[Question #1535] Confusion about a Sexual Encounter with CSW

93 months ago

Dear Dr HHH

Here's my story - I had an encounter with a commercial sex worker in Dubai, the escort was a high end one from Iran, 1500 AED, i was a little drunk not much though. She was carrying durex condoms, we had 2 rounds of protected vaginal sex, on the 3rd round of protected vaginal, after i ejaculated i asked her to hold the condom and then i withdrew, on withdrawal i could see the condom to be ok from the top but i hardly saw any semen at the tip. She removed the condom with a tissue, my ocd mind has the following questions:

1. Had the condom failed I am sure she would have noticed and mentioned something?

2. From the top the condom looked ok - is it possible it would have ruptured from the bottom or at the tip?

3. The fact she was carrying durex herself - does that mean anything?

4. Is my OCD spiraling unnecessarily or should i do an HIV DUO after 28 days?

5. My confusion is why was the semen so less or does the amount of ejaculate reduce after 2 rounds in the same night?

6. I am married with a child - can i continue unprotected sex with my wife?

Edward W. Hook M.D.

93 months ago

Welcome to the Forum. Clients on this site are not permitted to request who responds to their questions. All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions. As it happened, today I happened to pick up your question. As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary. I will be addressing this question.

The exposure that you describe was very low risk and not something to worry about. Most CSWs do not have STIs, even when they do, most unprotected exposures do not lead to infection and in your case, your exposure was condom protected and therefore essentially not risk. With that background statement, let me go directly to your questions:

1. Had the condom failed I am sure she would have noticed and mentioned something?

Correct. condom failures are not subtle- when they fail condoms break wide open. She would have noticed and there is no good reason for her not to mention if the condom had failed. Trust that the condom did not fail.

2. From the top the condom looked ok - is it possible it would have ruptured from the bottom or at the tip?

Condoms typically rupture, breaking wide open at the tip of the penis.

3. The fact she was carrying durex herself - does that mean anything?

Yes, it means that she was a professional who took steps to protect herself from her clients, reducing the likelihood that she had an STI of any sort.

4. Is my OCD spiraling unnecessarily or should i do an HIV DUO after 28 days?

There is no medical reason for you to seek HIV testing using a 4th generation HIV test at 28 days. If you need to do this for your own peace of mind, that is, of course, another thing. If you choose to test, please just do it once and commit to believing the test results.

5. My confusion is why was the semen so less or does the amount of ejaculate reduce after 2 rounds in the same night?

With repeated ejaculation, the amount of semen present would be expected to decline.

6. I am married with a child - can i continue unprotected sex with my wife?

I see no reason for you to worry about unprotected sex with your wife. There is almost no realistic chance that you acquired HIV or any other STI from this exposure.

I hope these answers are helpful to you. EWH

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93 months ago

Dear Dr Hook

Thank you for the replies, this has cleared my confusion to a great extent.

I have read several posts on medhelp as well and considering I have ocd for hiv I need to be clear on my behavior going forward.

My questions are as follows:

1. I read posts wherein Dr HHH advised a poster to test every 1 or 2 years even with consistent condom use? Why this recommendation given if the condom is checked always and is intact?

2. Does one need to still test for HIV annually despite using condoms consistently and correctly, even if they dont fail?

Would be happy if you could help me decode this and get more confident about condom use.

Edward W. Hook M.D.

93 months ago

Good follow-up questions. Straight to my replies

1. I read posts wherein Dr HHH advised a poster to test every 1 or 2 years even with consistent condom use? Why this recommendation given if the condom is checked always and is intact?

This question and the one below deal with the same issue. First let me state emphatically that for persons with multiple sexual partners consistent and correct condom use for all acts of intercourse remain the most effective way of preventing STIs. For monogamous persons, sometimes they are put at risk because of their partners' behaviors. Annual check ups may be a bit more frequent than is necessary but they are easy to remember. Further, at the same time, condoms are not quite perfect. On occasion they break (and when they do, it is obvious that this has happened), sometimes people forget to use condoms or assume that they do not need to use them for a sex act, and then finally, on rare occasions for reasons that no one can clearly state, people get STIs despite condom use (I emphasize that this is EXTRAORDINARILY RARE). Most importantly however, both Dr. Handsfield and I believe and endorse the importance of regular check ups for health in general and sexual health in particular. This is an opportunity for persons to interact with health care providers, learn as new knowledge as it emerges, and to validate that they are taking good care of themselves. For all of these reasons, we believe that regular check ups remain a good idea.

2. Does one need to still test for HIV annually despite using condoms consistently and correctly, even if they dont fail?

I hope these comments are helpful to you. EWH

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93 months ago

Last question.

This statement confused me

"on rare occasions for reasons that no one can clearly state, people get STIs despite condom use"

Do you mean the same reasons as condom break or forgetting to use a condom etc?

Or you mean other means of transmission other than condom protected sex?

93 months ago

Honestly Dr that statement has scared me as well.

Pls help me interpret and comprehend it correctly.

Across forums people say condom protected sex means safe sex...a rare occurrence ofdespite hiv infection despite the condom not failing is running shivers in me right now.

Please help me calm my worst fears.

93 months ago

That should have read

"a rare occurrence of hiv infection despite the condom not failing is running shivers in me right now."

Edward W. Hook M.D.

93 months ago

I think you are over thinking this, and perhaps worrying too much. Condom use cannot be studied with direct observation. As a result, studies need to ask participants about how and when they have used condoms. There are VERY RARE cases in which study participants state that they have correctly used condoms all of the time and they have not broken yet they have STIs (most often gonorrhea or chlamydia). What has actually happened in such situations cannot be determined for sure- did the infected person not use a condom and was embarrassed to tell the investigator, did it break and go unnoticed (unlikely), or did it fail for some other, known or unknown reason. One cannot say but fortunately, when studied scientifically these occurrences are VERY, VERY rare. Nothing more to say about this and repeating the question will not change the reply..

As you know, we are limited to three replies per question. this is your third reply from me. Therefore this thread will be closed later today. I hope the comments have helped. EWH

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