[Question #7765] How safe is protected oral and virginal sex with csw (also check condom)

 
8 days ago
Dear experts,

It looks like monogamous relationship doesn't work for me. I have sex with CSW once or twice a month. However, I am using 100% of the time for both oral and virginal sex. I also check briefly after the sex that the condom doesn't break. Is my risk of getting HIV or other STIs very low (1 in millions) but it is still not a bad idea to get checked up like once a year?

Also, I understand that symptoms should never be used as indicator. However, can I say that if after any specific event, and I don't have ARS symptoms in the following 1 month, the probability of getting anything becomes even lower? (Maybe 1/million * 0.1 doesn't make any real difference tho)

Thanks!

8 days ago
I had 3-4 protected encounters with csw after I was tested negative for HIV. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 days ago
Welcome to our Forum and thanks for your questions.  I’ll be glad to comment.  I’ll try to provide information which indicates That the activities you described do not put you at risk for HIV or other STI ‘s. This information includes:

1.  Most commercial sex workers do not have sexually transmitted diseases or HIV. There’s a generalization they tend to be more careful and get checked more often than other persons who may engage in casual sexual activity.
2.  As long as they do not break, condoms remain the most effective means of preventing acquisition of HIV and STI’s if exposed to an unprotected, untreated partner.
3.  Receipt of oral sex from an HIV infected person is a virtually no risk event. There are no scientifically proven instances in which a person has acquired HIV from receipt of oral sex from an infected partner.
4. The risk of acquiring HIV from unprotected sex with an untreated, an infected sex partner is very low. The risk of infection in such situations is less than one infection per more than 1000 sexual encounters.

In summary, the activities you describe are safe sex.  This leads to the question of, in the unlikely event that you were to acquire HIV, would there be symptoms such as the ARS. While the precise number is imprecise, less than half of persons who acquire HIV experience the ARS syndrome.  For this reason, on the site for persons with multiple sexual partners or partners who may have multiple sexual partners, we recommend regular sexual health check ups at which time tests for classical STI‘s such as gonorrhea, and chlamydia are performed as well as blood tests for HIV. Given your circumstances the likelihood that these tests would be positive is very, very low however out of an abundance of caution testing is recommended. 

I hope this information is helpful to you. If any part of my response is unclear or there are further questions, please don’t hesitate to use your update to follow up questions for clarification. EWH


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8 days ago
Dear Dr. Hook,

Thanks for your reply. I will get checked for sure. Just wanted to figure out whether I am putting myself in some risks.

When you said 'low risk', I am assuming it's lower than 1 in millions?

Since sometimes I don't have the condoms, if I check the condom after sex and make sure it is intact (eg. semen all in condom), I can conclude that the protection was perfect and I don't have to worry about condom expiration, oil lubricant, condom package, etc. Right?

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
8 days ago
The risk is so small that I question how useful it is to try to put a precise number on it. Once estimates of risk become lower than one in 1 million the differences are really challenging to even debate. Remember a one in 1 million chance means that 99.9999% Of exposures will not lead to infection.

When condoms fail they must typically break wide-open leaving no doubt that they have failed. The habit of checking the integrity of a used condom with water has never been scientifically proven and is not recommended by experts. If a condom appears intact, it most certainly was.  Issues such as lubrication and expiration date impact the likelihood of failure but do not mean that using a condom which is out of date or has been incorrectly lubricated is not better than nothing. 

Hope this helps EWH
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8 days ago
Thanks Dr. Hook,

I asked because days before the csw told me she opened the condom package and put some of the condoms in one Zip-loc bag so she could easily carry them. 2 days before we met. It means the condom somehow was exposed to more air I guess. I checked the condom after the sex and it looked perfect. I think it's okay? 

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
8 days ago
I agree. Using a condom that had been open for a day or two should not affect its performance. The fact that it appeared intact and contained ejaculate when you had finished also serves to confirm that the condom functioned as intended. I will caution you against overthinking this.

As I suspect you know, we provide up to three responses to each client’s questions. This is my third response. Thus this thread will be closed shortly without further  responses. I hope the information I have provided has been helpful to you. Please don’t worry. EWH
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