[Question #9723] Hiv risk if condom slipped

29 months ago

Hello Dr,

I’ve been dating this lady for a few weeks and we’ve had protected vaginal sex 5 times but on the last one (11 days ago) the condom slipped completely and I’ve been exposed for 20 or 30 seconds. Let’s say one minute. I asked her, while trying to keep my composure, if she always uses condoms. She said that she always does and that she got tested recently and that everything was good. This is the first time I’ve had a risk exposure like this and the anxiety is totally out of control. I’ve never had unprotected sex and the only sex I’ve ever had was vaginal and heterosexual. I’m going to wait a few more days to get tested using 4th generation at the 2 weeks mark and then at 3 weeks. Can I trust these tests at these times? Because I can’t imagine waiting for 3 months to get tested in this state of anxiety/madness. And how many people from your experience have you seen become hiv positive from a situation like this?

Thank you Dr

H. Hunter Handsfield, MD

29 months ago

Welcome to the forum. Thanks for your confidence in our services.

Congratulations on consistently using condoms for sex with non-monogamous partners. There's always a risk of breakage, slipping, etc -- which is why condom use is highly protective against HIV and other STDs, but not perfect. However, any single episode like this rarely results in any infection, and this event is a far lower risk than you apparently fear. First, it is very unlikely your partner has HIV: most people don't lie about their HIV status, testing, etc. And it sounds like your partner is at low risk anyway, since she presumably also uses condoms consistently with other partners (or clients, if she is a sex worker). Most likely her other partners are low risk too: men like you! In addition, when a woman has HIV, the average risk of HIV transmission by unprotected vaginal sex is one chance in 2,500. And if we assume roughly a 1% chance she has HIV after all, your risk of infection becomes one chance in 250,000.

This risk is low enough that HIV testing is optional. However, given your concern, you should be tested as planned. But stay mellow while you await the result. Going to your closing question ("How many people...become HIV positive from a situation like this?" Zero. Never, both in my clinical experience or on this forum. In the nearly 20 years of this and our previous forum, with thousands of questions from people concerned about HIV after a sexual exposure, not one has yet told us s/he tested positive. You will not be the first. If and when it happens someday, I expect it to be from a genuinely high risk exposure (like unprotected anal sex between men, for example) -- and not an extremely low risk situation like yours.

You do not need to wait 3 months for conclusive HIV testing. Most newly infected people have positive HIV AgAb (4th generation) test results by 2 weeks (60-70%) or 3 weeks (80-90%). Those negative results will be very reassuring. You might consider adding a PCR test for HIV RNA ("viral load" test) at 2 weeks, which along with negative AgAb will be nearly 100% conclusive; and the combination will be 100% conclusive when you have a final negative AgAb test at 4 weeks.

You also should consider your risk for other STDs. Have a urine gonorrhea/chlamydia test (valid any time more than 3-4 days after exposure) and a syphilis blood test in a few weeks. You can expect negative results from these tests as well, but better safe than sorry.

In the meantime, try to not worry. There is almost no chance you have HIV. If you have a regular sex partner, you can safely continue unprotected sex with her, especially after a negative gyn/chl test.

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

HHH, MD

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29 months ago

Hello Dr Handsfield,

Thank you, your response has brought me great relief and I hope to be back to my normal relaxed and confident self again soon.

I've done a full std panel 13 days post exposure and results came back negative for all STD's. The HIV test was an AgAb test. Is this the one called 4th generation? What are my statistics to stay negative given the nature of the exposure and these negative results 13 days post exposure? I asked the doctor at the ER for the HIV PCR test but they said we don't do it and I got the same response from the BCCDC. This is in Vancouver. I also tried for the PCR online but it's only available in the US. Do you have any ideas on how I can get the PCR test done in British Columia? Should I just visit a regular doctor and have them order this test for me?

Again, thanks a lot Dr Handsfield

H. Hunter Handsfield, MD

29 months ago

Yes, AgAb is the updated terminology for the test that previously was called 4th generation. The chance you will "stay negative" with future testing is 100%; re-read my reply above if you don't understand why. There is no need for PCR testing in this situation and I agree with BCCDC and the others who have advised you.---

29 months ago

Hello Dr,

Last question. Should I just move on now even though the test was just 13 days post exposure? Because I don’t understand how you’re 100% confident this early? Because you said 60-70% accurate 2 weeks after exposure. I’d love to move on with my life if only I had your confidence.

Thank you Dr

29 months ago

I don’t know how correct I am in this but if we say 0.04% times 50% chance the test is wrong at 13 days, can we say it’s 99.98% favorable chance? Considering the exposure was not more than a 60 seconds, the odds might be even more favorable than 99.98%? Is that why you say 100% or is it really 100%? I’m aware of how disproportionate my fear is to the odds. But I had to ask because I’m still thinking about this a lot.

Thank you Dr

H. Hunter Handsfield, MD

29 months ago

Why am I so conficent you don't have HIV? See my calculations above. Even before you were tested, the chance you had HIV was maybe one in 250,000. Your negative test result at 2 weeks was probably around 75% reliable; hence at that point the chance you have HIV becamse 1 in a million. If that's not zero, what is??? (The National Safety Council www.nsc.org estimates that if you live in the US, there's one chance in 1,750 you'll be dead of an accident of some sort within the next 12 months. That's 570 times higher than the possiblity you have HIV. Sounds like zero chance to me!

Perhaps you'd also like to know that in the nearly 20 years of this and our preceding forum, with thousands of questions from people concerned about catching HIV, nobody has yet reported they were infected. You won't be the first. If and when that finally happens, surely it will be a genuinely high risk situation.

I am well aware that anxiety and fear are not always rational and not necessarily resolved by understanding the statistics. But surely the numbers must have SOME effect on your assessment of your risk!

That concludes this thread. Stay mellow as you await final conclusive test results. They will be negative.

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