I had following exposure with CSW:

She rubbed my penis with her bare hands for few seconds, then put on a condom on me.

I inserted my penis inside her and had intercourse for less than a minute. During intercourse, I kissed her nipples 3-4 times.

She took off the condom after sex, and it looked intact, the semen seemed to be inside the condom.

I am planning to go back tomorrow and talk to her. In your opinion, what is my risk for HIV and other STDs from this exposure?

Drs.,

Thank you so much,

I see no reason for worry. It seems most likely the apparent pubic hairs were your own. I cannot envision a mechanism through which they could get inside a condom after it was placed, and therefore they must have gotten there through hand-genital contact before the condom was placed -- and hand genital contact (including fingering) doesn't transmit STDs. So even if the sex worker says she has HIV or any other transmissible STD (which is unlikely, since at any particular most sex workers are not infected), I would judge this is a a zero risk exposure, or trivial risk at most.

So I don't recommend any testing unless you develop typical STD symtpoms in the next 2-3 weeks (penile discharge, painful urination, penile blisters/sores. Of course you are free to be tested if the anticipated negative results will further reassure you. If you decide to be tested, I would recommend a urine gonorrhea/chlamydia test, which is valid any time more than 4-5 days after exposure, and a syphilis and HIV 4th generation test after 6 weeks. But if somehow I were personally in your situation, I would not be tested.

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

HHH, MD

1. I'm not aware of studies of condom breakage, although I imagine such research has been done. Anyway, commen sense and patient stories in my clinic suggest that almost all condom failures involve wide open rupture that would be hard to miss. (Just thin of any elastic material, under tensions and stretched thin, such as an inflated balloon. When you damage it, you don't jget a just a small defect.) Also, the notion of microscopic leaks that could allow disease transmission also is mostly (If not entirely) an urban myth:  I doubt anyone has ever been infected because of such problems and consider after-sex "water testing" of condoms to be a waste of time.

2. Good question and an important one. The brief answer is yes, you're exactly right. For infection to take, HSV typically must be massaged into the exposed tissues; simple superficial contact with a susceptible tissue is lower risk, perhaps zero in most circumstances. In animals used for lab studies, e.g. guinea pigs, it's difficult to get infection to take unless the skin is actually damaged to the point of redness or even slight bleeding. In patients with herpes, this fits with the common observation that initial herpes lesions usually appear only at the sites of maximum friction during sex:  vaginal or anal opening, or labia minor; the head or shaft of the penis; etc. We rarely see initial herpes outbreaks involving the groin, scrotum, and so on. As you obviously already know, this is quite different for recurrent herpes outbreaks, which can occur in any area served by the same sensory nerves that supplied the initially exposed site(s) -- explaining the "boxer shorts" concept.

That concludes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helfpul. I also hope you'll just drop all this business and not waste your money on the planned STD tests and urinalysis.