[Question #6466] A question

15 months ago
Hello, dear doctor!
I’m a male and recently had sex with another guy. 
I was top, so we used a condom. After sex I usually check it filling the condom with water. To my surprise I found out that there was a small tiny hole on it. Water was leaking from a condom making a jet. 

So my questions are:
1) What are the chances of being infected with any STD in this situation?
2) How can condoms be trusted again after this case? I’m very concerned about having sex with anybody using a condom protection. It can fail without even noticing :( 
How to go on leaving the traces of anxiety behind?

Thank you in advance. I’d really appreciate your answers. 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome to the Forum.  I'll do my best to help.  Before I get to your questions, let me provide some background information which may be helpful not only now but in the future.  Condoms remain the most effective way to prevent HIV and other STIs during casual sexual encounters despite the fact that on average they break about 1% of the time they are used.  Factors that make breakage slightly more common include sex with a new partner and rectal intercourse.  Also, the "water" test is not a recommended or reliable means of assessing whether or not a condom has failed.   More typically when a condom breaks during sex it breaks wide open. 

Finally, you do not mention whether or not you ask your partner if he had HIV, if he had been tested recently or whether or not he was on PrEP.  In the future, all of these are helpful questions to ask of a new partner.  most people do tell the truth.

As for your specific questions:

1.  Statistically, it is unlikely that your partner had HIV.  most people including most men with other men as sex partners do not have HIV.  Even i he did have HIV and was not on treatment (effective HIV treatment makes persons with HIV non-infectious to others), your risk of acquiring infection from a totally unprotected exposure is less than 1%.  None of that means that it is not a good idea to get tested for HIV at other STIs but the odds are strongly in your favor that you were not infected.

2.  See my comments about condom failures above.  I presume you have used condoms in the past and they worked. They will work in the future as well.  Make sure that you put your condoms on correctly, use lube for rectal intercourse and you will reduce the risk of failure.  PLEASE do not presume that because you had one episode of bad luck you should not use condoms going forward. This was just bad luck. 

I hope the information I have provided is helpful.  Please feel free to use your up to two follow-up questions if anything is unclear. EWH

14 months ago

Dear doctor,

I'd like to adress you the following questions:

After an exposure (giving unprotected oral sex to a man) I made 5 tests: PCR test for oral gonorrhea and chlamydia (after 5 days) and RPR, anti-Tr. Pallidum IgG+IgM and HIV 4th generation Ab/Ag (after 28 days)

Only RPR came back positive with titer 1:2. 

1. Doctor, could you clarify, what does negative anti-Tr. Pallidum and reactive RPR mean? Do I have syphilis? Or should I repeat testing after 2 weeks? (No symptoms, including chancre during this time were observed). 

2. If I have syphilis, what treatment should be prescribed?

3. Should I warn my partners with whom I had only mutual masturbation and French kiss?

Thank you in advance!

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thank you for your followup.  Your results provide strong evidence that you do not have gonorrhea, chlamydia or HIV from the encounter that you described. 

1.  As for your syphilis tests. from your description it appears that you have a falsely positive RPR test.  When persons have syphilis typically both the RPR test and the tests for Treponema pallidum are positive.  Falsely positive results do occur with both tests from time to time and in persons with true infection, both tests are positive.  I am not familiar with the specific syphilis test for Treponema pallidum antibodies that you describe but presuming that you were tested in a reputable lab, I would believe the results

2.  As I understand your tests, you do not need treatment for syphilis

3.  Since there is not evidence that you have syphilis, there is no need to inform partners.  Even if you have syphilis, the likelihood of transmitting syphilis through mutual masturbation and French kissing is very, very low

I hope that this information is helpful.  EWH

13 months ago

Dear doc, hello!

Thank you so much for the previous answers. They were very helpful!

I'd like to ask you a question regarding oral gonorrhea. 

A recent study provided by Australian investigators, confirmed that there's the possibility of transmission of oral gonorrhea via kissing. 

What do you think about that?

Should we get tested after every single French kiss with a guy with unknown STD status (no unprotected sex involved)?

Or if the transmission somehow occured, can we leave asymptomatic oral gonorrhea untreated? Will it somehow affect the immune system or our health in general?

What to do?

Need your advice. 

Merci d'avance!

Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

I am aware of the Australian hypothesis regarding transmission of gonorrhea through kissing.  In fact, I wrote a paper questioning their data about 7 months ago in which I pointed out hat while this may happen RARELY, it is unlikely to be a major route of gonorrhea transmission.  After my paper was published, Dr. Handsfield debated the Aussies at a scientific meeting.  He and I agree that while this may happen (RARELY!!), it is not well characterized and is more of a hypothesis than a fact.  I would not worry and would not feel the need to test regularly if my only exposure was French kissing.

Hope this helps.  As you know, this is my 3rd reply.  Thus, as per Forum guidelines, this thread will be closed shortly.  Please don't worry about kissing.  EWH