[Question #719] Protected intercourse with CSW - Condom status unknown

103 months ago

Hi doc, last time I received a response from Doc Hook and was pretty helpful. So I am here again trying to evaluate my risk and testing needs.

Background: I am a circumcised male who is HSV2 positive. Have had total of 20 CSV partners all in North America (Canada and California) - always protected though I a never really checked the condom after intercourse for break. I am trying to reduce my partners, recently in a exclusive relationship so want to make sure I don't engage with her and put her at risk.

Concern: On the 10th of April I visited a CSW. Didn't look like a drug user but I was much concerned about her heigine. I bought condoms myself, but forgot to check the expiry. The exact brand was "Trojan Ecstasy - Extra lubricated". She gave me a blowjob with the condom on, which was a little toothy so I am concerned about tears in the condom by her teeth. After that was vaginal intercourse which was not at all rough. Since I felt guilty putting her at risk for HSV2 and was nervous about HIV I ended the intercourse within 2 mins. The condom was not snug over the shaft, there was a lot of room. However it was very tightly held at the base and I had to put significant effort to take it off later. I didn't really look at the condom in detail just took it off and threw it but now my mind is playing tricks that maybe the condom broke and I didn't realize.

Questions: Do I have any risk that recommends testing? Or can I simply move on? My girlfriend knows about my HSV2 status and she is okay with it. Can I resume intercourse with her or am I putting her at risk for HIV? How noticeable is it if your condom breaks? Over other forums the advice has been "if you don't have a fringed hula hoop on your shaft your condom was intact". How accurate is this statement? CDC doesn't claim condoms to be 100% effective. Is it because condoms don't completely prevent the passing of HIV through them or is it simply because they can break and that takes out their effectiveness?

H. Hunter Handsfield, MD

103 months ago

Welcome back to the forum.

You needn't worry; you are not at risk of HIV from the events described. It seems you are too worried about details of exposures and condom use that don't matter. Concomd expiration dates are very conservative; the vast majority last much longer. More important, beyond the date there may be an increased risk of breakage, but if the condom doesn't break, protection is complete, no matter how old. Oral sex is zero risk even without a condom, and regardless of superficial tooth injuries. With a condom that doesn't obviously break, no risk for sure. Snugness of condom makes no dfference in risk. You do not need to look at condoms closely after sex. Any breakage will be obvious.

Those comments pretty well answer your questions, but to be explicit so there is no chance of misunderstanding: You are at no risk, do not need testing for HIV or any other STD, and can have sex with your regular partner without putting her at risk. Most condom breakages are immediately obvious at the time: the rupture often is felt, and on withdrawal it is obvious the penis was not covered. The hula hoop statement is a bit too cute for my taste, but if I understand it correctly, it's accurate.

Your last sentence shows you understand the main reason condoms are not 100% effective: breakage or mis-use. For those reasons, people who rely only on condoms to prevent HIV, STDs, or pregnancy have less than 100% protection over the long term. But for any single possible exposure to HIV, a properly used condom that remains intact is 100% protective or very close to it. Of course there is no 100% protection from any safety device: people die in auto accidents despite seat belts and of house fires despite smoke alarms, and once in a while someone gets HIV despite careful and consistent condom use. If you want 100% certainty you'll never get HIV, you need to plan on not having sex with high risk partners.

I hope this has helped. Let me know if anything isn't clear.

Best wishes-- HHH, MD

---

103 months ago

and once in a while someone gets HIV despite careful and consistent condom use. If you want 100% certainty you'll never get HIV, you need to plan on not having sex with high risk partners

Thanks for your response doc, however taking into account your above statement, your recommendation is still no risk and moving on with no testing? Why is that so?

H. Hunter Handsfield, MD

103 months ago

Yes, that is my recommendation, which is clear from everything else in my reply.

---

103 months ago

so the risk of HIV while using a condom is only due to breakage or something else? your last statement shook me a bit I.e people can get HIV even with proper and consistent use of condoms. I don't mean to nag you. I have accepted that I don't need to test, am very much at peace but that bit is still there. Any comment on that would be appreciated. Thanks!

H. Hunter Handsfield, MD

103 months ago

There is no conflict between my two statements. On one hand, I'm telling that your exposure was zero risk for all practical purposes. OTOH, if you have similar contacts daily for life, you will be at some small risk of HIV, and in that case you should be tested from time to time, like maybe once a year. But never just because of any single exposure, if the condom is properly used and doesn't break.

But if seems obvious you are obsessing about HIV, and nothing I say is likely to completely erase all fears. If you remain concerned, then get tested. Not because you're at risk from the exposure described, but because the negative result might help you get beyond your exaggerated anxieties about it. So it's up to you. Takd care and stay safe.

---