[Question #1415] Hiv risk condom slippage

54 months ago
Saw a female CSW of unknown status. received unprotected blowjob deepthroat and performed cunnilingus .  then she got on top of me with condom for some vigorous vaginal coitus .  The problem is that the condom slid up from the base of my penis an inch or two but didn't come off .  I finished in her mouth (deep throat again) . this was 13 days ago.  my urethra was never exposed in her vagina.  is the exposure on the base of my penis an hiv risk?  her vagina was very clean looking. ..
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
Welcome back to the forum.

Congratulations on consistent (I trust) condom use for vaginal (and anal) exposures with CSWs. As you might imagine, there are no scientific data on which to accurately judge risk in this situation. But as a general rule, condom protection is considered reliable as long as the head of the penis and urethra, and the inside of the foreskin in uncircumcised men, are covered. A certain amount of sliding of the penis inside the condom probably is very common -- which, along with direct skin contact above the condom, explains the lesser protection of condoms against skin-to-skin STD transmission (e.g. herpes, syphilis, HPV) than for secretion-transmitted infections (gonorrhea, chlamydia, HIV, etc). In other words, you can assume the base of your penis always is exposed to some extent during condom-protected sex; maybe somewhat more this time, but that's all.

For those reasons, I see no HIV risk here, only for the skin to skin infections, and that risk is always low for any single exposure. Also, from a statistical standpoint, it is unlikely your partner had HIV; in the US, on average fewer than 1% of female sex workers, and probably under 1 in 1,000, have HIV. Syphilis is similarly infrequent, currently a dominant problem (in the US) among gay men. HPV and herpes probably are the main risks, but no higher in this exposure than any other condom protected vaginal sex.

As for unprotected oral sex, that carries clear risks -- relatively low, but still some risk -- for gonorrhea, nongonococcal urethritis (NGU), and herpes due to HSV1, and syphilis if your partner was infected. However, absence of typical symptoms by 13 days (urethral discharge, with or without painful urination; penile blisters/sores) at 13 days is strong evidence you didn't acquire gonorrhea, herpes, or NGU. HIV is rarely if ever transmitted oral to penis, so that's not really an issue. Cunnilingus is nearly zero risk for all STDs.

I hope this has been helpful. Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

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54 months ago
I've had a mild sore throat for days. could that be oral gonorrhea ?  What would the signs and symptoms of that be? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
Gonorrhea can cause a sore throat, but usually does not; >95% of cases are entirely asymptomatic. And as noted above, cunninlugus is very low risk for transmission of any STD, including gonorrhea. The large majority of oral gonorrhea is acquired by people performing oral sex on men -- for which reason throat gonorrhea is primarily a problem only in women and gay men. So it's much more likely your sore throat is a garden variety upper respiratory infection, not gonorrhea or any STD. ---
54 months ago
Last question/ comment:  I'm getting the typical body aches malaise and chills I get when  i have sex outside my marriage.  no fever however.  if you keep my question open I'll report back the results of my tests in 2-3 weeks .  thanks Doc. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
As you probably realize, the consistent timing of such symptoms in this situation strongly suggests a psychological origin, not an infectious one. And no STD would cause those symptoms. You don't say what tests you are contemplating, but I would recommend a urine gonorrhea/chlamydia test (valid any time more than 3-4 days after exposure) and blood tests for HIV and syphilis at 6 weeks. Nothing more.

Normally threads are closed after two follow up comments and replies, but I'll be happy to keep this open until you report these test results.

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