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Condom break scared..! donation right a way Dr. Bob
May 21, 2011

Bonjour Dr. Bob,

First of all I would like to commit to you that I would do the small donation of minimum $100.

I have been reading various questions on condom break & your answers too!. I have some questions in post condom break problems;

I had the same incidence a week before and did not notice till the act was over. I ejaculated inside vagina & I took out the penis after 3 to 4 minutes. The condom was tightly holding the joystick and was slightly difficult to remove. Half centimeter puncture was noticed on the tip which made me extremely scared. I immediately washed it with some lukewarm water and applied disinfectant alcohol. The sex worker kept denying of having HIV (which can never be trusted) & contrary asked me the reason my worry (could be an act). Though I started feeling burning penis (due to alcohol) but ignored due to the probable fear. The girl accepted to get tested but disappeared when called her several times the same day.

I had acted immediately and got PEP started with 13 hours of exposure. My questions are as follows Dr BOB,

1) If it was vaginal insertive sex and if the CDC data shows 5 getting infected out of 10000 exposures then protective vaginal sex can have potential hazard of infection?

2) Can a half centimeter condom torn at the tip be as equal to non protective sex?

3) Condom holding the penis tightly could protect the penis getting exposed to infected vaginal fluid?

4) When do I test for HIV test? After 3 months of the exposure or after 3 months from the end of the PEP treatment?

5) I heard PEP can damage the lever. What diet you suggest during PEP treatment which would keep level healthy. I used to drink lot but now stopped since 5 days due to this scare!

6) What is the percentage of success of PEP.

Trust me Dr. Bob, I will contribute to your foundation.

Response from Dr. Frascino

Hello,

1. If the latex condom is used properly and doesn't break, the HIV-transmission rate is essentially nonexistent. If the condom does break, the estimated statistical risk would be the same as that of unprotected sex. Your estimated statistical risk would be less than the figure you quoted, as that statistic assumes the partner is confirmed to be HIV positive. Your sex worker's status is unknown.

2. One would assume the risk would be somewhat less, but since we are dealing with hypothetical situations that have many variables (viral strain, viral load, local trauma, concurrent STDs, host immune integrity, etc.), the best we can say is that if the condom breaks, even a little, there is some degree of HIV-transmission risk and HIV testing would be warranted.

3. HIV transmission would involve contact with the foreskin or urethra (pee hole). Contact with the rest of the penis (shaft) would not be a risk.

4. The post-PEP testing guidelines recommend HIV-antibody testing at four to six weeks, three months and six months from the date of exposure.

5. It is extremely unlikely that a 28-day course of PEP would harm a healthy liver. Diet would not have any effect, either helping or hurting. Avoiding excessive alcohol is always a good idea, as this can harm the liver.

6. We don't have accurate statistics, because each case is so different -- different exposures, different PEP regimens, different start times, different viral strains and viral loads, etc. The best we can say is that PEP helps abort HIV infection after exposure, but is not 100% effective.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org) it's warmly appreciated. In return I'm sending my good-luck/good-health karma that you are now and will forever be HIV free.

Good luck.

Dr. Bob



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