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HELP! The condom broke............
Nov 2, 1999

I have been HIV positive for 15 years. I have a negative partner and we had sex and the condom broke. I am not on medications and what is his percentage to become infected? I am not handling this well, please answer this question. What are the studies on female to male transmission? Is is possible for him to be come infected with only a one time exposure, I was using a spermicde also. It is possible I know, but what are the percentages? Thanks

(My viral load is over 32,000. Does this matter?)

Response from Dr. Pavia

First, take a deep breath. This is a scary moment, but it's not as bad as it seems. Heterosexual transmission seems to be one of those unfair twists of nature, where it is easier for a woman to become infected than a man through vaginal intercourse. The estimated chances for a man of being infected through one episode of unprotected vaginal intercourse is somewhere in the 1 in 300 to 1 in 1000 range.

Usually, what leads to infection is repeated exposure, but of course it does only take once. Factors that may make it riskier for your partner would be genital sores or inflammation on either one of you, very advanced disease on your part (which you DON'T have), and maybe anal sex. So the chances are pretty low of anything happening after one broken condom.

There is a lot of interest in "post exposure prophylaxis" or PEP in this kind of situation. The idea here is that if someone has had a high risk sexual exposure and can start treatment right away (we think that means within a few hours, the sooner the better), it PROBABLY will reduce the risk of infection. That means usually going on a two drug cocktail for 4 weeks.

Does it work? Not proven yet. Who should consider it? Well, it makes the most sense in a really high risk situation - rape, for the person on the receptive end of intercourse with ejaculation, particularly if the infected partner has a high viral load. Some people would still consider it in other situations though. Call your HIV doctor. If your live in the San Francisco Bay area, call the AIDS program at SFGH or the City Health Department and talk to them about PEP. Hang in there, its very likely your partner will be fine.

ATP



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