[Question #5502] Anal sex with Condom

22 months ago
Hello Doctors,

I had a protected anal sex with a sex worker.  The encounter was with a trans girl, who wore the condom and had anal sex with me.  (I was the receiver for let's 10 minutes or a bit longer)

During the event, she pulled out a few times and each time I checked to see that the condom was on and not broken or had partially slipped off.   Each time it appeared that the condom was completely on, covering to the bottom of the penis.

Also, we touched the shafts of our penises at a point but not the heads where fluid could be exchanged.  Just skin to skin for a time.  Finally, she removed the condom, masturbated and ejaculated on my waste just above my pubic hair.   

Based on this encounter, what would be my risks?  I know herpes, HPV, and Syphillis due to the skin to skin contact.  

My OCD has me worried as usual.

Thank you!



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back to the forum.

Second question first:  Touching penises is zero risk for all STDs for all practical purposes. So is hand-genital contact, even if genital fluids are used as lubrication. You have correctly named the STDs typically transmitted by skin-skin contact. But that doesn't mean any and all skin contact is risky. In general, these bacteria and viruses need to be massaged into the exposed tissues for infection to take hold. Brief or fleeting contact confers little or no risk; and hand-genital contact probably doesn't transfer enough fluids to be risky. In theory it could happen, but neither I, Dr. Hook, nor any other STD experts we know have ever had a case of any STD after only having such contact.

Anal sex:  You are playing with fire, more (as I recall) than suggested by your previous 8 questions. This time, transsecxual "girl" suggests she must be anatomically male. Receptive anal sex with other men is the hi9ghest risk of all sexual practices for HIV transmission, as well as for all the main STDs. Condoms sometimes break, and it happens a lot more often during anal than vaginal sex. If you continue such exposures, you're going to have at least a low risk of catching HIV and rectal infection with all STDs, no matter how careful you are about condoms. You can limit the risk by asking partners about HIV and STD status, but obviously that's not foolproof. Is the risk high enough now to need testing? No. But if your sexual lifestyle continues as it apparently has during the 3 years you have been a forum regular, you should have routine STD testing (gonorrhea, chlamydia, HIV, syphilis) from time to time, even if there have been no condom failures or other lapses in safe sex. If you haven't been tested recently, this would be a good time, when it's on your mind -- bu tnot because of this particular event.

Having said that, I need to point out a common theme to all nine of the questions you have asked over the past three years. You keep asking our reassurance about pretty much the same issue:  "What is my risk after exposure xyz?", generally meaning exposures that a) everybody knows are very low if not zero risk, often with condoms, and b) you can predict based on Dr. Hooks and my previous replies. Given that knowledge, it really shouldn't be necessary to ask about each individual sexual exposure. 

I hope these comment are helfpul. Let me know if anything isn't clear.

HHH, MD
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22 months ago
Thanks for your reply!  I don't disagree with anything you say in terms my lifestyle and playing with fire.

So... for the record ... As long as the condom was intact as I believe it was, I should be clear of having acquired something.  My mind is going places and coming up with other scenarios that no one can provide an answer for I'm sure.

Also, should I wait a specific period before being tested?

This is my turning point...  I'm stopping drinking and going to a therapist (appointment made).  I'm sick of the anxiety, and all of the worry and fear of destroying my life due to my poor judgement and sex addiction.  

Finally, yes... I've asked the same questions over and over and knew what the likely response would be.  However, as I sit here today feeling ashamed, guilty and with all the other emotions, I have no one to talk about it with as it's too embarrassing and a very thing...... so please understand, this is a help to me and it's the only place I have right now.

Wish me luck in changing my behavior!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Yes you correctly understand "for the record".

As I said, testing in relation to the recent exposure makes no sense and I do not recommend it. So it doesn't matter to me when you are teated. But if you nonetheless want testing at conclusive intervals after this particular event, then 3-4 days for rectal gonorrhea/chlamydia testing and 6 weeks for HIV and syphilis. (Note that urine or urethral swab testing is irrelevant for an anal exposure.)

I'm glad to hear of your intent, always the first step. But don't get overconfident. Most such pledges don't last. I hope you hang in, and certainly endorse the notion of managing alcohol concumption and seeking professional counseling. But don't get decieved by your own intent:  keep those condoms handy!

A couple years ago, a professional colleagues of Dr. Hook's and mine, discussing this forum and the high proportion of anxziety-driven questions in absence of real risk, said "Well, it's probably the cheapest therapy available for them." I don't disagree and I hope it helps.
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22 months ago
Hi Doctor -

Thanks for your comments.

A few final comments/questions/thoughts from me.....

1) I'm not in any way overconfident about this.  I think my biggest problem is the alcohol.  Every episode I've ever posted about + the ones I didn't post about took place under severe intoxication.  I don't think I ever had an event like any i've described on this forum where the influence of alcohol wasn't a highly contributing factor.  So, dealing with that issue is my first step.  I usually will scale back my drinking to a level where it's under control and then some binge scenario will take place where feels mind and judgement is taken over and lost in pursuit of sexual gratification in the intoxication.  (In a 6 hours period Friday I had three 20 oz high alcohol beers and 5-6 glasses of straight scotch ... I think that qualifies as highly excessive binge drinking).

2)  While I think I've described the event accurately and it seems there was no issue with the protection used, it does surprise me that you state "Is the risk high enough now to need testing? No.." and "As I said, testing in relation to the recent exposure makes no sense and I do not recommend it. "....  I'm not criticizing your assessment of the situation in any way.  I'm happy you seem very confident in your assessment.  However, aren't there other ways you could be infected even with a fully intact, non- broken condom.... Let's say the individual has a sore or cut of some kind at the base of their penis which is not covered and it touches a hemeroid (which I have) or some unique scenario like that....I get such scenarios fall into the %'s that condoms are highly effect but not foolproof.  I guess we also need to consider that no all people are infected.  Anyway...  I feel better today and will do my very best to change.  You're "playing with fire" comment hit me hard.

Another question... The only testing for rectal gonorrhea/chlamydia is a swab of the area?  Would any blood test provide a result for gonorrhea/chlamydia?  And, also, If you have an std specific to the anal area, can you infect someone through sex from the penis?

3) Finally, thank you for the good work you and your colleagues are doing here.  It has helped me.  I'm hoping I can get past this all.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Yes, STD/HIV transmission sometimes occurs despite correct and proper use of a condom that doesn't break, and the mechanisms you mention are plausible. But the chance of a new infection reamins very low, although not zero. But testing is not a black and white, always do or always don't sort of thing. In general, the risk of infection is too low after any single exposure to recommend testing, and standard advice by STD expoerts is to pretty much ignore individual exposures unless the risk is especially high (e.g. unprotected with a truly high risk partner, sex with known infected partner, etc) and otherwise to just have routine testing at a standard interval  Depending on overall risk that interval could be as short as 3 months or as long as 1-2 years.

You're of course free to be tested if you would like to do so, which is why I gave you the timing of testing if you decide to do it.

Blood tests for chlamydia and gonorrhea exist but are highly unreliable. The only useful testing requires specimen collection from site(s) of exposure or sympotms.

That concludes this thread. Thanks for the thanks. I'm glad to have helped. Good luck.
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