[Question #8230] Condom not covering entirely

47 months ago

Hi Dr

I am worried about an incident that happened recently in a brothel in aus. I had a protected bj and sex with a worker there however when i was finished i realized that the condom did not cover the whole shaft i believe this is due to the fact that it was loose fitting , however the head was covered, i am worried that vaginal fluid may have come in contact with a piece of foreskin that was left over after circumcision as a baby. Is this a risk that requires testing?. Also i have heard the workers there are supposed to get tested every 3 months

H. Hunter Handsfield, MD

47 months ago

Welcome to the forum. Thank you for your confidence in our servcies.

This event was little or no risk for HIV and I see no need for testing. Condom protection is considered complete as long as the head of the penis and urethral opening are covered. An exposed foreskin remnant is not likely to increase the risk of HIV transmission: it isn't foreskin tissue itself that increases HIV risk in event of exposure; it's the moist tissues inside the preputial sac, i.e. the underside of an intact foreskin and surface of the penis in the same situation.

I don't know recommended or required HIV testing requirments in registered brothels or sex workers in Australia (or is it Austria?), but with or without regular testing, the large majority of female sex workers in industrialized countries do not have HIV.

So as I said, from a medical or risk perspective, HIV testing isn't necessary. On the other hand, many people in your situation are more reassured by negative HIV test results than by professional opinion and analysis, no matter how expert (we don't take it personally!). So feel free to be tested in a few weeks if the negative result would help keep you from worrying. Also, all people who are sexually active with multiple or potentially high risk partners should be tested for HIV from time to time, like once a year. So if you haven't been tested recently, this might be a good time, when it's on your mind. But not because of this particular event.

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

HHH, MD

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47 months ago

Thanks for the reassuring response.. one more question ... the remaining foreskin i sizable enough to cover a bit of the head when the penis is flaccid. Does this change your assesment in any way thanks?

H. Hunter Handsfield, MD

47 months ago

It isn't foreskin tissue itself that raises the risk, it is having an enclosed preputial sac. Without the foreskin covering the head of the penis, I can't imagine that this would elevate the risk -- especially when the exposure in general was so safe, and when the foreskin remnant was inside the condom. I really don't think you should be worried.---
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47 months ago

Yes this is why i state that when flaccid the skin does overlap the head a bit but not when erect, is this still safe? and i cant be 100% sure that this skin was not exposed when the condom moved although i am 100% sure the head was covered. I understand this is my final question and i will try to move past this.

H. Hunter Handsfield, MD

47 months ago

You're overthinking all this. The male condom never covers the entire penis, and it is normal for condom-protected sex to include some skin-to-skin contact and exposure of penile skin to vaginal fluid. This is why condoms are less effective against STIs transmitted primarily by skin contact (syphilis, HPV, herpes) than those transmitted by fluids (gonorrhea, chlamydia, HIV). And sliding of the penis within the condom probably can move sexual fluids under the condom. Still, as long as the head of the penis is covered, protection against the fluid-transmitted infections is considered complete. Finally, the skin of a foreskin remnant probably is no more susceptible to infection than the penile shaft.

As I said, you are welcome to be tested as implied above, if the negative results will give you some additional reassurance.

As you suggest, that concludes this thread. I hope the discussion has been helpful.

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