[Question #3281] risk assessment, exposure with escort

39 months ago
Dear Dr.,

I met an escort last 30th November in Las Vegas, she is hispanic 25 years old.
She came into my hotel room and she practiced protected oral on me (5/10 mins), and then protected vaginal (roughly 30 seconds as I lost interest). Before applying the condom she put a tiny bit of body lotion (the one given in the hotel) in the inner of the condom. So we did both oral and vaginal with the same condom. I read that oil lube can weaken latex, this scared me and I got tested:

- after 2.5 weeks for Chlamydia and Gonhorrea, both negative
- after 4.5 weeks (32 days)
Syphilis IgG/IgM by EIA Negative
Hep B surface Ag (HBsAg) Negative
Hep.C Ab ELISA ( 3rd Gen ) Not Detected
Hep.C Core Antigen <3.0 fmol/L HCV Not Detected
HIV 1/2 Abs/P24 Ag screen Not Detected

1. As I withdrew (no slippage) after the 30 seconds exposure, as I was losing the erection, I didn't notice anything that would make me think the condom had been compromised. I didn't check in detail but I remember masturbating afterwards with condom still on and didn't notice anything odd, also removed it from the tip and it came out with no problem (i.e. not splitting). Did I have a risk / missed a broken condom?
2. would you have recommended testing in first instance given the above circumstances?
3. are my tests accurate enough to rule out hiv/hep b /hep c? if not would you recommend testing again
4. can I stop worrying and resume unprotected sex with my wife? I just want to leave this behind me.
Thank you for your expert opinion.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your question.

"Escort" generally means a higher cost female sex worker, by appointment -- as contrasted with brothel workers, bar pickups, etc. Escorts generally are believed to be safe partners, with low risk for all or most STDs. Typically they know the score, use condoms for vaginal or anal sex, get tested frequenty, and generally have low risk partners (men like you). So most likely you weren't exposed, and most experts would not have recommended all the tests you had. Still, it was wise to use a condom (congratulations) for the vaginal exposure.

Oil based lubricants can weaken condoms so they break more easily, but they do not cause leaking through intact latex. Since the condom didn't break wide open, you were protected. And oral sex, even unprotected, is low risk for all STDs and zero risk for some, including HIV and hepatitis B and C. (Hepatitis C should not be considered an STD in heterosexuals. For sure zero risk there, even if she had it and even if you hadn't used a condom. The only proved hep C sexual transmission scenario is in men having potentially traumatic anal sex with other men.)

So all that information should be pretty reassuring. To your specific questions:

1) You would have noticed a ruptured condom. They're hard to miss. This sounds like a well protected exposure.

2) No, I would not have recommended testing, for the reasons above.

3) All your tests are reliable, except the hep B and C tests were a little early, probably around 90-95% reliable; 6 weeks usually is recommended for 100% reliability. However, the risks for both these viruses was zero for all practical purposes, so you don't need any further tests.

4) Yes, you can stop worrying and safely resume unprotected sex at home.

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

39 months ago
Dear Dr. Handsfield,

thank you very much for your prompt and exhaustive answer.

So to conclude, am I correct in assuming that the condom cannot tear a little (I am not referring to the microscopic holes theories), but would fail dramatically/structurally and I would have noticed such event unambiguously?

Thank you in advance for your input. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Of course there are no data on something like this. But it seems to me any break large enough to be a risk would be noticed. And anyway, you have all those negative tests. Since they prove you were not infected, the level of risk when the exposure doesn't matter any more. Whatever it was at the time, you weren't infected. Believe it and do your best to move on without worry.

39 months ago
Thank you very much Dr. Handsfield.

I'll consume my last question and I promise I'll let it go.

When you say "the risks for both these (hepb - hepc) viruses was zero for all practical purposes" is it because of the nature of the exposure or because of the test results? or a combination of the two?

Overall I feel much more relaxed now, and I found this exchange very useful. Thank you very much again for providing this invaluable service to the community.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Hepatitis C is never heterosexually transmitted, or so rarely that it should not be considered an STD at all. The 20 year spouses of HCV infected persons have no higher rate of infection themselves than the average in the population, unless they have other risks like shared drug equipment. It simply isn't transmitted by vaginal or oral sex; tHe only proved sexual transmission for HCV is in men who have potentially traumatic anal sex practices with other men. And hep B is simply very rare in this situation:  among other things, most 25 yo Latinas probably have been vaccinated. And also because of the condom, and no risk from oral sex.

Thanks for th thanks. I'm glad to have helped. Take care and stay safe.