeks is in Canada, namely the British Columbia Centre for Disease Control.
---
27 months ago
Hello doctor, 

Just wanted to give a little update. I got tested at the 5 week mark (dec 13).  And i have not received a call from the clinic which means that all tests for hiv, hep b &c, gonorrhoea and chlamydia and herpes came out negative.

Ive had some intense anxiety over the past few weeks and although the negative results calmed me down, my heart is still racing. I hope my body can just relax in the coming days. 

The nurse told me that she’d like to do one last round of testing at the 3 month mark to be 100% certain so ill do that. 

My last question is:  Would you consider the negative results from testing at week 5 to be conclusive?  

Thanks for all your help and insight on this matter and hope you’re having joyous holidays! 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Thanksfor the update. Glad to hear of the negative results. As discussed above, for 100% assurance on HIV, you might want another test at 6+ weeks after the exposure, but it isn't necessary to wait 3 months. Up to you whether you want to discuss an earlier retest with your doctor's office. In the meantime, your results are conclusive for all practical purposes:  adding up the nature of your partner, the low risk of HIV from any single encounter, the brevity of exposure after the condom failure, the test result so far, the chance you have HIV is under 1 in a billion, and even that's probably too high an estimate. If you have a regular partner, you should have resumed your normal sexual practices by now.

Thanks for the holiday wishes. Same to you. Best wishes and stay safe.

---