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Had sex with a Transexual CSW, condom broke but was quickly replaced, risk of HIV?

Hello Doc,

You were very helpful to me in the past so I decided to ask this on this forum due to your trustworthiness.

I had intercourse with a CSW who happened to be a trans female. Condom broke during insertive rectal intercourse and my penis was maybe exposed for less than a second or two as she immediately noticed and pulled me out.

I had a small scratch on the exposed skin that was about to heal but was still there. I did not notice any blood or fluids on the condom or exposed skin and promptly put on a new one and continued, but I'm still very anxious about the whole ordeal.

Please kindly evaluate my risk of HIV or any other STI as there's still some time till I get tested and I've been living with the crippling anxiety of a possible infection. I know risks are much higher when it comes to rectal intercourse so this has me worried.

This happened in a country where transexual people are at risk of HIV and other STI's and where CSW is illegal. Even though she seemed to be practicing safe sex all the time, I'm still worried as condom breaking is considered unprotected sex.

I appreciate and look forward to hearing your response.
Best Answer
20620809 tn?1504362969
The good news is that a condom was used. Means that she probably uses them regularly. Chance of transmission from a one time event like this is less than 1 percent. So low. The likelihood of your getting hiv from what happened is negligible and I would not overly worry. You do, however, need to take a test at 28 days with a 4th generation test or any other test at 3 months. Don't over test or let this get too in your head. I would not suspect she has hiv which she'd have to have in order to give it to you and it's such a low rate of transmission. You test for formality, but you should not fear you got hiv from this.  
Hello GuitarRox, thanks for your reply.

Indeed, she was very alert when the condom broke and acted quickly in pulling me out so the encounter was very brief, but still there.

Your answer put me at a little more ease and I will definitely be testing at the 28 day and 3 month marks. However, do you know of any other tests that could provide reliable results before that timeframe?

I'm trying to keep it out of my head, but can't seem to stop over-thinking those couple seconds of exposure every few hours.

I just want the days to pass faster so I can get tested and be at ease. Although I appreciate your words and will try to neglect it until that time.

Lastly, would that little scratch on the skin (Not open wound, rather, almost healed with scab) increase my chances of infection?

If you test with a 4th gen test, do NOT waste your money and test again at 3 months. If you don't take a 4th generation test and take a 3rd generation, don't bother testing at 28 days. You barely had a risk. Regardless of the little scratch on the skin, you had less than a 1 percent chance of transmission. Test at 28 days with a 4th generation and not again OR test at 3 months with a earlier generation test and not before.
Alright, sounds good, will do it like that. Just want to get your opinion on one final thing, you think I should go on PEP or is the risk too little to consider?

All the advice is much appreciated, thanks once again.
This is when I peg you as suffering anxiety. I am actively telling you how low the risk is. PEP is for an exposure with someone KNOWN to have HIV.
Maybe I am thinking too much about it, the risk is indeed very low and PEP maybe overkill. Although I don't know if she has HIV, I also don't know if she does not. With both possibilities being on the very low end, I shall wait until the tests. Thanks once again for your input. You put my mind at ease man. Keep up the good work!
She likely is negative because the condoms cost her money. If positive she might be required to warn you to avoid a criminal offence.
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