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The condom burst, what should I do?

The following letter was written to Nac by a client and we have found it worthy to share the response with readers of our column:

Dear Doctor
A few nights ago my condom burst during sex. Two days later I started feeling weak and tired. What could this be? What should I do?

Dear Worried
Accidents happen. In moments of passion, a condom worn incorrectly or past its expiration date can break or slip off, putting you at risk for sexually transmitted infections (STIs) including HIV and pregnancy if you are woman.
There are immediate steps to take if a condom breaks during sex. If a condom breaks while having sex, it is best to stop immediately and pull out carefully. The most important thing at this stage is to avoid panicking.

Instead, take the time to calmly assess what just happened, asking yourselves if the condom is still on the penis or has it disappeared inside the vagina? Were you just starting to have sex, or were you near the point of ejaculation? Did the breakage happen after ejaculation?
If you are relatively confident that there was no exchange of body fluids for instance if the condom burst just as you were starting to have intercourse, then you may decide to start afresh with a new condom. Take the time to check the expiration date on the condom and be sure to use an approved lubricant.

If on the other hand, you think that there may have been an exposure, it is best to stop altogether. You can wash the genital areas gently with soap and water, but do not douche, scrub, or use a harsh disinfectant of any sort.

Douching can strip away protective bacteria from mucosal tissues, as well as physically disrupt the delicate membranes. Disinfectants can also damage mucosal cells and cause an inflammatory response that promotes, rather than inhibits, HIV infection.

If there has been ejaculation, try to remove as much semen from the vagina as possible. Clear, clean but do not stress the delicate tissues of the vagina.

After such an accident, you and your partner should get tested for Sexually Transmitted Infections, including HIV, as soon as possible.
Before treatment is prescribed, a rapid HIV test will be given to assess whether you and or your partner has HIV. Even if both tests are negative, you may still want to proceed if there is any chance that you are within the window period during which HIV tests can sometimes deliver a false negative result.

If you have been exposed to the HIV virus, you will be given post-exposure prophylaxis (PEP), a prescription treatment for HIV that may prevent infection. The treatment is a month-long course of antiretroviral medications that are most effective if you start them right away a�� but may still work up to 72 hours after exposure.

As it stands you are still within the 72-hour window. Side effects can include extreme nausea and fatigue. To find PEP you will have to visit your local health centre.

If you are a woman worried about unwanted pregnancy, consider following your condom accident with the high-dose birth control pill which is available over-the-counter (it is also known as emergency contraception or the morning after pill) and can prevent pregnancy if taken within 72 hours.

Again this is most effective when taken right away, and taking it within 24 hours is encouraged. Many womena��s health organisations recommend purchasing it before you need it, so that ita��s readily available if you ever do. These are available at local pharmacies.

The side effects of morning-after pills may include nausea, vomiting, abdominal pain, fatigue, headache, and menstrual changes. If you experience severe abdominal pain, see a doctor.

If your period is more than a week late after taking the emergency contraception, you might be pregnant and should get tested.
It is important to avoid future accidents. Once the immediate crisis is over put some thought into why the condom broke. These accidents dona��t happen easily.

Are you using condoms correctly? Are you using a kind of lubrication which could be causing the breakage? Are the condoms old or expired? It is important to identify the problem so you can avoid an accident in the future.

Other tips to avoid burst condoms are never wear two condoms at once. The friction caused by the two barriers can facilitate breakage. Make certain that you are using properly-sized condoms. And never reuse a condom.

It must be stressed that PEP should not be used as regular prevention against HIV. PEP is effective in preventing HIV when administered correctly, but not 100 percent. The side effects of the ARVs can be unpleasant.

In addition you may not be able to access PEP all the time from the health facilities especially if they suspect you are abusing the privilege.
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