[Question #2496] Risk assessment and opinion

45 months ago
I had an encounter with a CSW 54 days back in Budapest. I think I should be describing every single details so as to not miss anything. It was a protected encounter. She came with condoms. Put it on my penis. Proceeded for oral sex. We then had vaginal sex in 2 different positions with the same condom on. Once we were done I had a look on my penis, condom looked intact without any visible wear or tear. Rolled it back and disposed it using a tissue. I asked her twice if she was free of stds, she said she was free. 
After about 28 days, I developed high fever around 102, with a back ache and a dry cough, and to a doctor , he said its LRTI and put me on antibiotics. I observed that few of my relatives too developed the same type of fever and fell sick one or 2 days later.  The fever subsided within 3- 4 days. On 29th day I developed something similar to balanitis, which went away after doctor prescribed vitamin tabs. I should add, after the intercourse I am filled with guilt and anxiety, I paid very less attention to cleaning my genitals given the fact that i'm an uncircumcised male. I have also developed jocks itch near my inner thighs. 
The cough I spoke about still disturbs me from time to time, nothing chronic but it is still there.
I'm sorry if I have overloaded you wit information.  I want to known if my encounter was safe and I can move on? Or do I need a testing, given the fact it was my first sexual encounter. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome to our Forum. Let me congratulate you in practicing safe sex for your first sexual encounter.  These practices will keep you safe.   I'm pleased to tell you that there was close to no risk for HIV or any STI from the encounter.  Condoms are the most effective way to avoid STIs when having sex with a potentially risky sex partner.  When one considers that most people, even most CSWs do not have HIV or STIs, that most single exposures to infected partners do not lead to infection, and that condoms are highly effective for preventing infection, there is no need for concern and not need for testing related to this exposure.

I should add that genital cleansing after sex is not needed and does not reduce STI risk.  Further, when condoms appear intact following sex, they are.  When condoms fail, they break wide open leaving no doubt that they failed.  

I hope these comments are helpful and reassuring to you.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
I should add that while your flu-like illness about a month afterwards may worry you, the symptoms you describe are not concerning for an STI or HIV and, as your doctor told you are far more likely to be the respiratory tract infection your doctor mentioned when you saw him or her.  EWH---
45 months ago
Thank you doctor. 
You're right,I got worried because of the LRTI but observed that my relatives too got infected around the same time and we were travelling extensively then. I've read elsewhere that hiv symptoms aren't contagious. 
You were also right assessing my fear about the condom break/ leak. A few websites out there says condoms aren't 100% protective. I guess it has more to do with human error.
45 months ago
Doctor, I forgot to add that I had developed a mouth ulcer around the same time. 1 or 2 days after I started taking antibiotics. 
It went away after 14 days. 
Sorry.for missing this piece of information.
Thank You.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
A mouth ulcer does not raise concern about STI.  As I understand it, your mouth was not exposed to her genitalia and there is no risk of HIV or other STI from kissing.  No change in my assessment or advice.  EWH
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45 months ago
Thank you doctor. 
My final question to you is regarding condoms. Please do answer them.
Should I change condoms for each act? 
Also, why do people say condoms are not 100% effective? Is it due to human error? Or manufacturing error? Is there any way to know if they condom would protect you before having sex? Or is it only following sex or halfway through it you realise it's failed/failing? 
Looking forward for a reply.

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Certainly.
Should I change condoms for each act? 
It is advised to change condoms following each sex act because friction and pressures which may occur during sex can increase the risk for condom breakage.  Some commercial sex workers will use the same condom for oral sex followed by vaginal sex but changing the condom between acts is what is advised.

Also, why do people say condoms are not 100% effective? Is it due to human error? Or manufacturing error?
The effectiveness of condoms is hard to study as it would be difficult to conduct large studies where sexual activity with condoms was directly observed.  As a result, these studies rely on self report and it is always possible that, out of embarrassment, study participants may state that they used condoms when they did not.  In addition, careful studies have shown that people sometimes use condoms incorrectly, starting to have penetrative sex before they put on a condom- condoms do not work well in these situations.  Finally, condoms do clearly break sometimes- typically about 1% of the time they are used. 

Is there any way to know if they condom would protect you before having sex? Or is it only following sex or halfway through it you realise it's failed/failing?
There is no way to be sure a condom will not break.  Breakage increases with rough sex and statistically is slightly increased with new partners.  On some occasions people are aware of breakage during sex when it occurs, in other situations it is overlooked. 

I hope these answers are helpful.  As you probably know, our Forum guidelines call for up to three replies per question.  This is your third reply.  Therefore this thread will be closed in a few hours and if there are new, further questions, you will need to start a new question.  EWH
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