[Question #3049] Condom slip need reassurance

42 months ago
Hello Dr. Handsfield,

11 days ago i made the mistake of  going to a strip club in Connecticut and having brief vaginal intercourse with one of the dancers. We used a condom it only lasted 2 minutes at most but when I withdrew the condom stayed in. I did not see if it was hanging out or not but she didn’t seem to have trouble removing and and didn’t seem overly concerned. Two days after i was tested for clymidia and gonnorea both came back negative.  now for my questions

1. What are my chances of contracting anything in this brief one time partially protected exposure (hiv, syphillis, herpes, etc)

2. Knowing what you know, should i refrain  from having sex with my wife 

3. Do you recommend testing from this one time exposure 

Thank you and good day. I appreciate all the info
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome tot he forum. Thanks for your confidence in our services.

It's fairly common for the penis to withdraw from the condom, leaving it behind in the vagina -- probably usually when withdrawal is delayed until erection is substantially lost. All experts agree that such exposures still should be considered protected; the exposure to vaginal fluids during such witihdrawal probably is minimal. Of course this has not been studied, but to my knowledge I've not seen any patients who appeared to have acquired any STD in this circumcstance. And your negative gonorrhea and chlamydia tests are reassuring.

1) Even with no condom at all, the risk of these infections is low from any single exposure. HIV, HSV, and syphilis are inefficiently transmitted, i.e. most exposure don't result in treansmission. For HIV and HSV, it's probably on the order of once for every 1,000-2,000 exposures. Syphilis is probably more likely, but syphilis is very rare in partners like yours -- most cases in the US are in men who have sex with other men. And HIV also is rare in such partners. Herpes is more common, but still it is probable your partner wasn't infected. Finally, having gone 11 days without symptoms is reassuring with regard to herpes and syphilis.

2) If somehow I were in your circumstance, I would continue unprotected sex with my wife without worry. The risk you are infected, and the chance you could infect her, are not zero -- but they are low enough to take the chance, in my view.

3) Testing is optional for the same reasons. However, since you're worried enough to come to the forum with these concerns, I recommend you be tested for syphilis and HIV 6 weeks after the exposure. No matter how expert the advice based on probability and statistics, many men in your situation will continue to worry and will gain additional reassurance from negative testing. However, I would not test for HSV. The tests are not sufficiently reliable, and the chance of false or misleading results is higher than the chance you were infected. And if someday you or your wife turn out to have genital herpes, there will be no way or reason to attribute it to any particular exposure; it would be equally likely from some distant past exposure before you and your wife were a couple. (Same for HPV, by the way.)

I hope these comments are helpful. Let me know if anything isn't clear.