[Question #2311] Effictiness of condom

45 months ago
Doctors,

In the early morning hours after a night out I solicited a MTF Transexual escort. We engaged in anal sex, me the top, and used a condom. The condom remained intact, but she pulled it off as soon as I finished and was pulling out of her. Never the less, I saw that my semen was in the condom when she pulled it off. What worries me is that I had a few small cuts on my penis from the last time I had sex with my girlfriend the day before. Not huge open, bleeding cuts but little knicks from friction. All the Saale, they were open wounds, as in I did see blood.

After sex with the escort I noticed them again, one being on the upper third of my shaft. I know it wasn't covered by the condom during sex and I'm really panicking. I am unsure of her status, but assuming she's positive how big of a risk would this be? 
45 months ago
Also, during the intercourse last night she asked me to penetrate her deeply so I was thrusting hard and fully instering my entire penis, so I'm fairly confident the tiny cuts on my penis would have been in contact with her anal secretions. Am I at serious risk? As I stated previously the way I got these cuts was with my long term girlfriend, with whom I don't use condoms. Should I abstain from sex with her after this exposure? 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome to the Forum.  I'll try to provide some information.  Recent papers from the CDC looking at the scientific literature have refined our estimates of risk for different sorts of sex acts.  For insertive anal intercourse, if your partner had HIV, the probability of becoming infected is now estimated to be about 1 infection per every thousand acts of unprotected insertive rectal intercourse (the actual estimate is 11 infections for every 10,000 sex acts).  In the same paper, condom use is estimated to reduce the risk for infection by 99% and the presence of an infectious genital ulcer disease increased the risk of infection about 3-fold.  Non-infectious genital ulcers such as the cuts you describe are not expected to increase risk meaningful.  Putting all of this together, your risk of infection, even if your partner had HIV (and that is unlikely - about 15% of trans-women have HIV), your risk for infection would be less than 1 in more than 30,000.   Whether you test or not is a personal choice.  Your risk for HIV is quite low.

In addition, I would add that for the small cuts/abrasions you describe to heal it would be best to abstain or, at least use lubrication until they have healed. 

I hope this information is helpful. Take care.  EWH
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45 months ago
Thank you, Doctor Hook. I assume you'd advise against PEP in this situation? I will plan to do a 4th generation DUO test at 28 days. Regarding intercourse with my girlfriend until then, would it be safe for me to continue our usual practice? 
45 months ago
Doctor Hook, I'm a bit unclear as to why something like a genital herpes ulcer is likely to cause higher risk whereas the tears I have on my penis would not. I'm now at 28 hours post this experience and I'm panicked about it. I know for sure my urethra was covered, but fairly certain some of the abrasions were not and they looked quite red after this encounter. Is PEP something I should seek? Should I also abstain from sex with my girlfriend? Thank you for your help! 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
I would not recommend PEP in this situation.  You do not know that your partner had HIV and wore a condom during insertive rectal intercourse.  On the basis of this most experts would recommend against PEP.  While I suspect you could find someone who is willing to write the prescription for PEP if you want it, I would not be willing to do so.  Taking PEP can lead to side effects and is costly. 

While you wait for the 28 day time, I would suggest that you need not hesitate to have unprotected sex with your regular partner.

The difference between genital herpes or syphilis and a non-infectious cut or abrasion is that the body responds to the infections be concentrating lymphocytes, the targets of the HIV virus, in the base of the sore.  In contrast, the base of non-infectious cuts and abrasions do not have high concentrations of lymphocytes and thus infection is less of a concern (because their are fewer lymphocyte targets for the HIV).   EWH
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