Am I at high risk, Condom broke while performing Insertive sex now on PEP

[veryworriedman]

Hi Ann and colleagues,

I am writing from England and I am going mad with worrying about what happened. I apologise if the following inquiry is long but I want to be as thorough as possible. Sorry if offend any of the moderators by going into too much detail. The following is the incident.

I had a sexual massage session with a massage therapist who is Dutch born with African-Caribbean Heritage (information provided by him). This incident took place yesterday the 11th November 2013 at about 5.45 pm British Time where the massage session turned into a oral and anal sex session. I and the other person performed oral onto each other. I am the only one that inserted my penis into the other person with a condom, there was no ejaculation that occurred during that activity, not sure about pre-cum though. The entire penetration session was around 5-10 minutes.

I did not realize or feel the condom broke and only realized it when the person moved away. I am not sure if the condom broke from the shaft at the start, middle or end of the sex session. I immediately stopped having anal sex and asked the other party when was the last time they had an HIV check-up (I know I can't take their word for it, but just wanted an indication). I was informed it was 6 months ago, the other party seeing me in distressed tried to assure me that there is not going to be an issue because there was no ejaculation but I know that to get a HIV virus infection. I further asked if he had unprotected sex before and his initial answer was that I have protected sex and even if I don;t use protection, I don;t let anyone ejaculate in me. I asked the same question again after some time and the answer was they he has never had unprotected sex in the last 6 months.

As I was worried and realizing that from my reading that African men tend to be at high risk of contracting HIV I went to the Accident & Emergency unit at the local hospital at 9.30 pm and was seen by a Triage nurse at 10.55 pm who passed on my case to the ER Registrar and I was seen by him at 2.30 am . After discussion I was told to take PEP as my contact is considered high risk. I was given TRUVADA & KALETRA tablets as my PEP. I took my first course at 5.30 am (1 TRUVADA & 2 KALETRA) and was told to take my second course after 12 hours at that I should always stick to these times to keep the level of medication stable. I have been given the tablets for 5 days initially and earlier today at about 9am went to the sexual health clinic at the hospital to do the blood test to check for my kidney and liver well being as a baseline. I did a 4th generation HIV test and that showed that I was HIV negative. I will complete the 28 days of PEP no matter how bad the side effects get.

With all that has been said I am extremely worried and scared as I read that if the person doing the insertion if uncircumcised is at equal risk (0.62%) to the person who receives unprotected anal sex but with no ejaculation (0.65%) compared to someone who is circumcised who is only at risk of 0.06%. This is where I got the information from http://www.aidsmap.com/HIV-risk-levels-for-the-insertive-and-receptive-partner-in-different-types-of-sexual-intercourse/page/1443490/#item1443493

I was also informed by the Dr. at the sexual health clinic that PEP is not a 100% protection against HIV infection. But when I contacted Terrence Higgins Trust (www.tht.org.uk) I was informed that their experience with people using PEP has been extremely successful. I am extremely worried because of the contradicting information by both these parties. Knowing that I took the first dose within the first 12 hours, how high is my risk at the moment. I am extremely scared and worried. Please do advise and assist me in this. Will PEP protect me? I am not sure of the other parties HIV status and am treating it as positive. I am of Indian origin. Does my ethnicity put me at a higher risk? What should I do now? Please help me.

From,

veryworriedman

[veryworriedman]

I forgot to mention that I was unaware of any bleeding that occurred when I penetrated the other party and am not sure if the other party had any injury within their anal membrane, but the person told me they don't think there was any tear as he would have felt it and that when he wiped himself with a tissue there was no blood. But as I am not able to verify this 100% other then by what was visible, I am extremely worried. Please advise.

[Jeff G]

You're ethnic background of the person in question isn't a factor in your situation . What matters is you did have a risk and did the right thing by seeking council .

The fact that you were the insertive partner an are no on pep is all in your favor and you should fully expect to come out of this OK . Its rare for the insertive partner to go on and test positive after a condom break and brief insertion , that and the fact you went on pep in 12 hours is heavy in your favor .

You can test at 6 weeks post pep and again at 3 months to confirm the results and you should expect a negative HIV test .   

[veryworriedman]

Jeff thank you so much for your reply. The data on the transmission scares me a lot. Will this be a huge issue as the persons ethnicity is of African Caribbean.

The guy also inserted his finger in my anal and had his saliva around my anal region as he rimmed it. Does that make it much more dangerous and increases my risk?  I feel like there is some anal tear as it hurts when I wipe myself. Could the virus through the saliva get into the injured area?

I am not sure how to calm myself down... been reading this postings and I am afraid the PEP wont work and that I will get infected... I know I might be coming across as paranoid but I am very very very worried as I took the right precautions but as the condom broke... I am extremely worried. Does oral sex also pose a risk? Please advice. I am sorry for being so restless and jumpy.

[Jeff G]

You are on Pep for a broken condom exposure where you were the insertive partner . These are the facts that matters most . The overwhelming odds are in your favor that you will not test positive for HIV .

Ethnic background has nothing to do with your case and if he did have HIV the odds are you will test negative due to PEP and the facts of your exposure . Saliva isn't infectious for HIV and fingering isn't a risk .

You need to find a way to take you mind off what ifs and find some thing to distract you or its going to be a long few months , its your choice how you spend this time . Just take your PEP and stop searching for information about HIV transmission on the internet or you will drive yourself nuts .

You are going to be OK when this is done  .

[Ann]

Worried,

You need to understand that PEOPLE are not high, low or no risk, ACTIVITIES are high, low or no risk. It's not WHO you do, it's HOW you do it. 

A person could be in one of the alleged highest risk group on paper (ie African, uncircumcised, injecting drug user, gay male) but provided they always use condoms for anal or vaginal intercourse and don't share drug injecting equipment, they're actually in the LOWEST risk group.

So stop putting people into risk groups according to their ethnicity or any other arbitrary pigeon-holes. Put YOURSELF into a risk group according to how you have sex - protected or not. It doesn't matter what sort of risk your partners have had in the past, what counts is what YOU do with them - protected or unprotected intercourse.

In over twelve years of answering questions on this forum, I've yet to see the insertive partner end up hiv positive following a condom break, PEP or no PEP. I do not expect you will be the first. Just keep taking your PEP and I'm sure you'll be fine.

Here's what you need to know in order to avoid hiv infection:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.

To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the condom and lube links in my signature line so you can use condoms with confidence. A correctly used condom rarely breaks.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.

Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

Ann