Broken Condoms cause panic for most people

Answered by Oliver Bacon, MD, HIV InSite Medical Editor

Question:

Two days ago I had sex with a woman whose HIV status is unknown (and it is impossible to ask her to get tested). I had condom on from the very beginning. But the condom broke during intercourse due to the air on the top. We both heard the sound and I withdrew immediately and found the condom broken on the top.

The maximum length time that I was inside her after the condom broke was 1 to 2 seconds.After that, I was worried to death. I called 1-800-TALK-HIV and was recommended to go to ER of a hospital for postexposure prophylaxis (PEP). I went there today but was told that ER doctor does not think that I need PEP due to a broken condom.

I then went to a clinic as recommended by the ER and tested negative. The clinic does not recommend PEP either. I know there is a window period before testing would any meaningful result. What is risk I was exposed? Thank you very much.

Answer:

I think your risk of becoming infected was low. Here's why:

1. You used a condom for all but 1 to 2 seconds of the sexual encounter. Although no one has studied the risk of extremely brief unprotected sex such as what you describe, it is probably reasonable to assume that decreasing the duration of contact with potentially HIV-infected vaginal fluids decreases the risk of becoming infected. Your story is also, by the way, a useful reminder to check every so often during sex that your condom is intact.
2. In general, the risk of female-to-male transmission is low, although this varies according to where the studies have been done. Two large studies in California and Europe found a per-contact risk (meaning the risk of a man becoming infected from each instance of penile-vaginal sex) of 0.0001 (1 in 10,000) and 0.0003 (1 in 3,000). Three studies done in Thailand and Kenya show a higher risk of female-to-male transmission, between 0.001 (1 in 1000) and 0.16 (16 per 100). The men in these studies had either recently had sex with a female sex-worker, or were regular clients of female sex workers, either of which situations may have increased their risk of becoming infected.

Finally, continue to protect yourself and your partners by wearing a condom and using plenty of water-based lubricant every time you have vaginal or anal sex.

Thanks for writing.

• if the condom breaks while you're having sex and there has been no ejaculation, immediately stop and very carefully pull out and move away from your partner.
• wipe the area clean with soap and water and immediately put spermicide into the vagina using an applicator full of spermicide.
• be sure to wash off your penis before engaging in sex again because there quite possibly is pre-ejaculate on it.
• use a new condom, obviously you wouldn't use the broken one but don't ever reuse a condom even if it isn't torn.
• if ejaculation has occurred, pull out carefully and both partners should shower or wash their genital area thoroughly with soap and warm water.
• never douche after a condom breaks because douching can force infectious microbes deeper into the vagina. Douching also causes membrane irritation, increasing the risk of disease transmission.
• never use contraceptive foams such as nonoxynol-9. Contraceptive foams can irritate mucous membranes and increase the risk of infection.

The reasons condoms break or slip off

The most common reasons a condom breaks or slips off is because:

• it wasn't put on correctly.
• the expiration date has passed.
• it has been exposed to high temperatures or ripped because it was not stored properly.

Other important condom pages

• how to use a condom.
• Condom Promise.
• broken condom.
• what is a condom.

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