Broken Condom

[ccase]

Dr Handsfield,

Thanks for the help that you are providing online. I am 32 Male, heterosexual married man (monogamous) till i went to a massage parlor in Bangkok. I had protected oral. For the vaginal, the first push tore the condom. when i removed i saw the side is gone with the head safe. Exposure lasted for 2-3 sec max and my adventure was over. I was so scared, on asking she told me that she also loves her life  and no matter how much money you give she use condom (which seems to be true as for oral also she said she will use condom).

Q1 I went through a surgey 9 days after exposure where HIV test was done it was "not reactive". No idea what gen of test. Any relevance of this result?

Q2 I read somewhere if u have microscopic injury then it might. It was a healthy penis, but not sure about what it means by microscopic?

Till i found your answer (few month back)  where u said it is zero in case the business end is intact. I wish i found your answer on the same day. But the moment i saw your answer I moved from days of sleepless ness, sleeping pill to normal life. But for last couple of days Q2 is hunting. Do you recomend a testing to end the fight between rational mind which says i am fine and irrational mind still asking "what if" as 5 months already passed. I don't search internet anymore.

Million thanks in advance .

[ccase]

Hi Dr,

I did oral swab at 24 weeks. I am very very happy.

Thanks a ton and please convey Dr HHH my sincere thanks. I had seen the darkest time and his info has made me survive and your recommendation force me to take the test for peace of mind and be reasonable.

On the probability part in my case (Mathematics)
A. Infected CSW probability = 1% = 1/100
B. Probability single encounter Unprotected = 1/1000
C. My time duration 3 sec = 1/100 (100th of 5 min avg course)
D. My 1 week test which is 50% = 1/2
E. Exposed area  (lets say 20%) = 1/5

Net Probability= A*B*C*D*E= 1 in 100,000,000  i.e 100 million (10 times reliable than airline) but difficult to have a peace of mind for a hypochondriac.

Thanks again doc and god bless for wonderful work you do.

[Edward W Hook, MD]

Glad to help. Take care. EWH

[ccase]

Thanks doc for the quick response.

I was actually referring to this link http://www.medhelp.org/posts/HIV---Prevention/Worried-about-broken-condom/show/255690

But anyway i have decided to prick the needle, rather leaving it to the game of probability to have some peace. Just lil worried now for few unprotected counter with my wife. Hope everything workout well.

Thanks again doc.

[Edward W Hook, MD]

Welcome to the Forum.  Dr. Handsfield and I share the forum.  Today you got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Broken condoms are always a source of concern.  In your case however, the risk that you were infected is quite low.  The reasons for this are many and include that most CSWs in Thailand do not have HIV (Thailand has been one of the most successful countries in reducing their HIV rates through a national condom campaign), that your exposure was so brief (there are not scientific studies which quantify the risk of infection relating to duration of exposure but it makes logical sense), and the fact that the average risk for infection, IF she was infected and your exposure was completely unprotected is less than 1 infection per 1000 sex acts.  Taking these together, your overall risk for infection is very, very low.  Perhaps not zero but less and perhaps far less than 1 in 100,000.

When condoms cover the tip of the penis even with breakage like you describe, they do protect against urethral infections such as gonorrhea and chlamydial infection.  Whether or not they offer complete infection against HIV however is unknown- there should be some protection.  

As for your specific questions:
Q1 I went through a surgey 9 days after exposure where HIV test was done it was "not reactive". No idea what gen of test. Any relevance of this result?
Certainly, no matter what test was performed, this test was not conclusive.  Perhaps some persons with recent HIV infections might have positive tests but, unfortunately, the proportion is certainly less than 50%.  I wish it were higher.  

Q2 I read somewhere if u have microscopic injury then it might. It was a healthy penis, but not sure about what it means by microscopic?
Not sure I follow the question.  The friction associated with intercourse does create microscopic abrasions which are thought to facilitate HIV transmission.  How much infection is transmitted through sure abrasions as opposed to the through the urethral mucosal is unknown –both likely contribute to some degree.

Overall, your risk for infection as a result of the condom failure you experienced is very, very small- certainly less and perhaps far less than 1 in 100,000.  On the other hand, probably reasonable to have a repeat test in the future.  Results with a 4th generation, combination HIV p24 antigen/HIV antibody test would be conclusive at 4 weeks while with an antibody only test, results would be conclusive at 8 weeks,.

I hope these comments are helpful.  EWH