[Question #5722] STI Anxiety After Condom Break

21 months ago
A few days ago, I took a csw home from a go-go bar in Bangkok Thailand. She initiated unprotected oral sex on me. We then had vaginal sex with a condom. Unfortunately the condom broke. I immediately felt the condom break and pulled out. I was inside after the break for less than a second. I then immediately went to the bathroom shower and washed my penis with soap and water. I then got a new condom and continued sex for a few minutes, showering again post sex. In my drunken state and with a bit of a language barrier I did not think to ask her status.

This was the first time I have done anything like this so the worries/anxiety from the condom break and possibly catching HIV or another STD are probably being multiplied by some feelings of shame and guilt. 

I flew home shortly after this incident with multiple flights and lay-overs, taking up the 48 hours following this event. So reading this site I realized I missed the effective window for PEP?

I don't have a regular partner. I am an uncircumsized white male from North America.

At 14 days:

At 5 weeks a full panel of:
HIV 1 Ab
HIV 1 Ag
HIV 2 Ab
Herpes 1
Herpes 2
Hepatitis B
Hepatitis C

Should I get any additional HIV tests done to conclusively be negative?

Is waiting on gonorrhea and chlamydia until 14 days okay?

How confident can I feel after hopefully getting a negative on RNA test at 14 days?

How bad was missing the window on PEP?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum and thank for your confidence in our service.  I'll do my best to help.  Sorry to hear of your condom failure as well- FYI condoms do fail about 1% of the time, you were unlucky.  FYI, commercial sex workers in Thailand sometimes are infected with HIV or STIs however most exposures do not lead to infection  In the tests you list in your post you do not list the test results but from your follow-up questions, I presume the 14 day tests you list were all negative.  I am unclear about the results of your 5 week test results so I will comment primarily on your 14 day test results.  

HIV.  Your 14 day HIV RNA tests indicate you were not infected by this exposure.  Nearly everyone who acquires HIV has a positive RNA test by day 11 0r 12.  That said, perhaps out an abundance of caution, many experts do recommend a follow-up antigen/antibody test 4-6 weeks after exposure but I've never seen one become positive in a person with a negative HIV RNA test at 11 or more days.  I would presume that you are in the clear in terms of HIV.

Gonorrhea and chlamydia.  Your 14 day test results are conclusive and do not need further testing.  

Other STIs.  We specifically recommend against blood tests for HSV and there are major performance problems with these tests and if your result were positive, unless you had had prior negative tests, a positive test would not tell you how long you were infected, nor for HSV-1, the site of infection.  Syphilis and hepatitis infections are statistically unlikely and a negative blood test at 5 weeks would be definitive.

I hope that this information is helpful to you.  EWH
21 months ago
It has only actually been 3 days so I have yet to get any tests done actually. Sorry that was unclear,  I meant that that was my planned testing schedule. I would feel much better right now if I already had the negative RNA result, but I know they can be less reliable so I was asking a head of time. I'll leave out the hsv tests then based on your recommendations
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for the additional information.  If you choose to test, testing for gonorrhea and chlamydia will be definitive at this time.  EWH---