Expert: John Thai, M.D. - 10/3/2007

Question
QUESTION: Hi doc.

I recently had vaginal intercourse with a sex worker. Everything went well, as in the condom never broke or leaked. The problem is a few days later i read an article on defective condoms. They said the condoms had more than acceptable pin prick holes in them. This got me worried as i used that perticular bran. Its a government condom. Am i at incresed risk if i used a condom like this, since i have heard in the past that all condoms have very tiny holes. I am from South Africa

ANSWER: Hi,

I cannot comment on the condoms manufactured by Choice as it is still under investigation by the South African and other governmental authorities. Since I have no knowledge of the type of irregularity or defectiveness of the condoms, I am unable to inform you of the risks imposed on any individuals who may have used it in the past.

Thus, it is in your best interest to have a rapid HIV-1/2 test now, 3 months from now, and 6 months from not to determine if you were exposed to the HIV virus. If you have had sex with the sex worker within the past 72 hours, I would recommend that you immediately ask your physician for HIV prophylactics to decrease your chances of seroconverting if you were exposed to a HIV  individual. The HIV prophylactics is taken for 30 days which include 3 medications. This includes nelfinivir 1250 mg 2x/day with either

(1) zidovudine 300mg 2x/day plus lamivudine 150 mg 2x/day; or (2) stavudine 40 mg 2x/day plus lamivudine 150 mg 2x/day; or (3) stavudine 40 mg 2x/day plus didanosine 400 mg 1x/day

It is also highly recommended to get screened for all STIs at this time - syphilis, hepatitis B, hepatitis C, hpv, lgv, gonorrhea, and trichomoniasis.

If you are negative for hepatitis B, I would highly recommend that you vaccinate for hepatitis B and hepatitis A.

Regards,

John Thai, MD

---------- FOLLOW-UP ----------

QUESTION: The incident happend about 3 weeks ago.... Details of the defects can be found at www.sabs.co.za. I did have an elisa test (fourth gen) at about two weeks which showed negative.... Should i go for further testing, i was going to go for another elisa at four weeks.... I am stressing quite abit about this and should have went on a PEP program but didn't, i know it wasn't a very wise choice.....:(

Answer
Thank you for the website. Again, I cannot comment on that matter as it is an ongoing litigation in your country. I am confident that you will get an answer from your health department soon.

HIV cannot be detected within the first 8-12 weeks from initial date of sexual encounter. Thus, you must wait until 2 more months to test for HIV. You can always ask to be tested for p24 which is an antigen found in HIV. It is usually found in individuals about 1 month after exposure to HIV.

If you start getting flu-like symptoms, then contact your physician immediately.

Regards,

John Thai, MD