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Anal Sex Condom Broke
Apr 4, 2006

Hi Doc,

Your website truly is great, and I, like everyone else here, truly appreciate everything you're doing.

70 hours ago I had sex with a prostitute in Thailand. Recieved unprotected oral, had protective vaginal, and protective anal. However, during "protective" anal the condom broke twice. Both times I heard the break and withdrew immediately, within a second or so I believe. I put on a new condom and continued until done.

I contacted an hiv specialist and began PEP at the 48 hour mark (impressive being that I'm in New York now and had to stop in Tokyo for a night). I'm taking combivir twice a day and viread once a day.

I was curious if this is considered an effective pep combination? Also, I am unsure about the timing of when to take the drugs. Should I take the combivir(1) and viread together in the morning, or is it best to take them separately spread out over the day? Would it be better to take the Viread just a bit before bed in hopes of lowering any potential side effects during working hours (due to the fact that 8-10 hours would have already passed (sleep time))?

Lastly, I know it's tough to say, but could you give me a ballpark figure of my risk for HIV infection?

I'm so scared, but have been inspired by the strength i've seen in many people on this site.

Thank you,

dm

Response from Dr. Frascino

Hello DM,

You broke two condoms during the same sex act? Hmmm . . . that's highly unlikely. Possible explanations include: (1) the condoms were defective, (2) the condoms were not used properly or (3) your Thai hooker has teeth in her love canal. I would guess it's #2. I suggest you (1) review proper condom technique, (2) bring your own condoms to Bangkok when you're planning to bang cock and (3) always remember "lubrication is your friend".

Your PEP regimen, Combivir plus Viread, is a recommended regimen. Combivir is twice daily and Viread, once daily. It makes no difference if you take them together or spaced out. Likewise, there is no difference whether you take Viread in the morning or evening. One thing that I do recommend is that if you've had an HIV exposure significant enough to warrant PEP (and I'm not at all certain your situation does), I would advise you be followed by an HIV specialist who could (1) evaluate your true degree of HIV risk, (2) review the PEP regimen and change or optimize it if necessary, (3) manage any PEP-related questions, such as the ones you just posed to me) and PEP-related side effects and (4) arrange for appropriate follow-up HIV testing and counseling.

Finally, as to a ballpark figure for your risk based on what you told me, I would suggest your risk is so small that it is essentially out of the ballpark.

Good luck!

Dr. Bob



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