[Question #6550] Broken Condom - Risks?

14 months ago
Hello Doctors,

I was with an escort this evening (someone I see regularly and no one else) and the condom broke towards the end of Vaginal sex.  Neither one of us realize the condom broke, but I would guess the condom was broken for about 1 minute of vaginal sex.

We've been together several times and my test are always negative, but the condom never broke before.  What are my risk of exposure?  

I plan on getting tested in 11 days for everything and again in 3 months, but can you break it down if I'm looking at a big risk of catching something like herpes, HIV, etc....

Thank you so much!

Kevin
14 months ago
I would like to add that she told me that she is STD free and was last tested 4-5 months ago.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

Even before the additional info a few minutes ago, I would have said there's probably little chance your escort partner has any active infection of concern. In general, escorts (expensive female sex workers by appointment) are believed to be at low risk, a lot lower risk than many (most?) non-sex-working sexuallly active women of simlar age. They know the score, care about their health and know how to preserve it,  have clients who are themselves low risk for STIs (men like you), and use condoms consistently, and get tested frequently. So even with no condom at all, you'd probably be at low risk (not that I'm recommending condom-free sex, except for oral). And remember that STIs are inefficiently transmitted;  even in the presence of known infection with gonorrhea, chlamydia, herpes, or HIV, most exposures don't result in transmission of the infection. Finally, with only a minute of exposure after the condom failed, the risk is even lower.

So I really don't think you need to be tested at all, at leas not from a medical/risk perspective. I well understand that many persons are more reassired by test results than professional opinion, no matter how expert. At a personal level, if somehow I were in your situation, I wouldn't be tested and would continue unprotected sex with my wife without worry. But assuming you go ahead, don't overdo it. Once you're more than 3-4 days after the event, you can have accurate urine testing for gonorrhea and chlamydia. Then at 6 weeks, have blood tests for syphilis and HIV.  For sure it would be unwise to have any other tests or to wait until 3 months. You should not be tested for HSV, hepatitis, etc. The chance of false and milseading results are greater than the probability you were infected.

Finally, another approach is to have a conversation with your escort partner. Since it's been a few months since she was tested, she might agree it's time to do it again. You might even find that she's as concerned about risk to her from the failed coneom as you are. If you both are tested now and all results negative, you'll both know neither could have infected the other and no need to go through the possible anxiety of waiting a few weeks for the results.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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14 months ago
Hi Dr. Handsfield,

Thanks again for responding to my questions and concerns.  She is also planning on getting tested after this encounter.  She said she's due for her routine tests anyway, so she just needs to schedule it.

I plan on getting a urine test at 5 days, a blood test at 11 days (mainly the HIV RNA Early Detection test), and then more comprehensive blood and urine work done at 6 weeks.  Thoughts?

My last STD screening test was November 11, 2019 and all were negative.  After reading your response, I assume the 5 day, 11 day, and 6 weeks will be negative as well.  I guess gonorrhea and chlamydia may be more likely since I believe they are easily transmitted, but the other tests I would think would be negative.  What are your thoughts?

Thanks again.  You can close this question after your response?

Kevin

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
You're way overreacting to a nearly zero risk situation. The urine gon/chl test is fine, but since your escort partner is going to be tested, you can also have the HIV and syphilis blood tests at the same time. The HIV test should be a standard antigen-antibody test, which your partner also should have. it's a major waste of resources to have an HIV RNA test in this event. Do not wase resources on an HIV RNA test at 11 days or any other time. Whatever tests you do and whenever you do them, they will be negative.---
14 months ago
Hi Dr. Handsfield,

Thanks for all the feedback!  This was helpful.

You can go ahead and close this question.  I plan on asking a follow-up question in 6 weeks once I take STD tests.

Kevin
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Thanks; I'm glad to have helped. Please do not post a new question if all your test results are negative. Repeated questions on the same issue or topic are discouraged (and if overly frequent, are not answered). If your results are negative we would do nothing more than agree and advise you to not worry further. Thanks for your understanding.---