[Question #7380] Slipped condom

57 months ago

Dear doctors,

Today I visited a Vietnamese sex worker here in Kuala Lumpur.

While we were having vaginal sex, suddenly I felt something different and literally a second later I pulled out and noticed that the condom was no longer on my penis. I think I was unprotected for 3-5 seconds. Needless to say, I'm pretty much freaked out.

I called a hiv hotline, and they recommend that I start PEP. However a doctor friend of mine said don't waste my money.

1. What are the chances they I get hiv from this encounter?

2. If I was your patient, would you recommend PEP?

3. I plan to test, when can I test and get a meaningful result?

4. Do you recommend protected sex with my steady partner?

57 months ago

I'm circumcised if that makes any differences.

Edward W. Hook M.D.

57 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to provide some facts and figures. In Kuala Lumpur, the majority of persons with HIV are men- only about 11% of HIV infected persons are women. further, in most settings, most commercial sex workers do not have HIV. Finally, if your partner did have untreated HIV, your risk for acquiring her infection would be less than 1 in 1200. In other words, more than 99.9% of exposures to HIV infected women do not lead to HIV infection.

PEP is a personal choice. As mentioned above, the odds of you acquiring HIV are quite low. If you do decide to pursue PEP, the sooner you start it, the better it works. There is no reason to start PEP once a person is 72 hours out from their exposure.

In answer to your specific comments:

1. What are the chances they I get hiv from this encounter?

Please see above. There is a more than 99.9% chance that you will NOT get HIV from the exposure you have described.

2. If I was your patient, would you recommend PEP?

As I noted above, this is a persona choice although personally, in your situation I probably would not take PEP. PEP does reduce the likelihood of infection. OTOH, it delays your ability to get accurate test results. In terms of testing, you will have 99% conclusive test results from a 4th generation, combination HIV antigen/antibody test at 4 weeks after your exposure and totally conclusive results at 6 weeks. Taking PEP for 30 days, also will add 30 days to the time when your tests would be reliable.

3. I plan to test, when can I test and get a meaningful result?

Please see above

4. Do you recommend protected sex with my steady partnerAgain, this is a personal decision. At the very least however, before you do, I would recommend testing for the other, more traditional STIs, specifically gonorrhea and chlamydia, which are far, far more common than HIV.

I hope that this information is helpful. If there are further questions or a need for clarification, please use your up to two follow-ups for this purpose. EWH

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57 months ago

With regards to the real world, have you ever seen in these forums, or the medhelp one that cases similar to this becoming positive later? Broken condom etc?

Also, I saw Dr Handsfield said that female to male transmission is 1 in 2500. Any reason for this differing number?

As for PEP, I understand that PEP is prescribed for emergency. What would be the criteria if you were to prescribe PEP?

If I tested 14 days on a 4th Generation test, what is the accuracy?

Edward W. Hook M.D.

57 months ago

We have had the good fortune to have had no instances in which we know that Forum users have acquired HIV. The has not been our experience in our practices however but the risk for the encounter you describe is quite low.

Dr. Handsfield and I agree on the low risk for infection. There is really no meaning different between less than 1 in 1200 and 1 in 2500 (i.e. 0.08% and 0.04%)

Again, PEP is a personal choice. All medications have costs and side effects. We try to balance risks and benefits. We recommend PEP for persons with exposures to partners with known untreated HIV but again, this is a personal choice. Another strategy is that if you can get your partner tested, you will know if you were exposed or not. If it has been 14 days since your exposure, there is no role for PEP related to the exposure you described.

At 14 days a 4th generation tests vary and will detect approximately half of recent HIV infections, at 28 days, more than 98-99%.

EWH

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56 months ago

Today I went for a 4th generation rapid duo hiv test, and it was negative. I was told by the clinic that it is considered conclusive. I have based on the odds that you referred to, the chance that I'm infected now is one in many billion. I'll take those odds.

Thank you Dr Hook for the reassurance. I have had chills throughout these four weeks, but I think it was due to my severe anxiety, so I refrained from asking about it here. Also I'll learnt the lesson.

Just before we close this thread, so far I have no symptoms, no discharges whatsoever from my genitals. Is it necessary for me to go for a check up for gonorrhea and chlamydia? What about Hepatitis B? I'm not particularly worried, but would like to ask your opinion if I should get these checked right now.

Again, thank you very much. Hope you will have a great 2021!

Edward W. Hook M.D.

56 months ago

Thank you for the follow-up information. I hope that your negative test provides you with the reassurance you need to move forward without continuing concerns.

Your risk for other STIs from the exposure you describe is, statistically slightly higher than your risk for HIV since those infections are far more common than HIV and may occasionally be asymptomatic. Nonetheless your risk is virtually zero, particularly given that you have not developed symptoms (which would have developed seeks ago). I would not be concerned and see no reason for testing of any sort unless your anxiety requires it. If you choose to test, I'm confident the tests will be negative.

Take care. Stay safe. Please don't worry. EWH.

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56 months ago

Thank you. This thread can be closed.

Have a great Christmas, and let's hope for a better 2021!

Edward W. Hook M.D.

56 months ago

Thanks for your thanks. I hope my comments have been helpful. Take care. EWH ---