[Question #1828] Infectious Secretion

42 months ago

Dear Doctors Handsfield and Hook,


I have already read your helpful posts on Medhelp, however I would like to have an assessment of my specific situation. Recently I visited a brothel in Melbourne (Australia) and engaged the services of an Asian sex worker.


These services consisted of oral sex and then vaginal sex- both acts were protected with a condom. However prior to putting the condom on, the CSW applied some kind of substance on my penis. This is what has gotten me worried. 


I can’t remember what that substance was. If it was lubricant, then I am almost certainly safe. However it may also have been some kind of infected secretion, like if she had dug fluids out of her vagina and applied it to my penis. I know from your previous posts, that there has never been HIV transmission from hand-genital contact, even if infected fluid were used as lubricant. What concerns me is that if it was infected fluid, straight after applying it to my penis she rolled a condom on. The condom would have sealed the infected fluid to the surface of the penis, and I am worried that this has heightened the risks involved.


So my questions are:


(1) What is my risk for HIV infection based on these facts?


(2) I have read from your posts and the general literature that HIV is inactivated quickly after being exposed to air and the external environment. I am hoping this rendered the secretion non-infectious, but given that a condom was rolled over it immediately afterwards, I am worried that this might have protected the HIV from such exposure? 



Objectively speaking, I probably shouldn't be too worried. But on an emotional level I am quite terrified, given how difficult being HIV-positive still is.

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Welcome to our Forum and thanks for your confidence in our advice.  I would assess the events you describe as being no risk for infection,  If you went to a licensed brothel in Melbourne your partner would have been checked on a regular basis for HIV and STIs- this is part of the procedure for licensing.  Even if the brothel was not licensed, the events would still be no risk, in part for the reason that you describe.  CSWs regularly use lubricants in the course of their sexual activities and this was most likely what occurred for you.   It is difficult to imagine why a CSW would intentionally infect anyone, not to mention that such a practice would be quite bad for business.  That said, answers to your specific questions are below:

1.  As above, I would assess this to be a no risk event.  Even in the extraordinarily unlikely event that your partner had applied infectious genital secretions to your penis before applying the condom, any HIV present would have been non-infectious and you would not be at risk.

2.  Please see above.

I hope these comments are helpful.  I really see no medical reason for concern or for testing.   EWH

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42 months ago
Thanks for your careful consideration Dr Hook,

(1) Could you comment specifically on the condom being rolled on straight after potentially infectious secretions were applied to the penis? This seems to distinguish my circumstances from ordinary cases of hand-genital contact that have given rise to often heard reassurances. After all the condom would have created a seal and limited further exposure to the external environment and air. 

(2) I am also curious on how, historically, blood transfusions led to HIV transmission. I would imagine the virus, though being protected from air exposure, would be subject to other environmental threats like temperature that would kill it?




Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
1.  There is nothing more to say about you supposed situation in which material was applied under the condon.  There are no scientific data to inform this unlikely circumstance.   Further, the exposure to air and deactivation on the virus would occur during the transfer on a partner's hand. This is not marination.

2.  Transfused blood is combined with materials specifically designed to keep blood cells viable.  This system would also preserve the viability of the virus.  EWH
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42 months ago


Dear Dr Hook,


Thank you for clarifying the point about air exposure. Given my limited background in the area, I didn’t realise that even a second of exposure to the external environment would be sufficient to generate permanent change to the state of viruses.


Shortly after your response, I had the pleasure of visiting the Melbourne Sexual Health Centre. Their services are offered free of charge to all citizens and permanent residents. They are well resourced, staffed by caring people, and also offer counselling in addition to medical services. A substantial proportion of the city’s CSW attend MSHC on a quarterly basis for STI checks to obtain the certificate to keep working. According to statistics recorded by the MSHC, in a two year period from 2011-2013, out of ~3500 CSW STI checks, not a single one tested positive for HIV. Long term staff there have told me that they do not know of any visiting CSW who tested HIV-positive. 


I explained my facts to the nurses and they too commented on the very low risk. However my style is not to be persuaded by probabilities, but to prepare for a situation so long as it is possible. I became distressed contemplating life being HIV positive, though some aspects have markedly improved, there is still the social stigma, and potentially ruined careers and aspirations. What really disturbed me was reading studies showing ~50% of HIV positives having some form of cognitive impairment. However these studies appear to arise out of dysfunctional health care systems and limited treatment coverage. In Australia where we have early diagnosis, outstanding healthcare (including fully subsidised ART), I would expect those statistics to be much better.


I am due for a 6 week HIV test at MSHC next month, and hope to be pleased with the result. If the statistically improbable does happen, then I hope that early treatment and outstanding specialists will still allow me to have a nice life and successful career. One positive thing coming out of this dreadful episode has been my newfound admiration for Australia’s remarkable success in regulating sex work and managing STIs amongst its population.





Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Thanks for reporting back.  As you have found out, the Melbourne Sexual Health Center is a wonderful resource providing wonderful sexual health care for all who desire it.  I think you are over-stating and over-reacting with respect to the consequences of HIV infection for infected persons (and based on your reports, you will not become one related to the recent encounters you have described) .  This sort of mis-perception is out of date in the modern era of anti-retroviral therapy and reflects social misperceptions that are evolving to a more accurate reflection of the fact that persons with HIV who hare being appropriately treated act and function entirely normal, living an essentially normal lifespan.  I hope that you will join the forces in correcting the misperceptions that you mention.  I remain confident that your tests will prove (and hopefully, you will accept the results) that you were not infected with HIV. 

This is the final comment made as part of this thread which will be closed later today.  I wish you well.  EWH .

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