[Question #4630] CSW Incident - Appreciate your advice

80 months ago

Hi Dr. Hook, Hansfield and White,

I have a scenario and would appreciate your advice. I met a CSW whose status was unknown. I didn't give much thought to the risks after the incident as it was my first encounter (currently in a monogamous relationship) but am a bit concerned after observing ~8 red pimples on my chest and stomach and some rash symptoms (mainly redness around the pimples) exactly 4 weeks after the incident (no fever or other signs). It’s now 4.5 weeks & I have a slight burning sensation during urination. Pimples have less visible after a week.

We had protected oral, but did not change the condom before proceeding to protected vaginal soon after. After withdrawing, I removed the condom, but am afraid I did not remove the condom in the correct fashion such that the outside of the condom brushed past my penis head, and hence I was exposed to vaginal fluids on the outside..I was holding the condom in my hand and it was brushing against my penis for ~30 seconds.

1) Due to using the same condom for oral just before vaginal, could abrasions on the condom during oral due to her teeth grinding against the condom, have potentially exposed me to fluids when we proceeded to vaginal intercourse? I know few experts have commented the condom would burst as opposed to have micro tears? The condom definitely did not burst open / broken at least upon visually checking after withdrawing.

2) Any HIV or Chlamydia / Gonorrhoea risk from fluids on the outside of the condom touch my penis head briefly (lets say 30 seconds) immediately after withdrawal? I've heard that HIV is hard to contract in this fashion, but keep reading that condoms are much less effective for Chlamydia / Gonn and less exposure is needed to transmit ?

3) Any other risks to worry about? I did have unprotected sex with my partner after and on passing something.

Thank you.

H. Hunter Handsfield, MD

80 months ago

Welcome to the forum. Thanks for your confidence in our services.

There is little or no chance you have HIV. First, it is statistically unlikely your CSW partner has HIV, probably no more than roughly 1 in a thousand. Second, even with entirely unprotected vaginal sex, the average transmission rate, if the female partner is infected, has been calculated at roughly 1 in 2500. Third, oral sex is zero risk or close to it. As for the details of condom use, they probably make little or no difference. Recommondations to not re-use condoms are common sense, but of course there are no data on actual risks, and the amount of genital fluids to which you might have been exposed obviously are much lower than without a condom (and transmission risk for HIV and other STDs is crucially dependent on the amount of exposure -- transmission probably never results from exposure to only a few bacteria or viruses ). In the future, I would recommend you follow the guidelines, i.e. new condoms for sequential exposures -- but no sleep loss in situations like this. Certainly any condom is better than none!

1) Those comments partly address this question. It is generally believed to be true that micro-defects that allow disease transmisssion are an urban myth. And see above about amounts of exposure: even if they existed, probably it would carry little or no risk for HIV or any STD.

2) Again, your condom use greatly lowered any risk, regardless of the details of use. But I don't know where you heard that condoms "are much less effective" for chlamydia and gonorrhea. Not true, highly effective. Indeed, these infections are much more readily transmitted than HIV, but correct condom use still is highly protective.

3) There are no guarantees, and other STDs exist, like syphilis, herpes and HPV. But the risks are low for any one exposure, especially with condom use. It is not possible to have 100% security that you cannot infect your regular partner. However, the risks for all are very low -- low enough that I don't see any medical or risk-based need for you to be tested for anything at all. That said, some anxious persons are more reassured by negative testing than by expert opinion. If that includes you, feel free to have a urine gonorrhea/chlamydia test (valid any time more than 4-5 days after exposure) and blood tests for HIV and syphilis (6 weeks). But if I were you, I would not feel a need to avoid sex at home while waiting to be tested or for the results.

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

HHH, MD

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80 months ago

Thanks a lot Dr. Hansfield. Amazed at your patience in answering similar questions time and time again!

I feel reassured..the only follow up I had was regarding the condom touching my penis head after withdrawing. Would vaginal fluids on the outside potentially exposed me to Chlamydia? Can this virus live for long in air or does transmkssion efficacy reduce like HIV.

I shall get tested for reassurance nonetheless.

Thanks and God bless you

H. Hunter Handsfield, MD

80 months ago

STDs probably are never -- at least very rarely -- transmitted by such fleeting contact. For sure not HIV. They aren't so easily transmitted, unlike colds and inluenza for example; they're not just infections that happen to involve the genital area. The causative bacteria and viruses evolved to requrie much more intimate, prolonged contact. That's why they're STDs. If such brief contact could transmit them, tney would be far more common than they are and transmitted by many other routes than actually happens (towels, shared toilets or bathrooms, locker rooms, etc, etc) (and when you see claims for that kind of transmission, they're always bogus).---

80 months ago

Great. Thank you once again. Have a lovely day and wishing you a Merry Xmas and Happy New Year in advance! No more questions from me!

H. Hunter Handsfield, MD

80 months ago

Thanks for the holiday wishes. Same to you. I'm glad to have been of help.---