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Not sure if condom broke...
May 28, 2004

Here is the story, will try to make it short. I was on a business trip recently and several hours before going to a gay bar/ picking someone up/ taking him back to my hotel room, and then having receptive oral and anal sex with him (respectively not coming and then coming in me) I used a Fleet enema and two brief follow-on water enemas. Just before sex, I used a female contraceptive gel in my rectum because I'd read somewhere that helped "reduce the risk." Well I was the receptive partner in my second-ever anal experience with a man. We used a condom, and he came inside of me, and then immediately withdrew. It appeared that it was intact (saggy bag at the end, full of semen, no drips apparent) but a couple hours later I expelled what looked like semen into my underwear (yeah, I know, gross) when I thought I was only going to fart. Couldn't be sure if it was semen, especially since the condom didn't seem to have broken, but given this scenario:

1. Do you think the condom did hold, and that these are digestive / enema fluids only?

2. This guy informed me before we shacked up that he was "definitely negative" and that he hadn't been with anyone in months. Come to find out his former partner just died of AIDS. I've read posting after posting stating that the chances of getting HIV + after one-time unprotected anal-receptive exposure with a KNOWN positive person is like 0.1 - 0.3%, meaning one chance in 300 to 1000. What am I looking at given this situation?

3. This happened one week ago today, as I write this. Unfortunately, I didn't hear / read of PEP until about an hour ago when I read about it on your site. Can I take this now with any helpful benefit?

4. Also, given I'm at the one-week point, the CDC people tell me I can take a PCR DNA/RNA test with inconclusive results, but a very good indication. But when I call the actual phlebotomy labs, they tell me nothing doing until 28 days, at which point they say the reliability is like 97%. I would like to know SOONER than LATER -- who should I believe?

5. As it happens I have a girlfriend for one year now and until how have been 100% heterosexual. She's on the pill, and we rely on it exclusively; as in, no condom. Haven't had sex with her of any kind since the incident a week ago - any suggestions on how to talk her into starting to use condoms without blowing (pardon the pun) my cover?

Response from Dr. Frascino

Hello,

OK, let me make just a few comments here as I respond to your specific questions.

1. You used a Fleets enema and two water enemas before going to a gay bar while on a business trip. It seems to me you were a man with a mission that night and that this experience was not exactly an unanticipated event.

2. Female contraceptive gels are designed to "reduce the risk" of pregnancy. That most likely wasn't a potential risk for you. Also, please note that contraceptive gels containing nonoxyl-9 (N-9) can irritate mucosal surfaces (vagina or rectum), and actually increase the likelihood of HIV transmission.

3. Regarding that "fart" and those not-so-white designer boxer-briefs, I doubt this was semen/ejaculate. Now throw those nasty things away!

OK, now on to your questions:

1. I wasn't there, but from what you've told me, it appears the condom worked fine.

2. You misread (or mistyped) the statistics. It's up to 3%, not 0.3%. In your situation, your partner's status remains unknown (even though his lover died of AIDS) and the condom did not appear to fail. Consequently your risk, if any, would be much, much lower.

3. PEP would not be indicated for this type of situation. Also, to be effective, PEP should be started as soon as possible after a potential exposure and no later than 72 hours. To read more about PEP, check the archives.

4. I would not consider 97% accuracy good enough for this disease. That would mean three out of every 100 cases would be inaccurate. For a definitive result, you'll need to wait at least three months and get an ELISA test.

5. You've been 100% heterosexual, but pack Fleets enemas and female contraceptive gel in your toiletries bag when going away on a business trip??? Just what kind of "business" are you involved with??? As for trying not to blow your cover, why are you trying to hide? I'd suggest being honest with both your girlfriend and yourself. Gay or straight isn't all that's important, but integrity, honesty, and protecting your sex partners as well as yourself certainly are!

Good luck.

Dr. Bob



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