[Question #2604] Condom slipped off risk of HIV and STDs

96 months ago

3 days ago, I had protected intercourse with an escort. As I pulled out, the condom was no longer on me but fully inside of her. She pulled it out and semen was inside of it. She told me that she had only started escorting again (after a 3 year break) six months ago, always uses a condom and last tested six months ago with clean results. She was kind enough to offer to email me her results either today or tomorrow. Nevertheless, due to my own guilt, I find that I am worried about STDs and HIV. Should I be concerned about HIV? I am uncircumcised. Also, within 2 hours of having sex with her, I took 2 grams of Azithromycin. I know I shouldn't self-medicate but, do I need to wait 7 days after taking the Azithromycin to resume unprotected sex with my wife? I live in Oregon, not in Portland, if this matters and the escort is not an IV drug user and on the high-end side.

H. Hunter Handsfield, MD

96 months ago

Welcome to the forum. Thanks for your question.

It's fairly common for a condom to remain in the vagina when the penis withdraws. It's considered to still be safe sex. In general, escorts (expensive female sex workers by appointment) are though to be at low risk for STDs, especially HIV. After all, they tend to have low risk clients -- men like you! Further, it sounds like your partner is wise, understands the risks of her profession, and is careful about protecting herself. And I think your own statement ("my own guilt") is important: don't confuse regret or anxiety over a sexual decision you regret with infection risks from that decision. They aren't the same. I would have recommended against taking azithromycin, but in any case it has further protected you against gonorrhea, chlamydia, and syphilis.

If I were somehow in your situation, I would not stop having sex with my wife at all. In any case, the effect of azithromycin is fast: if you had acquired gonorrhea, chlamydia or syphilis, at three days they are no longer infectious.

All in all, I really wouldn't worry further about this. I don't recommend any testing.

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

HHH, MD

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96 months ago

You assessment and advice is crystal clear. Thanks very much for this service that you do! Sadly, the internet is scary with overly conservative folks that as soon as they hear escort and condom slippage, they immediately defer to testing. In other words, they rely on possibility without evaluation of probability. Thanks for giving me the rubber (pun intended) meets the road information I needed. You have placed my mind at ease and I greatly appreciate you!

H. Hunter Handsfield, MD

96 months ago

You're exactly right that many (most? nearly all?) internet advice resources about HIV/STD risk make little or no distinction between theoretically possible risks and real-world ones. You can reduce the chance of misleading advice by sticking with professional sites (academic, public health agencies, etc). However, even there the advice almost always is consertative. People like you, i.e. highly worried about a particular exposure, are a small minority of people who might be tested. The large majority of people at risk don't think about it much, i.e. are less concerned than they should be given their sexual or drug using lifestyles. Having a low threshold for testing is designed in large part to convince such persons they should be tested, even though this approach sacrifices accuracy and can enhance anxiety for people at lower risk.

Thanks for the thanks about our services. I'm glad to have helped.

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