[Question #6105] Encounter with CSW

17 months ago
I recently had an encounter with a CSW. I received unprotected oral and partook in protected vaginal sex. However, the issue is that in the middle of the session I went limp and when I pulled out, the condom was near the tip of my penis. I rolled it back onto my penis after I could get erect again but as it was dark, I could not tell if I had turned the condom inside out (I do not think I did but now my mind is making myself paranoid), or perhaps inadvertently gotten any genital secretions on myself when reapplying the same condom. The CSW is Australian, and considered high class (US$550 per hour). She mentioned that she is very careful and gets tested around every 3 months.

From my understanding from reading other responses here, the risk that I caught anything from this incident is low enough that I would not require testing of any kind in the absence of any symptoms, but to put my mind at ease and move on I would like to consult your expertise and confirm that my understanding is correct. Many thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Welcome to the Forum and thanks for your question.  As I read your description of the events, my understanding is that while the condom slipped down during your encounter, it did not slip entirely off.  If it had come entirely off, I would imagine that it would be difficult to simple roll the condom up to once again cover your entire penis.  As long as a condom cover the tip of your penis, it would prevent acquisition of most STIs. including HIV.

I do agree with you that your partner sounds relatively low risk.  Most CSWs, particularly those whose prices are higher is is the case with your partner are quite cautious about their risk for STI.  

If I were you, I would not be worried bout risk for STI, including HIV from the exposure you have described.

I hope that these comments are helpful.  If anything is unclear or if I have missed something, please use your up to two follow-ups for clarification.  EWH
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17 months ago
Thanks Dr. Hook for your prompt and helpful response. Now that you mention it, I believe that is what indeed happened. Particularly, to actually wear the condom inside out it would have had to fall off completely, and I would have had to turn it upside down and apply it again, which I could not imagine happening. I also think that the condom should have stayed on for the most part in the vagina, otherwise it would have fell off as I was pulling out. 

Nonetheless, just to cover all bases I would also like to confirm with you that even in the case where I did apply the condom inside out, that the chances are still sufficiently low to not warrant testing considering that there has been some (but not total, due to various wrinkles in the condom) exposure to air. Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
I cannot provide a complete assurance that, IF the condom came completely off and was re-applied, that there would not be exposure to some small amount of infectious material because the event is so rare that there are no scientific data to inform us.  Rather I will tell you that if I were in your situation, I would not be worried and would not seek testing.  This however is a personal assessment as opposed to a fact-based assessment which is what we do our best to provide here.  You will have to make your own decision regarding the need for testing.  Sorry.  EWH---
17 months ago
Thank you Dr. Hook. I would tend to agree with your assessment, particularly as I do not remember the condom slipping entirely off (as you say, it is most likely that I simply rolled it back).

As my final follow-up, could you kindly clarify: (i) what is meant by personal assessment and fact-based assessment; and (ii) explain a bit more the reasoning for your personal assessment?

Thanks for your comments, patience and understanding. I will now move on from this.
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
1.  By personal assessment I mean it is my judgement, based on the information you have provided.  that is different from a fact-based assessment in which I am able to use information from published, peer-reviewed studies to guide my assessment.

2.  My personal assessment reflects my sense that the CSW who you had sex with was unlikely to be infected and my sense from your description that it was unlikely that your condom came completely off during the encounter you describe.  

As you have acknowledged, this will complete this thread.  I hope the information I have provided will be helpful to you.  EWH
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