[Question #685] Condom completely slipped hiv risk

47 months ago
Hi, Sir
I had sex with a csw in Texas 1 April 2016 she was visiting from the bayarea of California.
I had protected sex with as she provided the condoms. I had erection problems the whole time.  Everything was protected until i went behind her and inserted vaginally with the condom on. I could see as im thrusting the codom was half way on...i made the mistake of adding lube onto my penis as i was trying to gain sensitivity.  So i kept thrusting until i pulled out to ejaculate...i decided to pull out becuz i noticed i couldnt see condom and wanted to ensure it was protecting my tip of penis, well it wasnt on and as i ejaculated i freaked out. The csw had to dig inside her vagina to get to it. Im assuming i must have been unprotected it felt like between 5 to 10 mins..i cant really recall. I told her what happened she seemed calm and i asked if she gets checked she says she does (every 2 months) i also asked if she checks for other stds she said yes and for hep c.  She stated she has a life besides what she does. I want to beleive her but cant take at her word. Im married and i recently went to UCSD 9 April 2016 to take the early test. UCSD says this test is conclusive. I took this test 8 days post exposure.  I told my wife what happened i have not had any sex with sinve this event. Could you please give me a risk assessment on my stupid encounter...i have to wait two weeks for my negative results. But ucsd stated if i come positive they will call me between those two weeks. So im going the hell and praying i dont receive a call.  And im already fearing the worse. The CSW will no longer take my calls..so that has me thinking she maybe hiding something. Your advise is very much appreciated.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome to Forum.  I suspect you have very little to worry about.  there are several reasons I say this. first, the scenario you describe is most likely compatible with the idea that your condom came off as you exited her, leaving the condom behind. If this as what happened, then you have nothing to worry about- the condom did its job.

if the condom actually did come off during sex, `then the odds are still very much in your favor.  It is unlikely that your partner had HIV since less than 1% of CSWs in the U.S. have HIV.  I would put her likelihood as lower since she was clearly committed to condom use (she supplied it).  Even if she had HIV however, transmission occurs on average only once in every 1000 sex acts. 

You did not mention other STIs but I hope you were checked for gonorrhea and chlamydia. If you were exposed to any STI, these are many times more likely than HIV.

I also think you did the right thing to tell your wife.  While tough this is preferable to dealing with the anxiety, guilt and tension of not telling her.

Finally, at 4 weeks you can be tested using a 4th generation combination HIV antigen/antibody test. If this test is negative, you will then know that you did not get HIV as I am confident was the case.  If you get the test at a commercial lab, you should be able to get a result of the test just a few days after testing at the longest.  EWH

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47 months ago
Thank you for response...where can i get the 4th gen or duo i dont see anywhere in southern california that offers that.  Sir the staff at ucsd tell me the early test im taking is very accurate and they are telling me if i recieve a negative it is considered conclusive.  What is your take on that? Of course i like that they say that it basically puts my fear to rest. But would you concurr with what they are telling me? As far as scenario i pretty sure the condom completely fell before climax, im assuming the ladder scenario at this time
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

4th generation tests are widely available.  Check with your health department.

I do not know which test they are doing at UCSD.  I presume it it a PCR type test and these are very accurate for early detection of HIV but they are not approved for use at such a short time period.  A negative test however would be strong evidence that you were not infected.  EWH

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47 months ago
From my understanding its an Rna test aka Naat test. theearlytest.com. They been doing this study since 2006.  Please take a look if you're interested.  Well with that said i will wait for my results and hope for negative...i will also check into the STIs and follow up with 4th gen in week 4.  Thank you Dr. Hook.  Could you ask Doctor Handsfield if he is aware of what UCSD is doing? Again thank you and i hope this ends well for me.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

I suspect you are correct that they are doing an RNA NAAT.  From what you said, I suspected that.

I am confident your tests will be negative.  Take care and try not to worry.  EWH

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47 months ago
Got results of Early Test it was Negative.  Thank God. The University of California at San Diego antiviral Research Center is telling me that my result is conclusive. They pretty much told me I have nothing to worry about I will however still go on the 4th week to take comprehensive testing for STI and for the 4th gen HIV test from what they are telling me I have nothing to worry about and I feel good they said the test that they have is very very accurate. Also considering that I did use a condom and the girl emphasized on the usage of a condom I feel good that I am out of the woods however I will still go and take that fortune like you instructed even though I am no longer afraid I am still a tad anxious and maybe the negative from this other test will conclude my fear thank you doctor for everything if there's anything else you'd like to add please do
47 months ago
Doctors after receiving my Hiv early test which was negative after 8 days post exposure.   I did the 4th generation ab/ag at 27 days (26 days 20 hrs if im approximate) and received my results. THEY ARE NEGATIVE!!!! Am I good!  Or should i continue to test at 6 weeks and then 12weeks?   Also all my panels for STIs were negative and all tests were normal!  I am so relieved and i want to thank you Dr Hook!  I hope this helps other that are in my position.  Again please advise to confirm that im good to go or must follow other instructions! Thank you and thank you God! Please inform.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Thanks for the follow-up.  There is no scientific reason for you to worry further about this exposure.  Your tests for both HIV and STIs prove that you were not infected during the encounter you describe above when your condom cam off.  Time to put this episode behind you and move forward without further concern.  Take care.

This reply will end this thread, as per Forum Guidelines which allow three responses to each question.  Take care.  EWH

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