Thank you for the incredible service you continue to provide. I just returned to the US from Tokyo and had condom protected sex with a massage therapist over there about 36 hours ago. During sex I don’t recall feeling the condom slip off, feeling bare vagina against my penis or feeling bunched up condom outside of my penis within the vagina. Upon withdrawal at the end, the condom remained in the vagina with its opening slightly sticking out of the vaginal opening. Pooled semen also spilled out of the condom on the bed in a consolidated way. (As opposed to semen mixed with vaginal fluids slowly seeping out of the vagina). The masseuse then removed the condom from her vagina and it looked to be in an elongated shape not bunched up. Based on prior forum post I am to believe this is condom remaining within the vagina upon withdrawal not condom coming off during sex. I believe protection was complete. Also my partner attested to being tested negative for full STD panel including HIV on December 6. I also believe that HIV rates in Japanese women including SW is very very low. Is that correct? Based on review of prior forum posts and my own healthcare career I am to believe HIV testing is not medically warranted based on this event alone. But I am hoping for your expert feedback. Once again, thank you.

Welcome back to the forum. I logged in a few minutes after you posted this:  most users should not expect nearly real time replies!---

Thank you so much Dr. Handsfield. I tested for HIV, syphilis, gonorrhea and chlamydia a couple months ago but I did end up testing again for HIV a couple weeks ago. This has been the only encounter of vaginal sex since then. Maybe I should wait for a three or four more encounters, if they happen to occur before testing again? Would this be a reasonable way to approach it? Once again, thank you.

Yes, that's a very reasonable plan. In view of the low HIV/STI risk given your sexual lifestyle, testing after every several exposures or on a regular time schedule (e.g. every 6-12 months) makes a lot more sense than testing after every exposure. ---