[Question #11738] Urgent Concern: Condom Slippage During Sexual Encounter and STI Risk

12 months ago

I’m a 32-year-old male who hasn't had sex in 3 years and recently used the services of a sex worker. She is in her forties and a smoker. During our encounter, everything seemed normal with no visible discharge or unusual signs on her body or in her private parts; in fact, everything appeared quite dry.

We started with deep kissing, and she then performed unprotected oral sex on me for about 3 to 4 minutes, during which I did not ejaculate. Afterward, I put on a condom and we proceeded with vaginal intercourse. However, as I pulled out, I noticed that the condom was no longer on my penis. It turns out the condom had slipped off inside her, and she retrieved it by reaching inside her vagina. This likely happened in the last seconds of intercourse.

I then put on a second condom, but due to my anxiety over the situation, I couldn’t maintain an erection and decided to stop. We ended the session by taking a shower together, during which there was some kissing but no further sexual activity. She finished the encounter with a handjob.

I’m feeling extremely anxious about the condom slipping incident and am concerned about the risks of contracting an STI. What are the odds of catching something serious, and should I get tested? If so, when is the appropriate time to do so?

12 months ago

I'd also like to add that I live in a country where if the test has to be reported to the gov and, if the thing I can't even get the courage to write was found, one would be deported. And the circumstances aren't viable to travel to another country now. So I don't really know what to do.

H. Hunter Handsfield, MD

12 months ago

Welcome to the forum. Thanks for your question. I'm happy to help.

You are at little or no risk of HIV or any STD from this event. Protection from a condom remains very good when the penis withdraws leaving the condom in a partner's vagina. Oral sex is near zero risk for HIV and low risk for other STDs, and the hand-genital contact was no risk at all. Also, at any point in time, most sex workers do not have transmissible STDs. If HIV is your main concern, even entirely unprotected vaginal sex with an infected partner has under one chance in a thousand of becoming infected.

Be on the alert for STD symptoms: discharge from the penis within the next 10 days or so, penile sores in the next few weeks, etc. Without such symptoms, testing isn't advised after any single sexual encounter, even if entirely unprotected. But even without symptoms, of course you are free to be tested if the negative results would give you more reassurance. In that case, I would advise a urine test for gonorrhea/chlamydia, which will be valid any time about 5 days or more after exposure. And perhaps blood tests for syphilis and an HIV in about 6 weeks. No other tests are recommended in this situation.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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12 months ago

Thank you very much.

I cannot test for HIV in the country where I currently reside because I am uncomfortable with the possibility that the results may be shared with the government. Based on the risk assessment you provided, do you think it is worth flying to another country in 6 weeks to get tested, or would you consider it unnecessary?

Additionally, I'm particularly concerned about HIV. If the condom slipped off and there was unprotected sex for about 10 to 20 seconds (definitely less than a minute), does the risk still remain very low/negligible? Have you ever seen/heard about a medical case getting infected due to brief condom slippage?

H. Hunter Handsfield, MD

12 months ago

Even with entirely unprotected vaginal sex with an HIV infected female partner, the chance of catching the virus is about one in 2,500. With a condom in place most of the time, the risk would be a lot lower than this.

Of course I can't know the policies about sharing test results with the government in your country. However, I very much doubt that negative results are shared -- and since your risk is very low, almost certainly a test would be negative. And HIV/STD testing usually is never recommended after any single exposure unless especially high risk, or if the partner is known to be infected. It doesn't seem to me that it's worth traveling elsewhere to be tested. But that's a decision only you can make.---

12 months ago

Thank you for your assurance. This is the end of the third day since the encounter and I'm not feeling any symptoms. My last question would be: do you think it's wise to resume my sex life as normal, or wait six more weeks and do the blood tests first?

H. Hunter Handsfield, MD

12 months ago

While of course I can make no guarantee, the chance you have HIV is under one in a million. In the 20 years of this and our preceding forum, with thousand of questions about people concerned about a possible HIV exposure, not one has yet reported they tested positive. You won't be the first. If and when it finally happens, it surely will be from a genuinely high risk exposure. If somehow I were in your situation, I would be very comfortable continuing unprotected sex with my wife.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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