[Question #1603] Extremely worried After looking at 2 articles from a Known Source

44 months ago
Dear Drs

I am a circumsized male and sexually active, I plan to remain that way with correct and consistent condom use to prevent HIV 100% without a doubt in my mind.

But these two Scientific Abstracts from this known site https://www.ncbi.nlm.nih.gov has got me worried to the extent that my entire confidence on protected sex and latex condom is shattered - I m even wondering if one should even be sexually active at all - if size of the HIV virus leaks through a latex condom and transmission would occur?

Please Please Please explain to me if these articles or data is old and not correct or something that I have understood incorrectly.

Article No 1 - 

Article No 2 - 

Please note that I have done loads and loads of reading on medhelp and thebody.com and I was 200 % confident about condom use and being HIV free until I read these 2 abstracts.

Please advise on how should I approach my sex life going forward considering there could be encounters with CSWs as well ocassionally?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome back to the forum. I reviewed your previous discussion with Dr. Hook and am sorry to see your self-professed OCD has continued to create the doubts it has.

The studies you quote address the theoretical possibility of viral particles penetrating latex or other barriers. The results actually are very reassuring:  the first cites reduced viral transmission of "4 orders of magnitude". That means 4 logs, or 10,000 fold reduction. These results don't mean that there is actual leakage of HIV through latex during real-world use for vaginal or anal intercourse. So I can't tell why these results have upset you. You seem to have searched for information designed to prove that condoms really aren't so great for HIV prevention. What's the point?

But these are exactly the wrong kinds of studies for you to hang your hat on. Your risk of HIV was extremely low even without a condom. First, it is unlikely any particular female sex worker in Dubai has HIV, for sure under 1% chance and probably more like 1 in 1,000 (according to experts at the main Dubai STD clinic). When a woman has HIV, the average transmission risk to a male partner, without condom, is around 1 chance in 2,000 (according to data published by the US Centers for Disease Control and Prevention, the CDC). So with 3 exposures, your risk for HIV -- WITHOUT condom -- was a maximum of 0.01 x 0.0005 x 3 = 0.000015. That's one chance in 67,000. If we now assume condoms are "only" 1% effective in preventing HPV (it's better than that), your risk becomes roughly one chance in 7 million. It's actually lower than this, because I used conservative rates for both the chance your partner had HIV and for condom effectiveness. For practical purposes, you can consider this a zero risk exposure for HIV. (You might also re-read your other thread, including careful concentration on all of Dr. Hook's resplies.)

I have no additional advice about your sex life going forward, beyond what Dr. Hook said. It is not possible to pursue the sexual lifestyle you plan and have zero STD/HIV risk, but you can limit the risk by selecting partners wisely (for example, expensive escorts are lower risk than street walker, bar pick-ups, or brothel workers). And of course use condoms consistently for sex with new or potentially high risk exposures, such as CSWs. Accept there is still a chance of catching one or more STDs, especially those transmitted skin to skin like herpes, HPV, and syphilis. The risk of HIV and other STDs transmitted by fluids (e.g., gonorrhea, chlamydia)  will be very low but not zero, because of the possibility of unrecognized condom failures or mistakes in their use. As you already know, I would also recommend you have routine STD/HIV testing from time to time, like once a year.

I also strongly recommend you stop searching this stuff online. Like many anxious or OCD persons, you are selectively seeing information that inflames your fears and missing the reassuring information that also is available. It isn't worth the effort.

I hope this information is helpful. Let me know if anything isn't clear.

Regards--  HHH, MD
44 months ago
Wow....I am gonna bookmark this reply.

I have read thousands of your posts and the way you explain things its just fascinating.

This search online true is OCD driven but with so much of fuzzy info about condom efficacy, thoughts started spiralling.

While I have understood most of the calculations. I apologise if my questions may sound OCD driven but I do have some followup questions to get this topic clear in my head once and for all :

1. Your recommendation for annual testing for Hiv/ STD is only incase of any condom failure or exposures that include no condom usage? Have I understood this correctly? If condom has been intact and if I carefully and mindfully observe after every act -  I should have no HIV worries right or the need to test?

2. Another doubt that occurred to me was about how stringent and particular are condom manufactures not just in the US but other parts of the world before they dispatch condoms for public use? My worry was in terms of condoms leaving the factory with microscopic holes, bad quality latex, or improper quality control? Considering they are medical devices is it safe to assume that they are carefully checked and manufactured the same way as prescription drugs are?

Thank you for your time and being there to educate non experts like myself.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
1) The question answered by Dr. Hook indicated you have seen my recommendation on this previously. Nothing has changed, and it is the universal recommendation of all sexual health experts. You should still be tested from time to time even if you are confident there have been no mistakes and no condoms apparently failed. Could you get away without testing? Probably. I'm sure a compulsive observer, as you undoubtedly are, is less likely to misuse or miss a condom rupture than the average joe. But that's the recommendation and why wouldn't you want to follow it? This isn't worth ruminating about! 

2) Condoms indeed are regulated as "Class II" devices (I haven't a clue what that actually means), and the FDA has standards for condom manufacture, but I have no idea how carefully they are followed or monitored by FDA.  Big name condom manufacterers (Trojan, Durex, etc) claim their manufacturing standards are high and it is logical to assume that some no-name competitors may cut corners, and I am unaware of any objective data on frequency of breakage etc by different manufacturers. On balance, it makes sense to me to stick with known brands and avoid generic, anonymous, or low cost condoms. That said, any condom is better than none (including natural membrane condoms, by the way). The overall risk and the worldwide frequency of sexually transmitted HIV and other STDs is not likely to be materially affected by any of this.

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