This afternoon I met with Venezuelan CSW in Paris whose profile I found on a popular escort website. I brought my own condoms and requested anal sex. As the CSW lowered herself onto my penis, attempting with difficulty to insert it in her anus, the condom broke, exposing the entire head of my penis.  We stopped instantly, and I'm not entirely sure we even achieved penetration at this time. If we did, it was just the tip of my penis and for only 1 or 2 seconds following the condom break. 

I would like to ask you about the likelihood that this exposure could result in the transmission of an STI or HIV. I did not at any time ask the CSW about her status, even after the condom broke. Unprotected sex was not offered as a service by this CSW, however. At this stage, I'm wondering if testing is necessary. In particular, I'm wondering about resuming unprotected sex with my girlfriend given this event.

Thank you in advance for any guidance you might be able to offer.

I would judge the STD risk from this event as extremely low, but I can't say it's zero. If there was no penetration, it's probably zero for practical purposes; and even if their was, it was obviously very brief, which lowers the risk. It also sounds like your commercial partner has primarily or only safe sex. I will also add that "escort" usually implies a rather expensive female sex worker by appointment, and this is supported by her use of "a popular escort website". Such women generally are pretty aware of STD risks and prevention; often select safe partners (men like you!); and get tested regularly. While of course there are exceptions, all these add up to pretty low chance she had a transmissible STD.

As for chafing from hand-genital contact, I wouldn't worry about it. STDs are rarely if ever transmitted by hand-genital contact, even in the presence of genital fluids. Read my reply to the question immediately before yours (#562) for more detail on this.

So if somehow I were in your situation, I would not feel a need to be tested for STDs and I would continue unprotected sex with my wife without any worry. But of course you are free to be tested (urine gonorrhea and chlamydia any time more than 3-4 days later, syphilis and HIV after a few weeks) if the negative results would give you further confidence. (This doesn't mean I really believe there was significant risk. I don't, and raise the issue strictly as one of possible reassurance.)

I hope this has been helpful. Best wishes and stay safe---  HHH, MD

Thank you kindly for your rapid response to my query. Naturally, I'm a bit anxious about the incident I described. I hope you won't mind my taking advantage of a follow-up question to clarify a few points, and in order to be somewhat more reassured until I can get tested (while you indicate you wouldn't feel a need for testing – which I appreciate very much – it's something I'll want to do, just to be certain).

In particular, I'm concerned about some gastrointestinal problems (mostly diarrhea, but also some nausea and one bout of vomiting) in the 72 hours immediately following the incident I described. Having read the WebMD forum fairly extensively, I think I can anticipate your response to this particular concern. First, that diarrhea alone is never an STD/HIV symptom. And second, that symptoms almost never occur within the 72 hours following a potential exposure.

The first line of the final paragraph of your response – which I really appreciate your using, in this case and throughout the WebMD forum – should be enough to put even the most obsessional person at ease. Having said that, I wonder if there is anything you can add from another angle that might help to set my mind at ease, particularly given the gastrointestinal issues I'm having – which are difficult to disassociate from the incident, even if my understanding is that no logical connection can be said to exist. Any statistics, data or examples in support of the extremely low probability of having contracted something during the incident I described would be very much appreciated. Having read the WebMD forum, I understand that testing is the only way to be 100% certain.

Finally, at what stage will HIV and syphilis tests be conclusive? I've heard a range from a few weeks to two months. I would like to take all of my tests at one go, and as soon as I can be sure to have a conclusive result.

Thank you once again for your reply and reassurance.

The gastrointestinal symptoms you report do not suggest any STD. HIV cannot cause symptoms of any kind after only 2-3 days (7-10 days minimum); and although HIV can be associated with GI symptoms, that would never be the main or only symptoms. It sounds like you caught a garden variety gastrointestinal virus or traveler's diarrhea. Could it be from the sexual incident? Sure, if your escort partner happened to have a minor GI infection herself. But it's equally likely you picked it up from a meal, a waiter, a friend, or anyone else in your environment. I don't have statistics to offer, but try this:  we might guess that every day in Paris undoubtedly there are thousands of people who get new symptoms of a GI infection, and every day thousands more episodes of unprotected sex. Logically, both those things will happen to some people simply on a random basis. The frequency of such a random occurrence probably is higher than the frequency of STD transmission in thouse couplings.

The most commonly used HIV test nowadays is the 4th genration (duo, combo) test for both HIV antigen and antibody. It is conclusive at 4 weeks. A standalone HIV antibody tests is conclusive at 6-8 weeks. The standard syphilis tests are conclusive at 6 weeks. If I were you, and if I decided I wanted testing, I would have a clinic based test for both HIV and syphilis at 6 weeks. (The home self tests on oral fluids are the only ones that still need 3 months for a conclusive result, so I would advise agaisnt that option.)