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broken condom insertive anal - PEP?

Jul 8, 2007

Hi, I was having protected insertive anal sex (I was top) a few hours ago with a person who last tested negative (according to him) mid-may 2007 (1.5 months ago) and never has had unprotected sex (according to him-- (a health/fitness/nutrition type of guy as well who is also reasonably educated, so i have no reason to mistrust him other than it being only recently that i met him).

The problem is during the act I grabbed the wrong bottle and used massage oil instead of the silicone lube to add some additional lube (i am... Italian and he was very tight, and i used one of his condoms instead of a bigger one; the bottles looked nearly identical in the dark; and i didn't even know there was massage oil on the table, stupid me!) I felt something strange and when i pulled out the condom had broken. I immediately washed myself with soap and water. I didn't see any blood or anything and I had not ejaculated. I've never had a condom break before so I am a little scared.

My history: Gay 26 yo male on west coast, circumsized, i have never had unprotected anal sex in my entire life (from first act at age 20 to several hours ago), i've had unprotected oral sex but i avoid ejaculate ( do not allow ejac. in my mouth) and I always ask if the person is negative before any sex act. I often worry about STDS when I am not at risk or at "very low risk," I usually comfort myself knowing that I behave safely. Now I have a (to me) scary and new situation.

I am not sure whether I should get PEP or not. Will I be able to get it for this type of episode? Is it recommended? Is it warranted? I know I will get an HIV test, it's been a while anyway. How long should I wait? Is 3 mo. enough or is 6 mo. warranted due to the theoretical lowness of the exposure? I have read around the internet(s) that the risk is 0.065% for any one act, and that is with a positive bottom, unprotected the entire time, right? or is that per act in general?

Thank you so much Dr Bob, I believe that you've taught a ton of people better safe sex practices... it's doctors like you who motivate me to study for my exams!

Response from Dr. Frascino


An Italian-sized sausage stuffed into a regular sized condom plus a very tight fitting docking station plus oil-based massage oil is indeed a recipe for disaster. I'm not surprised the condom didn't hold. It had three strikes against it.

The estimated per-act risk for acquiring HIV from unprotected insertive backdoor action with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. Your risk would be less, as we do not know the status of your bed-buddy.

Would PEP be recommended? Some facilities might "offer" PEP, but in general it would not be "recommended" by most HIV specialists for your particular situation. Personally I would recommend only a three-month HIV antibody test. If you're still in touch with your partner, you could ask if he'd be willing to get a rapid HIV test. If negative, that would give you considerable reassurance. The only hypothetical risk at that point would be that your partner was still in his window period. If, on the other hand, he is HIV antibody positive and you are within the 72 hour window, you could start PEP and continue follow-up testing out to the six-month mark to assure your negative status is definitive.

I'm sending my good-luck karma that your definitive test remains negative and that you do well on your other exams as well!

Good luck.

Dr. Bob

Reactive ELISA with non-reactive Western Blot.
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