[Question #7708] HIV possible exposure? Thank you!

2 months ago
Dear experts,

I had protected sex with a csw today. I understand the risk so I am very cautious. The csw is also very cautious, even overly cautious.

However, she used rubbing alcohol to clean the condom briefly before the penetration, which lasts for ~10 seconds. I wasn’t hard enough so we just chose to not keep trying. I’m pretty sure there was penetration, and I don’t think the condom was broken: checked briefly by taking a look. 

As a scientist, I understand that organic solvent( rubbing alcohol) can potentially damage the integrity of natural latex condoms. And actually I did an experiment by myself: I filled a new condom by rubbing alcohol, at the beginning the condom was fine, but after ~10 minutes the condom started to leak before it finally broke when I am swing the condom to let it break. So it looks like the rubbing alcohol can really influence the integrity of conforms and potentially make small holes(???)

I was last tested weeks ago, and the results were all negative. I talked with the local (actually top 10 hospitals in US) std clinic and the nurse thinks it’s not a problem since the condom didn’t break. But obviously my experiment is bringing me anxiety...

Do I need PEP?

Thank you!







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

Welcome to the Forum and thanks for your question.  I happened to be on the Forum at the time your question arrived so you are getting a response somewhat more quickly than is typical.  If there are follow-ups (you are allowed two), they may take longer.

 

This was a low risk event.  If you approached me in my clinic requesting PEP, I would decline to provide it.  The reasons I would not worry are as follow:

  1. Most CSWs do not have HIV or other STIs (less than 1% of U.S. CSWs have HIV)

  2. Despite your experiment, in which your condom was exposed to high concentration of rubbing alcohol for a relatively long period (10 minutes) the fact is that when condoms fail, they typically break wide open rather than becoming porous.  The condom used during your encounter did not visibly fail.

  3. Even if your partner had untreated HIV, the risk for acquisition of infection is substantially less than 1 in 1000 so in 99.9% of such encounters, transmission does NOT occur.

  4. The brevity of your penetration further lowers the risk for infection.

 

Putting all of these facts together, your risk for infection is minuscule.  PEP is challenging to take- over half of persons who start PEP do not finish it.  I see no reason for PEP at this time.

 

Hope this perspective is helpful.  EWH


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2 months ago
Dear Dr. Hook,

Thanks for your response. When you said low, or minuscule risk, is it under the assumption that absolutely no risk is impossible? Can you give me a probability? Do I need to test for this event and do I need to abstain from sex from my regular partner?

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

You re correct.  In the calculation of risk attaining a "no risk" status is scientifically impossible.  The statistical probability of you having acquired HIV is less than 1 in a million, likely far lower.

Testing and abstinence is a personal choice which reflects your level of concern.  Were I you, I would not feel a need for testing, nor would I abstain from unprotected sex with my regular partner.  EWH

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2 months ago
Dear Dr. Hook,

Thanks for your reply. Totally understood. Since I have another follow-up opportunity, I would like to know your insight, but it is not relevant so I will understand if you don't answer :) 

I am wondering the current HIV treatment efficacy.

What's the probability to reach undetectable level for someone who is HIV+,  was diagnosed early,  has access to health care, sticks to regime,  starts treatment ASAP, without other medical conditions, and cooperates fully with health providers? 

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Current therapy for HIV has been transformative, taking a uniformly fatal disease caused by an unknown pathogen first described in 1982 and in just 25 years describing the pathogen, developing reliable tests and developing therapies which allow persons with the infection to live a normal lifespan.  Having watched this process over the course of our careers has been a privilege and is testimony to what science can do.  Nearly everyone who becomes infected in this era and has access to health care and is adherent to their care plan should be able to totally suppress the virus, making it undetectable.

Thanks for the opportunity to comment on this extraordinary scientific achievement.  Take care, EWH 

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