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Condom broke? Risks and PEP consideration?
Dec 8, 2010

Hello Dr. Frascino (or whomever can answer my question):

I am a single gay male who doesn't have sex very often. Two nights ago, I met up with another gay friend of mine, and we decided to have anal sex (we had discussed this before). I wound up being the bottom (receptive partner). After about a couple minutes of protected intercourse, I had him pull out of me because I needed a break. I then saw that the condom had ripped, which meant his bare penis had been inside me with no protection! I had him put a new condom on and we continued to have sex, but then the second condom slipped off or broke too! UGH!! When the condom broke, he reassured me and said, "Don't worry, I'm negative." But how can I just take his word for it?

The two condoms broke prior to his ejaculation. (He ejaculated later into a third, intact condom.) Nevertheless, it's still possible for some of his "pre-cum" to have been exposed to me earlier on...

I've known this friend/acquaintance for 3 or 4 years, and I have never known him to be promiscuous. But I really only see him occasionally, and I have no idea what he does when I'm not around. He also says that he doesn't have sex too often either (which hopefully means he hasn't accrued a lot of potential exposures). However, one thing that concerned me was his initial eagerness to penetrate me, in the passion of the moment, without a condom. I had to explicitly remind him to put a condom on prior to each insertion. (I always insist on condoms.) I am also upset that the condom broke not once, but twice! I have never had this happen to me before. Could this be an indicator that he doesn't know how to put a condom on correctly (possibly due to inexperience with condoms)?! Another explanation could be that I haven't had sex in a while, so it was a bit awkward for me to be penetrated (which could have put stress on the condom).

Should I be worried? I don't think that he was in me unprotected for more than 15 seconds (both times), and this was PRIOR to ejaculation. On the other hand, I'm freaked out that his penis was inside me without protection no matter how briefly, because I have never had unprotected sex in my entire life (outside of a long term monogamous relationship).

My question is: What are the chances or risks that I contracted an STD or risked a potential HIV exposure?

My second question is: Should I go on a PEP (post-exposure prophylaxis)/antiretroviral regimen for HIV prevention or will this be an overreaction? By now, 40 hours have already elapsed since sex. So it's almost becoming a moot consideration...

Obviously, I will have myself tested in 3 weeks and at periodic intervals after that. But as for today, I need to make a quick decision about PEP for not because there is only a 72 hour window.

Please help, I'm quite disturbed by what happened and wondering if PEP is indicated here.

Also, do I have a decent enough exposure risk to warrant all my worrying?

Thanks!

P.S. I just spoke with him and he says he was tested Negative this Summer 2010. Since then, he has only had sex one time (with a condom), before me.

It's just that I feel one might not even be entirely sure of one's own risks, so his verbal reassurance isn't 100% reassuring to me.

Right now, I am just trying to decide if I need PEP or not before that 72 hour window closes on me. I know I am coming off as paranoid, but until one has had an accidental exposure, you don't know how scary and disturbing it can be.

It's always better to be safe than sorry. Which is why PEP is still on my mind.

Thanks for reading, if you've gotten this far. I hope I explained the situation as clearly as possible. I appreciate your time.

Response from Dr. Frascino

Hello,

Broken-condom (or, in your case, two broken-condoms) sex carries the same HIV-acquisition risk as unprotected sex. The decision whether to use PEP depends on the likelihood that your top gun is positively charged (and on other extenuating factors, such as trauma, that don't apply to this situation). Your unprotected exposure appears to be relatively brief from the details in your post. You also seem to believe that your partner is not promiscuous and that he tested HIV negative in the summer of 2010 and has not had potential HIV exposures since then. Based just on the information provided, I would advise you hold off on PEP and ask your buddy if he'll get a rapid HIV test now. The results will be available in 20 minutes. If he's negative, you'll be able to relax considerably, as the only risk remaining would be the remote possibility that he is still in his seroconversion window. I would recommend you get a single HIV-antibody test at the three-month mark to put this issue permanently to rest.

I'm also concerned about the two condoms breaking. What's up with that? Were they outdated? Maybe this guy really does only have sex on leap years and his condoms were expired. Alternatively he could have been using an incompatible lubricant, such as an oil-based lube used with a latex condom. At any rate, you both should review "proper condom technique." I've discussed this at length in the archives. Have a look!

Good luck.

Dr. Bob



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