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49 y.o. utallian terrified
Sep 20, 2010

Dear Doctor Frascino,

Thank you for the great help and the nice words of hope you give to all of us. I m a 49 y.o. married man writing for Florence, Italy, I m terrified and completely confused; In addition, reading so many different comments and statistics does not t help me to sleep and stay calm. Pls, pls, help me. Which are the odds for me to have contacted the virus? These are the facts : 4 days ago (sept.2) I had sex with a guy which I met for the first time, at his home, he was the top, I was the bottom, we used the condom for an anal intercourse, but in fact, it broke, with nobody realising till the moment we finished, he ejaculated inside me; practically the worst possible scenario- . I need to add the following: this guy saw me in such desperation, that he immediately cooperated and gave me some reassurances, he showed me his last negative test dated July 25, 2010, ( I saw it with my eyes) , than he also told me that he always has had protected sex , he has always been top, and the only unprotected sex operations he does are oral with no ejaculation, and some penis/anus outercourse ( he being the top) I have reasons to believe this is true, because this behaviour is compatible with what happened to us, ( we used the condom and he only wanted to perform top), to keep me more calm he told me, that if I wanted he would have done an other test, but so early maybe it does t make sense, and later I can do a test myself. Moreover, immediately after we realised of the accident , I immediately expelled all the sperm, and washed internally long time, I hope well enough. Doctor, I know that the only guarantee I can have is a first test end September and a second one end November, but pls, give me some comfort, I m loosing sleep, I m not focusing at work, and I am completely mentally absent at home- Thank you-

Ps. The are some Frascinos in Tuscany as well, but your name if mostly from Calabria, Cosenza area-

Response from Dr. Frascino

Buon giorno!

Broken condom with ejaculation inside carries the same degree of risk as unprotected receptive anal sex. The CDC's estimated per-act statistical risk for acquiring HIV from unprotected (or broken-condom) receptive anal sex with a partner confirmed to be HIV infected is 5 per 1,000 exposures. Your estimated risk would be less, as we do not know the HIV status of your top gun.

My advice is:

1. If your buddy is willing to be retested now, he should do so. If negative, you could relax significantly, because at that point your risk of infection would be limited to the remote possibility that your top guy was very recently infected and still in his window period (HIV infected but not yet having developed detectable levels of anti-HIV antibodies).

2. Level with your wife about your extracurricular activities. It's not only the best way to confront your guilt; it's also the right thing to do. You'll need to use latex condoms with your wife until your negative status is reconfirmed.

3. Get an HIV-antibody test at the three- and six-month marks.

4. Review the proper use of latex condoms. When used properly they very seldom break. You must also use compatible lubricants (no oil-based products).

My ancestors are from small towns near Naples (Taranto and Bari). I plan to spend some time in Tuscany and Umbria early next year. Perhaps I'll search out the local Frascino clan!

Good luck!

Dr. Bob



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