Condom brokes

[Matbp]

Hello doctors. Im am very concerned right now about 2 episodes that happened with me.

In this last month I have slept with 2 different girls and the condom has broke. I am even start to think that Im using it wrong because I cant be that bad luck. Anyway, in the first episode i was ok, because i've hearde vaginal sex is too dificult to get HIV, chances are 1 in 2,000. But yesturday it happends for the 2nd time and Im very concerned due to be 2nd time it happend and the chances can grow. My question is, what are my chances, in the very first moment i saw condom broke i stopped, so i must have had in maximun 1 minute of unprotected vaginal sex. Would You recomend me PEP? Would You recomend me get tested regarding that 2 episodes? Please tell me if i can relax because This is really buging me! Many thanks.

[Edward W Hook, MD]

PEP is expensive and causes side effects.   Less than half of peole who start taking PEP actually finish it.  Taking medicine that is not indicated is a waste of time, money and increases the chance of resistance, hard to treat infection.  I would not take it if I were you.

Sex with your wife is a personal decision.  I would not be worried if I was sure I had not gotten other STIs. EWH

[Matbp]

Thanks a lot for the prompt reply!

Last questions to close This case! Just for a mind comfort reinfortment, if You dont recomend me PEP is because chances are virtualy zero? Even with a very small chance isnt prudent to take PEP? If You were in my shoes would You have unprotected sex with a wife (regarding only HIV)?

Thanks a lot!

[Edward W Hook, MD]

Welcome back to Forum.  In preparing to answer your question I went back and read some of our earlier interactions.   Condoms seem to break a lot for you.  Typically condoms break about 1% of the time they are used and yours seem to break more often.  Condom breaks do occur more often with new partners than regular partners and with anal sex as opposed to vaginal sex.  They also occur if they are not put on correctly.  The most common error in condom use is when people fail to leave a bit of space at the tip, putting  the condom on the penis too tightly.

As for your risk, please remember that most women, even most commercial sex workers, do not have HIV.  If one or even both of your partners did have HIV (unlikely, as I said), the risk for infection is only 1 exposure per 1000-2000 exposures,  thus following two condom breaks, your risk for infection is less than 1 in 1500 (i.e. 1 in 1000 for each of your two partners) and probably much lower since it is so unlikely that your partners were infected.  PEP is not recommended in this situation.  On the other hand, following unprotected exposure to two new partners testing, both for HIV and for other STIs is a good idea.  You can be reliably tested for the most common STIs, gonorrhea and chlamydia at this time, for syphilis about a month after your last exposure, and for HIV with an HIV antibody test at 8 weeks after you last unprotected exposure.

I hope these comments are helpful.  EWH