Is there prophylaxis for exposure when a condom breaks during sexual intercourse?

Post-Exposure Prophylaxis After Condom Breakage During Sexual Intercourse

When a condom breaks during sexual intercourse, post-exposure prophylaxis should be considered based on risk assessment for sexually transmitted infections (STIs) including HIV. The approach depends on the type of exposure and potential pathogens involved.

Risk Assessment

• Condom breakage exposes individuals to potential STIs including HIV, herpes simplex virus (HSV), human papillomavirus (HPV), and other sexually transmitted pathogens 1
• The risk level depends on:
  • Known infection status of the partner
  • Type of sexual activity (vaginal, anal, oral)
  • Presence of visible lesions or symptoms in either partner
  • HIV status of both partners 1

Prophylaxis Options

HIV Post-Exposure Prophylaxis (PEP)

• Consider HIV PEP if the partner is known to be HIV-positive or high-risk status and the exposure occurred within the past 72 hours 1
• PEP should be started as soon as possible after exposure for maximum effectiveness 1
• Consult with healthcare provider immediately for risk assessment and appropriate antiretroviral medication regimen 1

Bacterial STI Prophylaxis

• Prophylactic antibiotics may be considered for exposures to partners with known gonorrhea, chlamydia, or syphilis 1
• Testing is recommended even if prophylaxis is given, as no prophylactic regimen is 100% effective 2

Hepatitis B

• For individuals not previously vaccinated against hepatitis B, consider hepatitis B vaccination as post-exposure prophylaxis 1
• Hepatitis B immune globulin may be recommended in certain high-risk exposures 1

Emergency Contraception

• For heterosexual encounters with risk of pregnancy, emergency contraception should be considered 3
• Ulipristal acetate (ella) can be effective when taken up to 120 hours after unprotected intercourse 3

Immediate Actions After Condom Breakage

• Wash genitals with soap and water (this may reduce pathogen load but is not considered reliable prophylaxis) 1
• Urinate to help clear the urethra 1
• Seek medical attention promptly for risk assessment and possible prophylaxis 1
• Avoid further sexual contact until both partners are tested and treated if necessary 1

Follow-Up Testing

• Baseline testing for common STIs is recommended regardless of whether prophylaxis was administered 1
• Follow-up testing should be conducted at appropriate intervals based on incubation periods of potential pathogens 1
• For HIV, testing at 4-6 weeks, 3 months, and 6 months after exposure may be recommended 1

Prevention of Future Exposures

• Consistent and correct condom use reduces risk of STI transmission 1
• Key aspects of proper condom use include:
  • Using a new condom with each act of intercourse 1
  • Putting the condom on before any genital contact 1
  • Ensuring adequate lubrication 1
  • Using only water-based lubricants with latex condoms 1
  • Holding the condom at the base during withdrawal 1
• Consider additional barrier methods or pre-exposure prophylaxis (PrEP) for HIV if at ongoing high risk 1

Important Considerations

• Condoms are not 100% effective even when used correctly; they provide partial protection that can substantially reduce but not eliminate STI risk 4, 2
• The effectiveness of post-exposure prophylaxis varies by pathogen and timing of intervention 2
• Regular STI testing is recommended for sexually active individuals, especially those with multiple partners 1