Dear Doctors, 

I'm a male (heterosexual) in his late 30s who is experiencing some dilemmas due to conflicted information on the safety of some sexual activities. I should start saying that outside my committed relation I would never seek any sexual practice that holds potential risks. But then the question would be: is there such a thing as 100% safety engaging in sex that is condom protected? I'll try to be more specific though. 

A few days ago I went to an asian massage parlor and as one thing led to another, the girl wanted to engage in sexual intercourse. She seemed very clean but I decided in that moment to refuse to have sex with her. Afterwards I started regretting this, although I knew I may have also regretted (or felt VERY anxious) if I had fully pursued my sexual instincts. There is a part of me that was telling me I was an idiot not to pursue my desire for this girl, and another part of me that was also telling me "what would have been the risk to have a condom-protected intercourse with her, after all?" 

1) If the condom doesn't break, is there a way viruses (especially HIV) can pass through the Latex material?

2) If the non-covered part of the penis does not come to contact with her vagina, is there still risk of (skin-to-skin) STDs?

3) Had I engaged in condom-protected vaginal sex, would I still have to be worried about having caught any STD as a result, with consequent need for testing?

As you can see, I'm very anxious to do something that would put me in a risky situation OR that should require any sort of testing afterwards. I'd like to do things in the safest way so that I can put any fear aside.  

Thank you for any clarifications about this and I appreciate the way you educate people through this website. 

Alex

Welcome to the Forum.  At present your questions appear to be theoretical and I will be happy to answer them.  Before I do however, I must comment that while some sex acts such as mutual masturbation are truly "safe" and are not associated with any risk for STI, other "safe" sex acts such as condom protected sex are only safe as long as the condom is used throughout the encounter and should the condom break, the act is no longer safe.  Thus there are grades of risk.  Further, all assessment of risk is statistical in nature, and all estimates of what is "safe" are just data-based estimates to which an exception could occur tomorrow.  I hope this perspective is helpful to you as you move forward with your decision making.

1) If the condom doesn't break, is there a way viruses (especially HIV) can pass through the Latex material?

No, viruses, including HIV and hepatitis do not pass through the latex or polyurethane that condoms are made from.

2) If the non-covered part of the penis does not come to contact with her vagina, is there still risk of (skin-to-skin) STDs?

There is a theoretical risk that if the non-condom portion of the penis skin comes in contact with a partner's infectious site, transmission might occur.  This is very rare but the possibility does exist and this can, rarely, occur.  STIs which might be transmitted in this way include, in their likelihood of occurring, HPV-genital warts, herpes, and syphilis.

3) Had I engaged in condom-protected vaginal sex, would I still have to be worried about having caught any STD as a result, with consequent need for testing?

If you had engaged in condom-protected sex your risk for STI and HIV, in general would be very, very low (I would guess certainly less than 1 in 100,000 and probably lower) but not zero.  Thus infection might be possible (just as you might be struck by lightening today) but the risk would be so loew that I would not necessarily recommend testing and would consider such an exposure essentially no risk.

I hope these facts and comments are helpful.  EWH

Skin to skin contact rather than genital secretions appears o be the major method by which HPV, genital herpes and syphilis are transmitted. The rubbing/abrasion that accompanies most sexual activity is thought to enhance transmission but it is the direct contact that is most important.

Women can have syphilis lesions inside the vagina as well as on the outside.  Since the sores of syphilis are painless, such sores could be a source of infection during unprotected, but not condom protected intercourse.

the reason that picking up an undiscriminating woman at a bar may be a higher risk exposure than having sex with a CSW is that CSWs tend to be aware to their risks and have a business interest which makes avoiding infection a good idea.  On the other hand, a "pick up" may not take such care to be checked or to prevent infection.  EWH.