[Question #3895] Condom slippage and STI concerns

33 months ago
Hello,

I have been seeing high-end CSWs about once a month since my previous long term relationship failed last summer. 

I met a CSW last night after work and while having sex with her, a condom slipped off my penis and was inside her. She removed the condom, we got a new one and after maybe 15-20 minutes I notice the condom had slipped off again inside her. For additional context we did perform unprotected oral sex on each other.

I spoke with her about my concerns over STIs and said that she isn't concerned at all and that she gets tested every 3 months. I am a little more circumspect (hence my message). 

So my questions are:

1. Did I have unprotected sex with an escort? 

2. Should I go get tests for STIs and should I see about getting on PReP asap?

3. I know that oral sex is safe sex,  but that true for cunnilingus as well?

I am pretty stressed about the whole situation and frankly I'd love to be in a new monogamous relationship sooner rather than later without any concerns about my sexual history hanging over my head. 

Thanks so for your time and your service.

Best,

Sam

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome back to the Forum.  I'll be glad to comment.  This was a low, but not no risk event.  Condoms do periodicaly slip off during use (about 1% of the time) and it is not clear why this occurs.  From your comments it appears that your condom slipped off during intercourse, rather than as you withdrew and if that is the case, indeed your intercourse was unprotected and you were exposed to any STI that she might have.  Having said, that, your risk for any STI, including HIV is low.  Most CSWs do not have STIs and many do get regular checks as she indicated to you.  Further, even if she had an STI, the risk for infection is low since most exposures do not lead to infection.  For instance, in the unlikely circumstance that she had HIV, your risk for infection would be less than 1 in 1000-2000 per act of intercourse. 

1. Did I have unprotected sex with an escort? 
Yes

2. Should I go get tests for STIs and should I see about getting on PReP asap?
STI testing is reasonable.  Tests can occasionally be negative on the day following sex but testing 2-3 days after your exposure is reasonable.  The fastest way to find out if you were exposed however would be to see if she would be willing to be tested.  This could be done today and would provide you with definitive information.

Seeking post-exposure prophylaxis is a personal choice and, for better or worse you could probably find someone who might be willing to prescribe it for you.  If I were you I would not pursue PEP and I would not recommend it at this time.  It is expensive and there are side effects (mostly gastrointestinal problems)

3. I know that oral sex is safe sex,  but that true for cunnilingus as well?
There at no proven cases in which HIV has been acquired from cunnilingus.  I would not worry about this.

I hope these comments are helpful.  EWH
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33 months ago
Hi Dr. Hook,

Thanks so much for replying promptly.

For a little more context on the condom slippage, I only notice it was of when I completely withdrew, so I'm a little confused if it came off during intercourse or when I was pulling out. 

You mentioned a 1% figure for condom slippage rates,  which makes it surprising to me that this occurred twice during the same event. 

I'll schedule an appointment for an STI check for Monday, but I'm curious as to what STIs would be detectable. Should also schedule a check up a few weeks out?

Thanks, 

Sam
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
I too am surprised that it happened twice.  No good explanation or guess as to what happened however.  If it came off as you exited, then the condom almost certainly came off as you excited.  When condoms come off during sex (as opposed to exiting) the condom winds up deep in the vagina.

On Monday you will get accurate results of tests for chlamydia, gonorrhea,  and if you are tested for it trichamonas.  These are also the most common STIs.  EWH
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33 months ago
Hi Dr. Hook,

Should I look into the 10 panel STI check or just check for the the common ones? 

Let's say that I was negative for what could be detectable on Monday, could I then be relatively confident that I would not pass on an STI to a future partner (I generally get tested twice a year).

Thanks for the additional guidance, I really appreciate your help and directness. 

Best,

Sam
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
I would not bother with the 10 panel check but would suggest you simply be screened for the common ones I mentioned.  Your risk for other STIs on the panel is low and some of them (like syphilis, hepatitis) would not be positive this soon after exposure.

All and all, once you have been screened for the common STIs, I would not worry about infecting future partners and return to your past practices of safe sex and twice yearly screening.  Such a practice will keep you and your partners safe. 

this is my 3rd and therefore, as per Forum guidelines, final response as part of this thread.  The thread will be closed later today without further responses.  Take care.  EWH 
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