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what is the effect of long term use of PEPS?
Nov 7, 2009

I am Hiv Negative and my boyfriend is positive.since meeting my boyfriend 5 months ago ( june 2009) the condom has broken every month (at least 3 out of 4 times) that we use condoms despite following instructions on proper use of condoms and using the ky gel. I have therefore been on PEPS every 28 days(more like every month) and am wondering what this is doing to my body? I had a liver test 2 weeks ago and my doc said it was fine.we always discover that it is broken before he comes and we change to a new one but I still would like to know whether during that period that it is broken he is capable of passing the virus to me or is the virus only contained in the ejaculated stuff. he does not have pre come and usually takes very long to eject and when he does it is not alot.i love him alot but i feel i am taking a very high risk here and PEPs are also very expensive.

Response from Dr. Frascino


The condom has broken every month and you've been on PEP nearly continuously???? WHAT??? Have you checked the expiration date on those condoms? Did you buy them during the Reagan era? Condoms very rarely fail (break) when used properly. That yours are failing repeatedly indicates something is either wrong with the condoms (outdated, damaged, defective, etc.) or with your technique. Also, remember, "lubrication is your friend."

PEP (post-exposure prophylaxis) consists of a combination of antiretroviral drugs. There are multiple different combinations used for PEP. All antiretroviral drugs have side effects and toxicities. Your chances of having side effects or toxicities related to any of these drugs is the same as that of anyone else taking them for PEP or for treatment of HIV/AIDS.

Regarding HIV-acquisition risk within a magnetic relationship, yes, when a condom breaks, there is a risk of HIV transmission, even if ejaculation does not occur. Even though you may not have noticed pre-ejaculate ("pre-cum"), it is normal to have some and pre-cum can transmit HIV. The concentration of HIV in pre-cum is generally much lower than in ejaculate, so this lowers the risk, but it doesn't completely eliminate it.

I would advise:

1. Check your condoms! (Also, consider changing brands and using "extra strength" condoms.)

2. Re-review proper condom technique. I'll reprint below some information from the archives.

3. Try a different lubricant (water-based) and use it liberally. ("Astroglide" is one brand name to try.)

4. Read through the chapter on magnetic couples in the archives and consider some of the harm-reduction techniques suggested there.

Good luck.

Dr. Bob

Increasing and Reducing Risk: Barrier Methods for Sexual

Transmission of HIV


Male and female condoms made of latex or polyurethane are an effective barrier and one of the most important tools in preventing HIV transmission.

Quality Control

In Canada, condoms as contraceptive devices are classified as medical devices, and are subject to regulatory control under the Food and Drugs Act and Medical Devices Regulations. The Regulations are administered by the Health Protection Branch of Health Canada, and they outline standards and conditions of sale with which condom manufacturers and importers must comply. The Regulations apply to all types of condoms available for distribution and sale in Canada, including those sold through vending machines and by mail order.

Some requirements apply to all condoms, regardless of their material of manufacture. For example, all condoms must be properly packaged and labelled, and all manufacturers must notify the Branch of the sale of condoms. Other regulatory controls are specific to the different kinds of condoms, depending on what they are made of.

Latex Condoms

Latex condoms must meet design, length and width require- ments as well as specific tests for water leakage, bursting volume and bursting pressure as described in the Regula- tions. The Health Protection Branch maintains a national program of sampling and analysis to monitor latex condoms sold in Canada to ensure that they comply with these requirements. Periodically, one lot from each brand of latex condoms available on the Canadian market is sampled and tested. Unsatisfactory lots are removed from retail sale and follow-up testing is performed to ensure product efficacy.

Imported condoms must be accompanied by documenta- tion demonstrating they meet Canada's standards.

Health Canada does not have the resources to inspect all condoms distributed in the country. There is no visible way for the public to know that Health Canada has spot-tested any particular product. However, complaints or concerns about a particular product can be reported to the Medical Devices Hotline at 1 (800) 267-9675. The Medical Devices Bureau is also able to provide further information about Canada's condom standards and test results from its periodic compliance surveys.

Lambskin Condoms

Natural membrane condoms are not required to meet the above requirements for latex condoms because of their different material characteristics. Lambskin condoms used alone are not considered effective in the prevention of HIV, because the virus is easily able to pass through the mem- brane. However, lambskin membrane condoms are made available for people who have an allergy to latex and "dou- ble-bag"that is a latex or polyurethane condom is placed over a lambskin membrane condom if the allergic person is the insertive partner, or placed under it if the allergic person is the receptive partner.

Synthetic Condoms

Manufacturers of condoms made from synthetic materials, such as the polyurethane female condom, must submit data concerning their safety and effectiveness to the Health Pro- tection Branch. The manufacturer must demonstrate that the condoms provide an effective barrier to micro-organisms and sperm, and must have acceptable test methods so that the quality of the condom sold on the market can be monitored.

Polyurethane Condoms

Polyurethane has been shown to be an effective barrier against HIV. Polyurethane condoms have different charac- teristics than latex condoms, which users should consider. Female condoms are currently made of polyurethane, and male condoms are also available in polyurethane, although they may be more difficult to find.

Polyurethane is stronger than latex, but the female condom and the male polyurethane condom are considerably more expensive than the latex male condom. In addition, polyurethane does not stretch like latex, which may make it more difficult to ensure a proper fit on the penis, in the case of a male condom made of polyurethane.

However, unlike latex condoms, polyurethane does not break down when exposed to heat and light, so they may be stored for up to five years. Also, polyurethane conducts heat better than latex, providing users with a more "natural" feel. Male condoms made of polyurethane are easier to put on, since they can be pulled on, rather than rolled on the penis. Finally, people who are allergic to latex can use polyurethane.

Male Condom Use

Condoms require getting used to. Men who are first-time condom users should practise using them by themselves before they use one with a partner. To ensure that their male partners are using condoms properly and to be more comfortable about their role in making condoms a regular part of intercourse, women can also practise condom-use by putting the condom on a penis substitute.

There is some evidence that condoms break or slip more frequently when used in anal sex, although this may be due to higher levels of improper use. Thicker latex condoms have been designed specifically for anal sex; however, there is little available evidence to date to suggest that they are more effective than regular condoms.

If condoms are used properly, they have been shown to substantially reduce risk of HIV transmission. However, sometimes condoms may fail, usually because they are not used properly and consistently. Because of evidence of HIV transmission due to broken or improperly used condoms, vaginal and anal intercourse with a condom are deemed to be low rather than negligible, risk.

The key to reducing risk is proper condom use. Therefore, it is important to follow the guidelines included here.

Buying and Storing

There are many different brands of condoms and preferences are personal. Try several brands to find the most comfort- able. When using condoms, follow these guidelines: Always use before the expiry date on the package. If in doubt, get a fresh supply.

Store condoms in a cool, dry place Exposure to heat can break down latex. Polyurethane condoms are not affected by heat or light and may be stored for up to five years.

Carefully open the condom package; teeth or fingernails can tear the condom.

Use a new condom for each act of sexual intercourse. Hold the condom over an erect penis.

If a penis is uncircumcised, pull back the foreskin before putting on the condom.

Put the condom on by pinching the reservoir tip and unrolling it all the way down the shaft of the penis from head to base.

If the condom does not have a reservoir tip, pinch it to leave a half-inch space at the head of the penis for semen to collect after ejaculation.

In the event that the condom breaks, withdraw the penis and put on a new condom before resuming intercourse.

Use only water-based lubrication (oil-based lubricants, such as cooking or vegetable oil, baby oil, hand lotion or petroleum jelly will cause the condom to deteriorate and break).

Withdraw the penis after ejaculation while still erect, grasp the rim of the condom between the fingers and slowly withdraw the penis (with the condom still on) so that no semen is spilled.

Remove the condom, making certain that no semen is spilled.

Carefully dispose of the condom. Do not reuse it.

protected oral sex with old condom (CONDOM IN CAR, 2009) (PROPER CONDOM USE, 2009) Sep 7, 2009 I received a protected oral sex in a massage parlor for a minute or two. But the condom I used was in my car for 2 months. It has been exposed to heat over 100F. However it did not break while I received the oral sex. Does the exposure to heat any way cause the condom to fail by making the pores larger and the virus to pass through condomn. I appreciate your answer greatly.

Response from Dr. Frascino


Your condom was in the car for two months? Wow, that's quite a dry spell, dude. Do you happen to resemble Dick Cheney or something like that?

Your worries are unwarranted. Heat can denature latex, making it more likely to break. Luckily your baked condom did not. So you're safe. Your problem is not unique. See below.

Dr. Bob

Condom in Car Aug 18, 2009

Hi Dr. Frascino.

First allow me to say my previous sexual encounter was May 10 of this year. This last Wednesday (August 13), I went in for my 90-day HIV screening - nice and negative. Or as you might say, "Whoo Hoo!"

Someone new Ive been dating and I finally decided to take the sexual plunge a couple of weeks ago. We used condoms every time, being my standard practice and apparently hers too. One of the condoms I used, though, had been in my car for a couple of months prior, from maybe June on. For the time of night my friend and I were together, replenishing stock wasn't possible, so we chanced it (my faulty logic being using one made more sense than not). I inspected the condom, it seemed fine.

I had in fact pulled out before ejaculation each time too, just as an extra "safely measure." Before tossing the condom in question out, I filled it with water - no leaks, no tears.

So my question succinctly is this: how dumb was it using a condom that had not been kept not in a recommended room temperature environment? The condom was well within its recommended use-by date, FYI. Should I be concerned about another 90-day screening, barring my girlfriend getting her test (hopefully soon)? Or should I take a deep breath and relax.

My health care advisor told me the latter, stating condoms, if made by a reputable company (as this one was) are surprisingly durable, so while not advised to keep one in weather extremes, Im probably OK.

Your opinion has been trusted, Id very much like to know your take.

Thank you again.

Take care.

Response from Dr. Frascino


Heat can denature latex increasing the likelihood the condom will fail (break). Yours did not and consequently I see no cause for concern.

I'll repost below one of my favorite posts from the archives dealing with condom storage.

Be well. Stay safe.

Dr. Bob

manbag condoms Jul 6, 2006

Hey Dr. McHandsome,


Thanks for your prompt repy,

Sincerely yours,


Response from Dr. Frascino






Good luck.

Dr. Bob

Condom question Jun 10, 2009

Hi Dr. Bob

You always state that condoms provide effective prevention when used correctly and consistently. My question to you is how are condoms not used correctly? I always practice safe sex and use a condom from absolute start to finish - would you consider this the correct way?

I would greatly appreciate any advice you have to share.


Response from Dr. Frascino


There are lots of ways condoms are not used properly! For example:

1. Using the wrong kind of condom: Natural skin condoms are made from lamb intestines and do not protect against HIV, although they are effective in preventing pregnancy.

2. Using outdated condoms.

3. Using condoms that have been damaged by excessive heat (stored in the glove compartment of your car).

4. Using the wrong kind of lubrication with condoms (oil-based lubricants can denature latex).

5. Using two condoms for extra protection. "Double bagging" can lead to condom failure, because the latex-on-latex friction can affect the integrity of the condom.

6. Applying the condom only just before ejaculation rather than from start to finish.

7. Damaging the condom as you try to tear open the foil packet.

This is only a partial list. I'll reprint below some information from the archives about proper condom usage.

Stay safe. Stay well.

Dr. Bob

PEP Treatment HELP? (PROPER CONDOM USE, 2009) Feb 20, 2009

Hi there,

I found your contact details online and your help would be very much appreciated as I am currently in a panic mode!

Here it goes:

1. I had anal sex (me top HIV neg) with a partner (bottom HIV pos with viral load 20k 26k copies) unfortunately the condom broke but I did not ejaculate.I am concerned that I might be exposed to infection and therefore I received PEP treatment from my local hospital on the 02.02.2009.

I had to travel to South Africa for 10days on the 03.02.2009 and I was due to go back to the hospital for tests and to receive my 2nd dosis of the PEP treatment (another 2weeks supply to make up a total of 4weeks/ 28 days) on the 12.02.2009. Unfortunately my flight had to be rescheduled and I only returned back to the UK on Wednesday the 18.02.2009. My medication ran out on Monday evening the 16.02.2009.

2. On Wednesday I had intercourse again with the same person and the condom broke again! Once again I did not ejaculate and penetration was only for a few seconds!

3. Thursday 19.02.2009. I returned to my local hospital to receive my further 2 weeks supply of PEP. By this time I missed 2 an half days worth / 60 hours of medication. I explained this to the doctor and there was explained to me that the PEP might not be effective. I am quite concerned about this...? 4. I did not tell the Doctor about the 2nd occasion on my return when the condom broke again. Now I would like to know if my PEP treatment needs to be increased or do I just continue with the normal dosage of 28days keeping in mind that I missed 60hours of treatment two weeks into the course and then their might be a second chance of infection at the time when my medication ran out.

I would appreciate if you could please get back to me ASAP with further thoughts on this.

Many thanks.

Response from Dr. Frascino


First off, what's up with your condoms? Did you buy them during the Reagan era? Have you been storing them in the glove box of your car parked in sweltering heat? Are you using oil-based lubricant (incompatible with latex)? I think it's time you reviewed proper condom technique. (See below.)

Next, as I have mentioned previously in this forum, anyone who has had an HIV exposure significant enough to warrant PEP should be followed by an HIV specialist. I suggest you contact an HIV specialist. Tell him the whole story. And I do mean the whole truth and nothing but the truth! He will evaluate your current PEP regimen and possible need for an additional course.

I'll repost below some information about the role of HIV specialists for folks taking PEP.

Good luck.

Dr. Bob

Chihuahua guy again (PROPER CONDOM USE, 2008) Oct 16, 2008

Protected" sex is indeed protected, if the latex condom was used properly and did not break. HIV cannot permeate intact latex (or polyurethane). No way. No how. This is the answer that you gave me, but can you clarify this: 1. - What is the proper use of a condom? In my case I pull it off the envelop, I put it in my penis till the base of it, I didnt take it off right after I cum but my penis was still hard when I take it off (about a minute or so, after cum), then with my hands I kind of squeeze it a little bit to look for any leak, which wasnt any, then into the garbage bowl. Is this a proper use? 2. is there any risk of hiv acquisition for touching the exterior side of the condom and manipulated it whit my hands? 3. Am I paranoid?

Thank you so much doctor you are such a wonderful person

Response from Dr. Frascino


1. The description of your use of the latex condom suggests proper usage. (See below.)

2. No.

3. Yes.

Dr. Bob

Another question and problem caused by Bush's abstinence policy (PROPER CONDOM USE) May 23, 2008

Basically, I'm 19, and we never had sex ed in high school. Specifically I never learned how to use a condom. I go off to college and I start dating this girl. Now the reason I am worried is that one of her ex's was found to be HIV positive. As such I was scared of having sex with her and still haven't. But I did have oral with her, but I made sure we used a condoms as in the archives it says if condoms are used correctly there is no chance of HIv transmission. Now this is what scares me, after she gave me oral I checked to see there were no breaks, and I didn't think there were because it appeared to be intact and there was no semen around me. But then I found a bit of I guess rubber on the tip of my penis. Could this be a sign the condom broke, as it did not appear broken, and furthermore if it broke wouldn't it just be a tear, like a bit of it just wouldn't fall off? Anyway this happened 4 weeks ago and I now have tonsillitis, a bit of eczema, a fever, and I feel dizzy. I am worried out of my mind and I am angry as I may get HIV due to not being taught how to use a condom properly. I think I did use it properly I just want reassurance on my risk and whether I did.

Thankyou so much in advance

Response from Dr. Frascino


You never had sex education in high school and now you're in college and "worried out of (your) mind "that you may have contracted HIV "due to not being taught how to use a condom properly." Yours is another prime example of how Dubya's sex-phobic, anti-science policies have placed people at risk for unwanted pregnancies as well as STDs, including HIV. I can assure you President Obama and a strongly democratic House and Senate will help rectify this (as well as many other) disastrous policies. (I'm counting on you to rally your college buddies to vote for Obama and the democrats!!!)

Here's the scoop on condoms. HIV cannot permeate intact latex or polyurethane. No way. No how. However, condoms are not 100% effective, because they are often used improperly and also extremely rarely they can fail (break). When a condom breaks, it is usually very obvious. The thin piece of latex or polyurethane is stretched tightly over a throbbing tallywhacker. Consequently, when it tears, it rips dramatically and Mr. Happy's head usually comes poking out, similar to your head poking out of a turtleneck sweater. Regarding what you should have been taught in school about proper use of condoms, see below. You can also read much more about condoms in the archives and also in the chapter titled "HIV Prevention Basics" on this site.

Regarding your HIV risk, it remains exceedingly low. Oral sex, even unprotected, carries only a very low risk for HIV transmission.

"Symptoms" are notoriously unreliable in predicting who is or is not HIV infected. The reason to get tested or even to worry about HIV would be having placed yourself at risk for possible acquisition of the virus. I would not be concerned that your bout of tonsillitis, bit of eczema, fever or feeling dizzy might be HIV related. These are extremely common symptoms and certainly not HIV specific.

If after reviewing the information below, you feel you may have been exposed to HIV, a single simple rapid HIV test at the three-month mark will provide you with an accurate test result in as few as 20 minutes. From what you've told me, the results would undoubtedly be negative.

Good luck. Get informed. Stay safe. And remember to vote Democratic to prevent others having to endure what you are currently experiencing.

Dr. Bob

Condoms April 12, 2007

What Are Condoms?


What Are They Made Of?



How Are Condoms Used?



Check the expiration date. Don't use outdated condoms.








Using a Male Condom:










Condom Myths

Condoms don't work: Studies show condoms are 80% to 97% effective in preventing HIV transmission if they are used correctly every time you have sex. Condoms break a lot: Less than 2% of condoms break when they are used correctly: no oils with latex condoms, no double condoms, no outdated condoms.


The Bottom Line



Where the Rubber Meets the Road April 1997

When used correctly, latex and polyurethane condoms stop the spread of HIV almost 100% of the time. Condoms are like cars: If you have an accident with one, the cause is almost certainly operator error, not mechanical failure. The estimated failure rate of latex and polyurethane condoms is between 2% and 5% -- and when a condom does tear during sex, the break is usually the result of misuse, not a defect in the condom itself. The Food and Drug Administration -- which considers condoms to be "medical devices," regulates their production, and makes frequent, unannounced inspections of condom-manufacturing plants -- has declared that the difference in quality between the best and worst condoms on the market "is tiny compared with the problems that users introduce." Condoms are like cars in another respect: They work best when you follow the manufacturer's instructions. The most common cause of condom failure is a simple mistake, one that people make almost as soon as the condom is out of the wrapper: They place the rolled condom on the head of the penis upside down. In this position the condom looks like a mushroom cap, and it can be unrolled down the shaft of the penis only with difficulty.

You may have to wedge your fingers between the condom and your penis to unroll it this way. The condom will still cover the penis, but because it is inside out, the ring at the base will usually be tangled, not snug and secure. This makes the condom more likely to slip off or tear during sex.

The rolled condom should be placed over the head of the penis the same way that a knit cap is placed on your head, with the rolled "brim" outside the cap, not tucked under. This way it rolls easily down the shaft of the erect penis. The condom ends up right-side out. The ring at bottom of the condom fits snugly at the base of the penis, and the condom stays in place during sex.

There's one more way in which a condom is like a car: You need to keep a condom well-lubricated. If you never change the oil in your car, the parts will grind against each other and break. A condom that is not kept lubricated is also much more likely to break -- but you should never use oil to lubricate a condom. Oil-based lubricants like Vaseline, cooking oil, Crisco, baby oil, suntan lotion, and most skin moisturizers will dissolve a latex condom, creating tiny holes. You can't see these holes, but they are there, and HIV can get through them.

For this reason you should always use water-based lubricants with condoms. And you should always use condoms made of latex or polyurethane, because non-latex condoms have pores that HIV can get through. Check the label. If the condom does not have the word LATEX or the word POLYURETHANE clearly printed on it, don't use it. And check the labels on all lubricants. Most lubricants designed specifically for sex -- brands like KY, ForPlay, and Astroglide -- are water-based, and the labels will clearly say so.

Many of these lubricants also contain an ingredient called nonoxynol-9 which may increase someone's risk of HIV. Using a lubricant that contains nonoxynol-9 without a condom will not prevent the transmission of HIV, and should be avoided because it could increase your risk of getting HIV.

Generously apply a water-based lubricant to your penis (or to the inside of the condom) before putting the condom on. (This allows the penis to move around slightly within the condom.) Once the condom is securely in place, rub lubricant on its outer surface, then apply more of the lubricant to your partner's vagina or anus. During sex, rub on more lubricant at frequent intervals. Keeping everything well-lubed cuts down on friction and puts less strain on the condom, making it even less likely that the condom will tear.

There is no such thing as a learner's permit for condom users, as there is for beginning drivers, and there are no mandatory driver- education programs for condom users either. That's too bad, because learning how to handle a condom with skill and confidence takes practice. Condoms do work. But they only work when they are used consistently and correctly.

Both women and men should study the following diagrams and instructions, and both should know that a newly developed "female condom," which is inserted directly into the vagina instead of placed on the penis, offers the same effective protection as a regular condom. Learning how to use condoms is like learning how to achieve sexual fulfillment. In both situations experience is the best teacher.

Correct Use of Condoms Condoms Worn by Men 1. Always use a new latex or polyurethane condom each time you have vaginal or anal sex. (Condoms are also recommended for oral sex with a partner who is known to be, or is suspected to be, HIV-positive.) Open the package carefully, so that you do not tear the condom.

2. Place a few drops of water-based lubricant on the inside of the condom or on the penis itself.

3. Before any form of direct sexual contact with your partner, place the condom over the head of the erect penis, leaving about a half-inch of empty condom at the end (Figure 1). Note: On an uncircumcised penis, pull back the foreskin to expose the head of the penis before you place the condom over it.

4. Gently squeeze the tip of the condom to force out any trapped air. The condom should fit over the head of the penis like a small rubber cap, with the rolled "brim" outside the "cap" -- so that it will unroll easily down the shaft of the penis.

5. Hold the tip of the condom against the head of the penis and unroll the rest of the condom all the way down to the base of the penis (Figure 2). Rub water-based lubricant over the condom-covered penis and, for extra safety and comfort, apply additional lubricant to your partner's vagina or anus.

6. Slowly insert the covered penis into the vagina or anus. If at any point you feel the condom break -- or you even think it may be broken -- pull the penis out immediately. If broken, throw the condom away and use a new one.

7. After you ejaculate (cum), hold the condom to the base of the penis while pulling out of your partner. This keeps the condom from coming off while it is still in your partner's vagina, anus, or mouth. Gently peel the used condom off the tip of your penis (Figure 3) and throw it away. Never use a condom more than once.

Please save me the embarrassment
re: RESPONSE TO SENSELESS and comment for PML questioner)

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