[Question #8292] Half of the condom was dangling

46 months ago

Dear experts,

Today I visited CSW and when she put the condom on my penis, there was part of condom dangling on my penis. (I think she just wanted to have extra space for the semen?) The condom was long enough to cover most part of my penis, including shaft. We had virginal sex for like 2 minutes, and I think there might be some virginal fluid going to the shaft tho but I think it is inevitable. After I ejaculated, we both examined the condom and the semen was in the condom. I’m wondering whether m such usage of conform puts me into any risk of STDs including HIV. Thank you!

H. Hunter Handsfield, MD

46 months ago

Welcome back to the forum. FYI, I reviewed your two discussions with Dr. Hook a few months ago and agree with all he said.

All three of your questions suggest you seriously overthink condoms and their effectiveness. As Dr. Hook said, without overt rupture, you can be confident that protection is maximal as long as the head of the penis and the meatus (urethral opening) are covered. Vaginal fluid contact with skin above the condom -- or even inside it, if fluids get in there -- carries little or no risk. For the events described, I'm very confident there was no measurable risk of HIV or any STD transmitted primarily by fluids (e.g. gonorrhea and chlamydia in addition to HIV). However, condoms provide much less effective protection against those STIs transmitted by skin-to-skin contact, like herpes, HPV and syphilis.

Another aspect also comes to mind, in response to both this and the previous exposures described. I would encourage you to stop worrying about HIV/STI outcomes or testing after any single exposure, unless particularly high risk (like overt condom rupture, or sex with a known-infected partner). A smarter approach is to disregard each event, but plan on testing at regular intervals, e.g. every 6-12 months, depending on the frequency of CSW exposures. At those times, have urine tests for gonorrhea and chlamydia, and blood tests for HIV and syphilis.

Finally, I would suggest it shouldn't be necessary to ask our advice every time you have commercial sex, even with condom slippage etc. All three of your questions so far have been about essentially similar events. You can be sure our responses won't change in the event of similar occurrences!

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

HHH, MD

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46 months ago

Thanks Dr. HHH,

I have already been doing what you suggested: getting tested every several months. FYI: I think I am well educated about HIV. I visit CSW ~once a month and use condoms for both oral and virginal sex. I also checked the condom every time. I have 2 follow-up questions:

1. you recommend 'disregard each event, but plan on testing at regular intervals, e.g. every 6-12 months' not because I will have any measurable risk if I keep taking precautions, but because it is a recommendation you would give to any sexually active persons and it is very convenient to do that in the U.S?

2. I should not worry about the sexual act with my regular partner?

Thank you!

46 months ago

Oh sorry Dr HHH, I think another important reason you still recommend getting tested periodically is that ‘ However, condoms provide much less effective protection against those STIs transmitted by skin-to-skin contact, like herpes, HPV and syphilis.’ ?

Thank you!

H. Hunter Handsfield, MD

46 months ago

I'm glad to hear you're already on a regular testing program. Your forum questions seem to imply that you're being tested after each CSW adventure.

1. Correct. With any relatively low risk event -- because of your precautions, but also because even the most sexually active sex workers have no transmissible STI at any point in time -- there's little point in testing after any single exposure. That doesn't mean the risk is zero, just that it's low enough that testing doesn't make much sense. However, the STI risk obviously rises with every such exposure. (Think of it this way: say the risk of infection is 1 in 1,000 for each event. After 10 exposures, the risk you have something is 10 times higher, 1 chance in 100.) Hence wise to be tested regularly but not after each event unless the risk is especially high. This advice is universal, not just for the US -- it applies anywhere. The actual per-exposure risk obviously is higher in some geographic areas than others. But Western Europe is a relative low risk area.

2. This doesn't guarantee there is no risk for your regular partner. There will always be some risk, no matter when and how often you test. But in these circumstances, the chance you'll acquire any STI and then infect her is very low. If somehow I were in your situation, I would continue unprotected sex with my wife.

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46 months ago

Thank you Dr. HHH,

So I think I have an idea: For HIV, the chance is very low, probably much less than 1 in millions. For Herpes, Syphilis, or HPV, the chance might be higher but still pretty low. But nobody can guarantee 0, just like all of us can walk out and be stricken by a meteorite. So all things considered, I should get check-ups periodically out of ample amount of precaution.

Thank you.

H. Hunter Handsfield, MD

46 months ago

Good summary. You correctly understand my advice. I would also remind you of my advice in my original reply ("Finally, I would suggest...") about repeating similar questions after such exposures. Thanks for your understanding.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been hellpful. Best wishes and stay safe.

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