[Question #7247] HIV Risk - Condom Use

7 months ago
Hello doctors,

I have a question about HIV transmission. I recently visited a TS CSW in Canada. I received protected oral (wearing a condom). I also performed protected anal on the CSW for about 2 minutes (and a lot of lube was used). I couldn't keep an erection so I stopped after that and didn't ejaculate into the condom. The condom was on me the whole time and it did not rip. From what I understand, protected insertive sex is considered low risk for transmission. 

My questions:

1. Would you consider this event low risk? Would you recommend that I seek testing or even PEP since this was 3 days ago? This is the first penetrative sex with a CSW I've ever had. 

2. "Proper" condom use is ensuring that the head of my circumcised penis is covered at all times, correct?

3. I wouldn't describe the penetration as "deep" since I wasn't able to keep erection. I would say 2-3 inches at most.  Does this matter at all in terms of transmission risk? Does duration of penetration also affect transmission risk? This is just for my own understanding. 

4. Once the condom is off, is there a way for fluids on the outside of the condom to cause transmission? This means when I take the condom off after sex, can fluids on the outside of the condom cause transmission? 

I really appreciate your response. Your tireless work on sexual health is extremely appreciated. 
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Welcome to our forum. Thank you for your questions. I’ll be glad to comment.  Let me start by congratulating you on your commitment  to safe sex. In addition, let me point out that you do not know if your partner had HIV or not. While admittedly more transsexual woman and men have HIV the other sub groups of the population, the majority still are not HIV infected.  Further, as you point out, condoms as long as they are worn throughout the encounter and do not break ( Condoms break about 1% of the time they are used, substantial lubrication helps reduce the breakage rate)  almost totally effective for HIV prevention.  This was a-virtually no risk exposure.  Thus,  in answer to your specific questions:

1.  Yes, this was a very low risk exposure. I do not see an immediate need for HIV testing related to this encounter. If you ask me to prescribe PEP I would certainly decline to do so.

2.  Correct

3.  Penetration is penetration. Depth does not matter.  Logically duration of exposure, if unprotected, might matter but there are no data on this variable.

4.  No, handling a used condom and exposure to Ano-genital secretions on the outside of the condo do not represent a risk for HIV.

I hope this information is helpful, and reassuring. If there are follow up questions please feel free to use your up to two follow-up questions for clarification. Take care. EWH