[Question #5907] Broken Condom - HIV Concern

20 months ago
Hi Doctors,

I met a CSW from Russia in Europe.  I made appointment through a popular Escort website.

Once we started anal intercourse, she asked me to pull out after around 5-10 seconds.  When I did, I realised condom was broken wide open, and my penis was fully exposed.  Like I said, this happened only after 5-10 seconds starting the intercourse, and until that point I was just trying to penetrate, so nothing rough happened. 

I immediately asked her of her HIV status and she said she was negative.  Few months later I texted her again asking her HIV status, she again replied she was negative but also kind of annoyed of my questions.  I was nervous after seeing customer reviews that she performed anal sex with most of them, although I am sure she uses condom because it was my second time visiting her and I know she carries condoms and uses them.  However, seeing that she provides anal service very often kind of bothered me, as I know it carries the most risk.

2-3 weeks after the incident, I had a mild illness with symptoms of scratchy throat, blocked/runny nose and mild fatigue; which all cleared in 3-4 days without medication.  Didn't have rash or fever.  I didn't have any other STD, before or after the event, as I have tested for all of them except for HIV.

What is my HIV risk from this event?
Does heterosexual insertive anal exposure carry same risk with MSM exposure?
I have a date tomorrow with a new girlfriend.  Can I have unprotected sex with her without fearing of infecting her?
Do I need testing?

Thanks.






H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome back, but I have to say I don't see the point. You're asking exactly the same question as a couple of weeks ago. I read that discussion and agree with everything Dr. Hook said, and I hve nothing differn tto add. To your specific questions (even though they are redundant):

For anal sex, if the anal partner has HIV, the chance of transmission is around 1 in a thousand. That's higher than for vaginal sex, but still the odds are strongly in your favor. And your risk is obviously much lower, because a) your partner probably doesn't have HIV and b) the exposure was very brief aftter the condom broke. (The 1 i 1000 risk is for several minutes of unprotected anal sex.) So your risk from this one event is extremely low.

Because you almost certainly don't have HIV, it is unlikely sex with your new partner will put her at risk. However, I cannot and will not guarantee you aren't infected. As Dr. Hook advised you, the only way to know for sure is to have an HIV test. Because you fear you were infected, you have an absolute ethical obligation to know for sure. In other words, to be tested. You should not have sex with a new partner until you have done that. It doesn't matter that you are afraid of testing: you have to do it; you have no choice.

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

HHH, MD
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20 months ago
Thanks Dr. Handsfield.

I have seen several times before you advised people with similar one time brief exposures that in fact they did not need testing at all, and if you were in the same situation you would continue sex with spouse.  I was wondering if your such advises would apply to my case as well, but it didn't. Is it because you believe I am in somewhat higher risk, or because I am worried and that itself obliges me get tested? 

I am going to get tested. But unfortunately the cliniques where I live doesn't work on weekends, and I have my date today. So I had no time until then, and seeked your advice.  I know nobody can guarantee I am not infected, but I needed to hear your opininion based on your vast medical experience. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
I always recommend testing when people remain highly nervous about having HIV despite expert, even when the risk is extremely low or zero. Such persons often find a negative test more reassuring than expert opinioin based on science and statistics. And as both Dr. Hook and I said, your risk is slightly higher than for many forum users, because you did have brief unprotected sex (because of the condom failure) with a partner at risk of HIV. The chance you caught HIV still is exceedingly low, and if I were in your situation I would indeed continue unprotected sex with my wife. However, I'm not you, and it seems clear you're going to worry until you have 100% proof about it.

Does that make sense? I'll also point out your moral dilemma: you're worried you might ave HIV, but apparently would be willing to have sex with a new partner without telling her about that worry or being tested. Instead of testing, you could go ahead with your date and possible sex witn your new partner, but you would first have to tell her you're worried about having HIV. What do you think her response would be?---
20 months ago
Dr. Handsfield,

Thank you for your clarifications.  At the end, I had condom protected vaginal sex and unprotected oral sex with my new partner.  I hope everything is fine and I will get tested soon.  

Meanwhile, I would like to ask you something I forgot to mention in my original message.  6 months after exposure, I had several (10-15 at total) non-itchy small rash spread around my mid/lower back, and they persists for around 2 months now.  They look like a red pimple, or folliculitis spot, or a heat rash but of course I can't diagnose myself what it is.  I also have similar rash on my shoulders and arms sometimes but they appear very few (only 2-3) and they tend to come and go.  I know these can't be ARS rash as it has been a long time now since exposure, but can ongoing HIV infection cause rash of these kind at 6 months after catching infection?  

I would appreciate your assistance on my final follow-up, and I thank you for the valuable service.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Condom protected or not, you should have informed your partner of your fear of having HIV, as we discssed above. It you did not, you should so so now. It is ethically unsupportable to not inform her just because you wanted to get laid and were afraid it would firghen her away. Which it should have.

The symptoms you describe do not suggest HIV, which is not a likely cause this sort of rash. 

That concludes this thread. It will have to be your last one along these lines. The forum does not accept repeated questions on the same topic or exposure. Future similar ones will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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