[Question #7562] Condom breakage.

55 months ago

Hi there,

Im a 31 year old Asian Indian Male from the UK.

For the past 3 years I've frequently visits escorts available by appointment (approximately 25 to 30 vists). All penetration has been protected, however I do receive oral without protection and have provided.

My most recent exposure was with a British Black Escort from London, aged 23. During vaginal intercourse, the condom broke! She told me she is clean and showed me confirmation of her results 3 months back (October)

Please note, the last time I tested for HIV and all other STDs including HIV was in 2019 I believe, and I was negative.

My questions are

1) Should I be worried about STD transmission including HIV regarding my most exposure? And my other sexual encouters with Escorts?

2) I plan to get tested with QUAL HIV-1 :CEPHIED test at 10 days; will this be accurate?

All in all since my last HIV test (2019) I've probably slept with 20 escorts and condoms have been used correctly apart from this exposure today.

I always ask for their STD status and this current exposure has really freaked me out.

Please let me know what to do and if you think im infected?

Kind regards,

Jay.

Edward W. Hook M.D.

55 months ago

Welcome to our forum. Thank you for your thoughtful questions. Congratulations as well on your routine practice of safer, condom protected sex. It will do much to keep you safe. I also applaud your practice of inquiring of partners what their HIV and STI status is. Nicely done! At the same time, for persons with multiple sexual partners, we recommend regular sexual health check ups, most typically on a yearly or every six month basis. Such checkups should routinely include urine tests for gonorrhea and chlamydia (which can occasionally result in asymptomatic infections) as well as blood tests for HIV and syphilis. While given your regular practice of safe sex is your risk for infection is low, regular check ups give you an added element of protection.

Your risk from the episode with condom breakage is relatively low. Most escorts do not have STI’s and tend to get checked relatively regularly. Receipt of oral sex is a no risk exposure for acquisition of HIV and a substantially lower risk activity for acquisition of gonorrhea or chlamydia than direct genital-genital contact. Even if your partner did happen to have an STI or even an untreated HIV, your risk for infection would be low as the majority of exposures do not lead to infection.

1. As noted above, while the exposure related to the breakage of your condom was low risk, we would nonetheless suggest a sexual health check up as part of your routine preventative health activities. On the other hand, I would not be particularly worried about your risk from the exposure resulting from your condom breakage.

2. The Cepheid test is excellent for detection of HIV. Most experts believe that a negative HIVPCR test any time more than 11 days beyond a sexual exposure is strong evidence that you were not infected. Some experts nonetheless recommend a follow up fourth generation HIV antigen/antibody test at six weeks for added safety. I have never seen a person with a negative HIVPCR at a time beyond 11 days who went on To develop a positive test.

I hope this information is helpful. As I mentioned above your risk for HIV is low. If there are questions or clarifications needed please don’t hesitate to use you were up to to follow up questions for clarification. Take care. EWH

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55 months ago

Dear Dr Hook,

Thank you for your informative response. It provides clarification in regards to the risks associated with my actions.

However, my concern is I thought I would be considered high risk due to the fact the condom broke wide open whilst inside of the CSW, leaving me exposed with no protection?

The Escort explained how she values the health of herself and clients; As previously mentioned she also showed me a text message from October confirming her tests were all negative. She has also sent me a text message informing me not to worry but get tested to be safe, she stated she will be doing the same.

The CSW also informed me the last time she had unprotected sex was in 2017 with a partner. She also informed shes only had 1 other condom breakage situation before, but has since tested negative on regular occasions.

I appreciate you stating the risk was relatively low in regard to the condom breakage, but I'm unsure how long I was left exposed.

Do you believe PEP would be required in this instance as precautionary measure? Although this episode is considered a small risk?

I know there is no way to know im 100% safe until I'm tested. Can I expect negative results in your expert opinion? (I know you can't guarantee this).

Thanks a million and stay safe during these uncertain times we are all facing.

Regards,

Jay.

Edward W. Hook M.D.

55 months ago

Your partner is addressing your fears and concerns very well by planning to test and planning to test herself. When you get your test results, I encourage you to share your result with her. I anticipate that she will do the same for you.

I am not denying that your broken condom left you at risk for any STIs, including HIV that your partner might have had. The concept of "risk" is used to provide information of the relative likelihood of you becoming infected and allows us to compare the probability of infection if your partner had HIV (unlikely on a statistical and epidemiological basis) to the probability of infection with another STI (gonorrhea for instance) or in the context of different sex acts. To illustrate what I'm saying, current estimates of becoming infected following a single vaginal exposure with an untreated HIV infected woman are substantially less than 1 infection per 1000 exposures, on average (i.e. more 99.9% of infections will not result in infection). OTOH, if your partner had gonorrhea, your "risk" for infection would be higher as estimates are that about 20% of men exposed to a female partner with gonorrhea would become infected. Based on these figures, as well as the fact that it is statistically unlikely that your partner was infected, I suspect your tests will be negative. If her test is negative, then you can be confident you were not exposed. Therefore, in response to your questions:

1. The risk for infection may change slightly with duration of exposure but that change is small and does not change my assessment.

2. If you had seen me in clinic requesting PEP, I would not prescribe it and your risk for infection is so very low.

3. I anticipate that your tests will be, and remain negative. I encourage you to test for other common STIs (gonorrhea, chlamydia) as well as HIV although once again, I suspect that you will not be infected.

I hope this information is helpful. While I understand your concerns, overall your risk for having acquired any STI, including HIV from the exposure describe is low. EWH

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