[Question #4636] PANIC condom break

26 months ago
Hi

Had sex with sex worker in London and condom broke. Noticed straight away and pull out. She replaced it with another however I was so worried I could not carry on so stopped there and left. I was inside her for no longer than 2 seconds. It might have even broker before I even was inside her. Married two kids and panicking. Any advice, what should I do.  Should I go prep? It was in the last 48 hours. Many thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

I scanned your two threads about a year and a half ago. One of the points we made is that HIV is quite uncommon in London area female sex workers. We also disucussed the estimate that when a woman has HIV, the transmission risk for a single episode of unprotected vaginal sex is around 1 in 2,500. (Maybe at that time I quoted an earlier estimate of 1 in 2,000.) And your risk probably would have been lower than this, if indeed your exposure was as brief as you suspect after the condom broke. So the odds are very strongly in your favor.

For those reasons, I would not recommend PEP. However, PEP decisions always should be made locally,  by providers who understand details of risk. For example, a London expert (e.g. at a GUM clinic, the Freedom Health sexual health clinic, or a nearby urgent care clinic) might know about HIV prevalence in particular groups of sex workers, or of sex workers in the setting and environment where you met your partner. Unless there is particular reason to believe your partner was especially likely to have HIV, I doubt they would recommend PEP. But I can say no more about it.

But knowing what I know, if I were you, I probably wouldn't even be tested for HIV or STDs based on this exposure. Given your chosen lifestyle -- married with kids, with occasional commercial sex with condoms (even if they sometimes fail) -- the smart strategy is not testing after any one exposure, but instead routine HIV/STD testing on a regular schedule, e.g. once a year. If you haven't been tested since our previous exchange on this forum, this might be a good time for testing, while it's on your mind. But not necessarily because of this particular event.

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

HHH, MD
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26 months ago
Many thanks 

I just got tested 10 minutes ago with an insti and this came back negative so I only have this one encounter (broken condom with csw) to worry about. Would you suggest the PCR test at 10 days or wait 3/4 weeks for the antigen/antibody test? I know you said not to test just because of this one low risk exposure but I need to be able to get on with my life and  then get some counselling regarding my failings as a husband. I am also being tested for chlamydia and gonnorhea next week.  Can I have unprotected sex with my wife? Not that I want to as I am disappointed and disgusted with myself but it’s can be awkward to keep turning her down 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
PCR testing is close to 100% conclusive (maybe truly 100%, the data are not solid), but not until 2 weeks. The combination of PCR at 2 weeks plus AgAb at 4 weeks is for sure 100% conclusive.

Nobody can guarantee you didn't catch HIV or other STD. That would be true even if the condom hadn't broken. (You cannot pursue any intercourse with sex workers without some small risk, no matter how safely you do it. If you need to be 100% confident you can never infect your wife, you're going to have to forego the extramarital exposures.) In any case, the risk is exceedingly low, and if I were in your situation I would accept that minor risk and continue sex with my wife. But I'm not you and you'll have to make your own decision.
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26 months ago
Many thanks again for your reassuring words. I have booked in to see a sexual health doctor tomorrow to discuss pep. As you mentioned he/she will probably state not to do it and just a precaution test later which I will book. I did speak to a doctor over the phone and they did state my situation is a 1 in the tens of thousands. Again I commend you on your work you do and am willing to donate a charitable sum of your chosen hiv charity
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Thanks for the thanks. I'm glad to have helped. If indeed you wish to make a charitable donation in support of sexual health, I would recommend the sponsor of this forum, the American Sexual Health Association. If you prefer an agency in your own country, consider the British Association for Sexual Health and HIV (BASHH) https://www.bashh.org

Best wishes.
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