[Question #7225] Incorrect condom use? or nothing to worry about?

59 months ago

Hi, this is my second question in as many days, so I understand no further questions will be allowed for 6 months.

I recently saw a number of CSWs in Europe and had protected oral sex followed by protected vaginal sex. After vaginal sex the CSWs used tissues to remove the used condoms from my penis. Sometimes in an attempt to clean ejaculate from the head of my penis the CSWs dabbed the tip of my penis with the same tissue used to remove the condoms. In their haste, on one or two occasions the used condom initially contacted my penis head rather than the tissue, thereby potentially transferring vaginal secretions from the outside of the condom to the meatus. Is there any risks associated with this ‘messy’ condom removal, and dabbing of the meatus with a used condom? I believe its no risk as the secretions were outside the body and exposed to air for a few seconds, but would like an expert opinion.

I am of course primarily concerned with HIV, but also interested in any risk for other STDs.

Thanks

H. Hunter Handsfield, MD

59 months ago

Welcome back, but sorry you found it necessary. This question is very similar to the one immediately preceding it (7224). Here is the same reply, with a couple of additional comments about your specific situation.

Condoms do not prevent all contact with a partner's genital or other body fluids. There is almost always a certain amount of contact with penile skin abive the condom, and often with body fluids on partner's hands. These are among the reasons that condoms do not provide 100% protection against any STD. Which also is why people who are sexually active (outside monogamous relationships) should be tested from time to time -- maybe once a year, in most cases -- for gonorrhea, chlamydia, syphilis, and HIV, even if condoms have always been carefully and correctly used, with no known condom failures or mis-use. However, the risk of transmission from any single exposure remains extremely low, and the chance of any infection being transmitted by the details you describe is exceedingly low, probably zero. This event did not carry any signficant risk and I do not recommend testing at this time.

As for the details you mention, tissues are unlikely to be capable of carrying sufficient secretions or infection bacteria or viruses to permit transmission of HIV or any STD. It is also true that if they fluids had dried, the risk would be truly zero.

I hope these commens are helpful. Let me know if anything isn't clear.

HHH, MD

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59 months ago

Thanks for your quick reply. My concern is not really transfer of secretions on tissue, rather transfer transfer of secretions on the condom. (I believe the other poster was concerned about contact with tissues). Im concerned about accidental contact with the outside of the condom on the tip of penis after sex. The contact took place about 10 seconds after withdrawal, from the vagina as the CSW was cleaning up. I assume latex is better at transferring secretions as it doesn't absorb them. Does this change your opinion or advise at all? Still no testing warranted?

Also i assume that of all the STDs you mention the lowest risk, closest to zero, would be HIV, right?

H. Hunter Handsfield, MD

59 months ago

Thanks for the clarification. This doesn't change my opinion or advice. Such indirect contact with genital fluids, such as the outside of a condom, probably occurs all the time. It may contribute to the rare cases of STI transmission that seem to occur despite careful and correct condom use. Also perhaps some pregnancies (compared to hormonal contraception, pregnancy rates are higher in couples who use only condoms for contraception, no matter how correctly and carefully condoms are used). But the risk for any single event is too low to warrant testing. OTOH, since all non-monogamous sexually active persons should be tested from time to time (e.g. yearly), if you haven't been tested recently, perhaps this would be a good time, while it's on your mind. But not because of this particular event.---
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59 months ago

Ok, i guess i should test then, for peace of mind. I assume you are expecting all negative results (as i have no other types of exposures)?

In terms of my earlier question: ‘ ...i assume that of all the STDs you mention the lowest risk, closest to zero, would be HIV, right?’ Is it correct to assume that while there may be some small risk of gonnorhea or clymadia the risk for HIV is zero for all practical purposes?

H. Hunter Handsfield, MD

59 months ago

If you go ahead with testing, you definitely can expect negative results. And yes, my comments apply to HIV -- indeed I thought that was your main concern. Gonorrhea and chlamydia are far more common and more easily transmitted than HIV, but still the chance of these is near zero as well.---
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