Broken condom!

[alantalbot]

Hi guys, I was on here for a short time last year when I was testing for HIV and other stuff (the tests were all neg thankfully.)  I just searched on here for old threads relating to broken condoms.
To my surprise, most of them came from people who had had hetero sex or had been the recipient in anal sex.  Anyhow, last night my boyfriend and I did a 3-way with another guy.  We both topped him - he was much more into me than my bf so I spent more time inside him.  Throughout the evening (a few hours) I used 3 condoms.  One of them broke and luckily I felt it break and was able to pull out and change it fast.  I realize HIV is hard to transmit to an insertive partner - I don't know if this guy was poz or not.  Should I head for my local clinic and get a free PCR test and ask for PEP?  I don't think my unprotected penis was inside him long enough to transmit anything and I was using condom plus water-based lube.  Does anyone know what the protocols for PEP are?  Do they give it to just anyone who requests it?   I always use condoms for full insertive but only recently found out that insertive anal carries with it some risk for the one doing the topping.  Is non-insertive anal a risky thing as well?
I guess anal fluids carry as much or more HIV than even blood or semen do?
Any advice appreciated.  Thanks, Al   

[Matty the Damned]

If the head of your cock was covered when the condom broke I wouldn't call this a risk at all.

That said, let's assume it wasn't covered. The likelihood of you contracting HIV from this encounter is vanishingly small and there's no need for PEP in your case. Nor should you pursue PCR testing as there is a risk of it returning a false positive.

You should follow the standard drill. HIV antibody test 3 months from the date of this risk encounter.

MtD

[alantalbot]

Hi Matty - first off, let me say that I LOVE your signature Brady Bunch image - awesome and original.
Nope, the head of my cock was not covered, that's where it broke
and thankfully I could feel the break before continuing on with activity.  I will heed your advice and just test in 3 months.

You mention something interesting about PCR though - what is it with that test and the false positives? I know it's DNA amplification and can tell you if you've got HIV within a very short time of exposure.  But why is it - and please put me back on track if I'm off the track - that PCR tests are not good indicators of HIV infection?  Is it true that after the window period is over, or if someone has finished seroconverting, the viral load can go to undetectable levels and never rise again until someone is well on their way to AIDS or already is in AIDS classification?  The test is expensive - $300 or more usually - but we have a clinic here in the Los Angeles area that does them for free.  How they can afford to do it is beyond me, especially in these turbulent economic times.  A lot of guys go in and get it though.  Interestingly, they do NOT offer free HIV antibody tests.  They only have rapids and PCRs.  The antibody+Western Blot test is $50 at most local health clinics here. 

Thanks again for your fast reply. -Al

[Matty the Damned]

Hi Matty - first off, let me say that I LOVE your signature Brady Bunch image - awesome and original.
Nope, the head of my cock was not covered, that's where it broke
and thankfully I could feel the break before continuing on with activity.  I will heed your advice and just test in 3 months.

You mention something interesting about PCR though - what is it with that test and the false positives? I know it's DNA amplification and can tell you if you've got HIV within a very short time of exposure.  But why is it - and please put me back on track if I'm off the track - that PCR tests are not good indicators of HIV infection?  Is it true that after the window period is over, or if someone has finished seroconverting, the viral load can go to undetectable levels and never rise again until someone is well on their way to AIDS or already is in AIDS classification?  The test is expensive - $300 or more usually - but we have a clinic here in the Los Angeles area that does them for free.  How they can afford to do it is beyond me, especially in these turbulent economic times.  A lot of guys go in and get it though.  Interestingly, they do NOT offer free HIV antibody tests.  They only have rapids and PCRs.  The antibody+Western Blot test is $50 at most local health clinics here. 

Thanks again for your fast reply. -Al

PCR (especially the DNA variety) is prone to producing false positive results. It really isn't suitable for HIV screening, particularly in situations like yours.

The risk of infection in your case is very slight even if the fellow you fucked was HIV positive. There's no reason you shouldn't follow the standard HIV testing protocol of an antibody test 3 months from the date of the risk incident.

I expect that you will test negative.

MtD

[Matty the Damned]

Also I should add that a PCR test will have to be confirmed by an antibody test in any event.

MtD

[alantalbot]

Thanks Matty!  Glad you are a resident authority here.  I'm sure I'll test neg as well but
HIV is a tricky motherf***er so I just thought I'd check back in here.  The PCR tests don't
even seem like they're worth doing unless somone has just had an exposure to someone who
was knowingly HIV+.  And PEP....all it does is attempt to delay seroconversion most of the time, as I understand it.  Thanks again for your time.  -Al

[jkinatl2]

I am sorry that you have had a scare. But I fully agree with matty in that this risk does not warrant undue fretting. A semi-annual HIV test will be fine. If you want that to match up with three months after this encounter, then you will likely sleep better.

[alantalbot]

Hey JKI - thanks for your concern.  It wasn't really a scare.  I've read all kinds of posts here and elsewhere about broken condoms, and I've never read one about a guy who was a top getting infected after a condom broke.  If I had been bottoming and it broke, then I'd be much more concerned.
I don't know if the guy I fucked was poz or not, but the "treat all partners as poz" rule is one that I'm inherently aware of.  I know, some tops do get infected, even though the chances are slim. 
Actually, my question here was more about the PCR test and why it is not recommended.
I kinda understand it, but not fully.  And I didn't know if seeking out PEP was recommended either, given that I was the insertive partner, and I didn't know if the recipient was poz or not.  It seems like a lot of people seek out PEP when they never had a risk to begin with.  Anyhow I'll probably just test in 3 months.   Thanks again for replying, -Al

 

[jkinatl2]

Thanks Matty!  Glad you are a resident authority here.  I'm sure I'll test neg as well but
HIV is a tricky motherf***er so I just thought I'd check back in here.  The PCR tests don't
even seem like they're worth doing unless somone has just had an exposure to someone who
was knowingly HIV+.  And PEP....all it does is attempt to delay seroconversion most of the time, as I understand it.  Thanks again for your time.  -Al

PEP, if started in time (studies cite a 72 hour period, but realistically, the first 24 hours are most important) and consistently followed, does prevent HIV infection in roughly eighty to ninety percent of followed cases. True, proving a negative is difficult, but the number of people who test positive following correctly instigated PEP is roughly the same percentage as laboratory and simian experimentation.

What PEP does delay, however, is the window period for HIV testing. Current guidelines state that the proper time for a definitive result is three months AFTER the last dose of PEP. For the unlucky few who DO seroconvert despite PEP, it does indeed delay the production of antibodies for a month or so. And you are absolutely correct, a LOT of people seek out PEP when it is not warranted, and even more people shell out hundreds of dollars on PCR testing. This site has seen an awfully large number of people freak out over what turns out to be a false positive using PCR screening. These are almost always males, and almost always heterosexual. Someone should seriously do a study.

I think you are responding to this event appropriately by testing in three months, though a test at the six week period would be a near certainty. The vast majority of people test positive by twenty-five or so days after exposure. What we stress on this site is that HIV is a shockingly difficult virus to catch, especially for the insertive partner.  Which is not to say that it does not happen, but that it is a remarkably bad stroke of fortune when it does.

I fully expect you to come out of this situation ok.

[alantalbot]

Yeah they should do a study...  What I don't understand is why there are false positives with the PCR testing.  From what I know, PCR basically just amplifies the HIV DNA - and if there is no HIV, how can it give a positive result?  Makes no sense.  What also does not make sense is the low numbers that the CDC gives for insertive anal partner risks.  Frankly I think their numbers are absolute bogus.  They report something like 1 in 1600 exposures.  There have been plenty of tops who got infected with far fewer exposures, which would make sense since anal fluid is rich in HIV if the person is poz and not on HAART especially.  Yet some say that unless you do unprotected full insertive/penetrative sex, there is really no risk.  What is the truth?  I guess no one has a definite answer because there are seemingly way too many variables.

I've also heard that most hospitals will not start PEP unless the patient really has a good reason.
Apparently those who show up at some hospitals saying they were the insertive partner are denied a PEP regimen because it's just not worth the time and money.  If they were the receptive partner, some hospitals apparently won't start it unless the top was known to be poz.  But I'm sure plenty of people who go for PEP just lie and say that the other person was definitely poz.  I've had other exposures in the past...I had a guy try to top me last year and he was inside me unprotected for only 10 seconds or so before I asked him to stop since I'd run out of condoms.  Then he tried a few more times to re-enter me and I kept pulling it out.  Luckily I tested neg after that incident but I've heard of 17 or 18 year old guys who have gotten infected upon identical circumstances and after a small number of exposures.  It only takes once, difficult to transmit or not.

Thanks for your vote of confidence....we shall see.... If I do happen to be unlucky, there is a great HIV clinic near my place (I'm in the Los Angeles area).  I've been there for testing and stuff for the last couple years.  -Al