[Question #539] Sanity check

44 months ago
It's great to see you on this site answering questions. I am very familiar with your work from medhelp and was sad to see they shut down the expert forums. So I am happy to see you guys on this site now.  I am asking these questions because I know literature constantly gets updated and I wanted to hear the latest on these subjects from the experts, in case any thing has changed.

1) With condom protected vaginal sex, is the consensus still that as long as the condom stays on and doesn't break, there is no risk for fluid transmitted disease (particularly HIV)?  Are there an proven cases of HIV transmission from protected vaginal sex without evidence of condom failure? Though I am not an HIV/STI expert, I am of scientific background and I can't conceivably imagine how one could become infected with HIV or even chlamydia, if the male urethra stays covered during the entire act of intercourse.

2) With unprotected oral sex, no risk (essentially) for getting a BJ and performing cunnilingus with respect to HIV, as there are no proven cases, correct? 

3) With regard to  condom protected vaginal sex and herpes transmission to the male partner... There is a risk, it does happen, but the risk is low - something like 1 in many thousands per act, perhaps 1/10000.  Is this correct?


Just wanted to make sure my understanding still holds true. Thank you for the wonderful work you do.


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to the Forum and thanks for your vote of confidence.  You ask three good questions.  As you will see below in my specific answers, while science is constantly on the move, more often than not that movement is slow.  On to your questions:

1) With condom protected vaginal sex, is the consensus still that as long as the condom stays on and doesn't break, there is no risk for fluid transmitted disease (particularly HIV)?  Are there an proven cases of HIV transmission from protected vaginal sex without evidence of condom failure?

the complete answer to this question is nuanced.  In every carefully conducted, well controlled study of condoms for HIV, the results leave no question that condoms are highly effective for HIV transmission. At the same time, in each large study there are typically a VERY few cases in which persons professing to use condoms correctly and consistently become infected.  Most investigators also point out that participants in such studies are often embarrassed to state that they did not use condoms some of the time or may have knowingly or unknowingly used them incorrectly.  Deciphering whether condoms have a vanishingly low failure rate when used correctly or the participants in these trials used them wrong is impossible.  We continue to have complete faith that consistently and correctly used condoms which do not break offer complete protection from HIV. 

2) With unprotected oral sex, no risk (essentially) for getting a BJ and performing cunnilingus with respect to HIV, as there are no proven cases, correct?  
Correct, there are no proven questions of HIV acquisition with these sex acts.

3) With regard to  condom protected vaginal sex and herpes transmission to the male partner... There is a risk, it does happen, but the risk is low - something like 1 in many thousands per act, perhaps 1/10000.  Is this correct?
Correct.  On average, following sex with an infected partner who does not have visible lesions, we estimate the risk for HSV acquisition to be somewhere between 1 in 1000 and 1 in 10,000 per act of intercourse.  Condoms reduce this risk further, by more than 50%

In summary, condoms remain the most effective mechanism for prevention of STD (including HIV) acquisition/transmission.  EWH
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44 months ago
Thank you for your answers Dr. Hook.

I am a single straight male in my early 30s.  For quite some time, I had restricted my sexual activity to only mutual masturbation out of fear of STDs and HIV, until a couple years ago. 

In the last couple years, I have had 5 to 10 female sexual partners with whom I had always used condoms for vaginal sex. This adds up to several events of condom protected vaginal sex. I have never had a condom break on me, and the head of my penis and most of my shaft were definitely covered during all of these events.  Would this constitute complete protection from HIV for me? 

Are there other factors that constitute failure, besides breakage or the head of the penis not being covered? What comes to mind is the penis becoming partially flaccid or flaccid before or during penetration, but the condom remains on.  Also, withdrawal of the penis after it becomes flaccid from vagina, such that the condom comes off the penis and stays in/ hangs out of the vagina..

Admittedly, I would prefer to continue to have condom protected vaginal sex, potentially with new partners, until I find the woman I will marry.  I just want to make sure I'm staying safe, especially with respect to HIV. 

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

I congratulate you on your safe sex/sexually healthy approach to sex.  it will keep you safe.  The use of condoms you describe is correct and will protect you.  The only additional caveat that I might add is that there have been occasions when persons have not pout on their condoms at the beginning of sex, mistakenly thinking that as long as they put the condom on before ejaculation they are safe- clearly this is an incorrect belief.  It sounds to me as though you are doing the right thing and should completely protect you from HIV.

When the male's partner slips out of the condom as he exit's his partner and the condom remains behind, the condom has still done its job and should not be a reason for concern.  similarly, if your penis becomes flaccid while still within your partner, as long as the condom is on, it is doing its job.

My only other suggestion for you regarding living a sexually healthy lifestyle is that you might want to consider getting the HPV vaccine.  the vaccine is typically recommended for persons 26 or less but given your history and commitment to safe sex, you (and your future partners) might well benefit from receipt of the vaccine.  You would probably have to pay for itself (about $300-400 for the full course) given your age but the vaccine would still be quite effective and at present your risk for having gotten HPV up to now is rather low.  EWH



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