Hi there,

After a party with friends I went to a brothel and was with a sex worker.

The sex worker had metal braces in her teeth.

Initially she gave me oral sex with a condom and after we made vaginal sex with the same condom.

Eventually I didn't manage to finish by vaginal sex so she removed the condom and gave me a handjob.

Before the sex worker removed the condom, the condom seemed intact but the room was half dark so i didn't see it clearly.

I read Dr Hook previous post saying that  if you make vaginal sex with a damaged condom, the condom should shred during sex

and this way you know the condom was damaged.

The problem is that after oral sex before vaginal sex I saw that the conodm  had some more slack and was looser than usual,

the resevoir for the semen at the top was loose about 3 centimeter which is not engaged on the penis.

My concern is that during oral sex the longer loose conodm tip was damaged by the metal braces and the teeth of the sex worker,

and that during vaginal sex the condom had a small hole on the longer loose condom tip and the condom didn't shred,

this is because the condom tip was longer than usual and don't strech and get pressure on it during vaginal sex.

I concern that during vaginal sex HIV infectious fluids could contact my urethra and cause HIV infection 

through a small hole on the condom longer loose tip which is very close to the urethra since the hole is on the condom tip.

1.   What do you think is my HIV risk from this case, should I make an HIV test for this incident?

2.   Do you think that the condom would have still shreded during vaginal sex with a small hole on a 3cm loose condom reservoir 

      or the condom could stay intact with a hole during vaginal sex?

3.   Are you familiar with previous HIV infection cases through vaginal sex in which the condom didn't shred

      when making vaginal sex with condom with longer loose tip when there was a concern for integrity of the condom longer loose tip?

4.   If for practical reasons it will happen to me to have vaginal sex with condom with longer loose tip and I concern for the integrity of the condom longer loose tip in a dark room,

      should I make the water test for condom after sex to ensure the condom was intact in such situation 

      or I can feel by fingers the longer loose tip and if it feels intact it is safe to assume the condom protected me from HIV?

Thank you for your time.

That the condom became "loose" is not the same as it breaking wide open. Female genital fluids probably almost always work their way along the shaft of the penis, under the rim of the condom, whether or not it is "loose". It is one of the reasons condoms are less effective against STIs transmitted by skin contact (herpes, HPV, syphilis) than by genital fluids (gonorrhea, chlamydia, HIV). But if the head of the penis and meatus (urethral opening) remain covered, protection is considered to be complete. A "small hole" in the condom -- i.e. not noticeable as an obvious break -- probably cannot admit sufficient fluids to allow transmission of HIV or other fluid-transmitted infections. I cannot say the risk is zero, and perhaps it explains rare infection in which the exposed person is unaware of condom failure. But if so, it is a very rare event. To your specific questions:

1. Your risk for HIV is zero or close to it -- and not only because it was condom protected. It is statistically unlikely a partner like your has HIV (in the US, under 1% of brothel-based female sex workers). And when a woman has HIV, even entirely unprotected vaginal sex carries roughly one chance in 2,500 her male partner will be infected. Adding a condom to these factors means your risk is under one chance in a million of having acquired HIV.

2. Yes, a condom could stay mostly intact in presence of a small defect. As discussed above, this probably would not significantly raise the risk of HIV transmission.

3. As discussed above, some men with HIV swear they always used condoms and had no obvious condom failure. But many of these undoubtedly were mistaken (either denying improper condom use or forgetting such instances, e.g. if intoxicated). 

4. I do not recommend any need to ever use the "water test" for condom integrity, and most experts agree with me that it's a waste of time and emotional energy. If the condom hasn't obviously broken wide open, you can safely conclude it did its job.

It is well understood that condoms are not 100% effective. In couples who use condoms as their only contraceptive, pregnancy rates are reduced by 90%, not 100%. People who say and believe there has never been a condom failure occasionally are diagnosed with STIs, including HIV. You cannot have non-monogamous sex with 100% safety in regard to HIV, no matter how carefully you use condoms:  you are and will remain at some risk of HIV. This is why all such persons should have routine STI/HIV testing from time to time. (The exact frequency of such testing should vary with frequency of exposure. If you have such exposures say once a month, I would suggest being tested for gonorrhea, chlamydia, HIV and syphilis every 6-12 months -- but not after every exposure, unless the condom breaks wide open.)

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

HHH, MD

Thank you very much for your detailed answer and information and statistics,

it helped me relieve my HIV worry from last exposure and relieve worry about HIV infection generally.

From your answer to question number 4 I can conclude

dark room(and I can't see the condom integrity clearly after vaginal sex) 

and prior to vaginal sex the condom was exposed to sharp objects i.e : 

finger nails or in case i didn't notice and

unprotected vaginal sex.

Can you please relate if  my conclusions are correct or not?

Thank you for your time and patience.

Thank you for the confirmation for my conclusions.

I have another question about your  first answer to question number 2 : 

If before vaginal sex there is more bigger/visible defect on the edge of condom tip with a condom with longer loose tip than usual -- 

A defect which during vaginal sex can admit sufficient fluids to urethra 

to allow transmission of HIV or other fluid-transmitted infections -- 

is it reasonable to assume that even with a condom with a little longer condom loose tip than usual, 

such defect on condom loose tip will cause the condom to shred during the vaginal sex.

By the way when you say condom break wide open you mean condom is fully broken and the penis is fully exposed?

Thank you

The important thing, it seems to me, is that the exposure you describe sounds to me like the condom obviously didn't rupture and probably worked fine. And also see my reply above to question no. 1:  even if you used no condom at all, probably you were at low risk for HIV.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has helped you to move on without all this worry! Best wishes and stay safe.