[Question #9606] HIV Maybe protected, maybe not???

30 months ago

Good afternoon Doctors,

On the 21/12/2023 I engaged in what I thought was protected sex with a transexual escort in Brisbane Australia. There was no oral sex, I was the insertive partner and wore a condom throughout the event that lasted 2 min max. When I removed my penis the condom was still on and appeared intact. I put the condom in my pocket and left immediately due to guilt for my regular partner.

About 30min later, I pulled the condom out of my pocket and blew in it, the condom expanded a little and then popped. This made me nervous, so I txt the escort and asked her HIV status, her reply made me even further anxious, her reply was "OMG if you can’t handle sex don't do it" then she blocked my number.

26 hours later I went to the sexual health clinic and was given Truvada only. I was told in Australia Truvada is given normally and if warranted a 3^rd, drug, in my case this was not warranted.

Baseline STI test were negative.

I took PEP at the same time every day, I did however take it on an empty stomach for the first few days.

Thank you for listening to my story, my questions are as follows.

1. The condom as far as I could tell was intact, I think oil based lube was used, could this have perhaps weakened the condom so when I blew in it it popped?

2.Logic tells me if a condom had a large hole it would not expand and the air would escape not allowing it to pop, do you agree with that logic?

3.Would a small hole in a condom have a significant rise in your risk assessment?

4.I took Truvada on an empty stomach, would this have an effect on its effectiveness?

5. Post PEP

Day 5 I had a sore scratchy throat,

Day 6, sore throat but a runny nose and nasal congestion,

Day 7, being today, nasal congestion without the sore throat, no other symptoms present,

Could this be ARS?

6. Is Truvada alone effective?

H. Hunter Handsfield, MD

30 months ago

Welcome to the forum. Thank you for your confidence in our services.

This was a zero risk exposure in regard to HIV and other STIs. I'm a bit surprised the sexual health clinic prescribed PEP. That said, Australia's federally funded sexual health centres are, collectively, the world's very best network of HIV/STI clinics and prevention services. If the Brisbane SHC is where you went, I would trust their judgment. Still, I don't understand why PEP was prescribed. I cannot imagine there was even one chance in a million of HIV in this situation. (Your partner's response when you texted her sounds pretty appropriate to me!)

To your questions:

1,2. It sounds to me like the condom was fully intact at the time of the sexual exposure. Oil-based lubricant raises the risk of rupture, but if it doesn't break during exposure, protection is complete. I agree with your "Logic tells me" statement: I have never heard of a condom rupture that was not obvious at the time of exposure.

3. The notion of microscopic defects that allow HIV transmission is an urban myth. To repeat, if the condom wasn't hanging in shards when you withdrew, it was intact and protection was complete. (We advise against condom inflation, "water test" or similar post-exposure condom assessment if it did not obviously break wide open.)

4. Truvada is fine on an empty stomach.

5. Your symptoms do not fit with ARS, which does not cause nasal congestion, runny nose, etc. You caught a cold. (Or maybe Covid. You should be tested for it.)

6. Truvada alone is highly effective as PEP.

I'm very confident you were at little or no risk. As implied above, I would not have prescribed PEP in this situation. However, since it was prescribed, you should follow up with the sexual health clinic where it was prescribed.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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30 months ago

Thank you Doctor Handsfield,

Everything you have said makes complete sense and is what my rational mind has been telling me all along, I just needed to hear it from an expert such as yourself.

Yes I visited the SHC is Brisbane but I should have clarified that my first point of call was the hospital due to it being after hours, the hospital prescribed me the first 3 days of PEP, the remaining course was prescribed by SHC Brisbane.

I think there was some confusion and miss communication, I told the doctor at the ER the condom popped when I blew in it, she might have thought that it had popped prior and when I blew in it I then found out.

Nevertheless I feel that I have done everything I can to keep myself safe, I used a condom and seeked medical advise i.e. PEP and adhered to it routinely.

I will take your advise and follow Brisbane SHC's testing advise, I have a test in a week and then another 6 weeks after that, so another 7 weeks in total, but I am 100% confident that I am going to be fine, actually the doctor at the SHC said that she was confident I am going to be fine, it was the last thing she said to me before I left the clinic.

Thank you for your help, it is very much appreciated.

H. Hunter Handsfield, MD

30 months ago

Thanks for the expanded details. It's nice to hear the SHC and I are in agreement. Thanks for the thanks; I'm glad to have helped.---