[Question #3135] Vaginal fluid / anal fingering

37 months ago
Dear Doctors 
I am a 30 year old male.
I recently had an encounter with a csw and I am worried about a potential exposure to HIV . We had protected vaginal intercourse for a while. As I was unable to ejaculate, we stopped and she took the condom off and started to masturbate me. 

Meanwhile - and that's what worries me - she inserted her finger in my anus with the same condom we just used for vaginal penetration. I am scared about being exposed to hiv given her body fluids (vaginal secretion or menstrual blood - I don't know) entered my anus.

I don't know her status but to what extent do you believe HIV could be transmitted this way?

Many thanks for your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome to the Forum.  I will be glad to comment.  As you might imagine, there are no scientific studies to base my answer on so we will have to rely upon logic  and extrapolation of what has been proven.  Before I go into my thinking, let me first provide you with my conclusion- this was a very low, close to no risk exposure.  Nonetheless, using an abundance of caution, you may wish to test for rectal STIs (gonorrhea and chlamydia) as well as HIV at the appropriate times (see below).  Having said that, i would be incredulous of you turned out to have been infected.  Here are the facts:

1.  Most commercial sex workers do not have STIs.  In general they tend to be good at protecting themselves.
2.  Most exposures to infected partners do not lead to infection.  The likelihood of infection following a single, UNPROTECTED exposure varies from organism to organism.  Had to been the receptive partner in rectal intercourse with an infected partner your risk for gonorrhea would be would be about 20% (1 in five) if your partner had gonorrhea and less than 1 in 100 (less than 1%) if your partner had untreated HIV.
3.  In the unlikely situation that your partner was infected, your exposure was lower risk than the figures noted above.  The organisms that cause STIs (including HIV) are fragile and become non-infectious almost immediately on exposure to the air and room temperature.  Since the used condom was exposed to air and room temperature, if organisms were there, they most likely would have become non-infectious before the condom was re-inserted into your rectum.  This possibility is purely theoretical and I suspect the event was no risk.
4.  There is no risk for infection form your initial vaginal exposure since the condom was on.  There is a slight possibility that her secretions were carried into your rectum on the used condom on her finger.  Even so, as noted above, any organisms present would have been non-infectious.

My advice.  Personally, I would not be worried about the events you describe but if you wish to test, you could have a rectal test for gonorrhea and chlamydia performed any time more than 3 days after exposure.  An HIV blood test with a combined HIV antigen/antibody test would provide conclusive results at  6 weeks (42 days).  Should you choose to test, I am confident you will find that you were not infected.  I hope this information is helpful.  EWH