Assessment of risk - please help!

[Freakedoutseriously]

Hello, this is my first post here. I would like to share my story and concerns and hear from experts on the forum. I'm 21 years old white male and on 25 may I met up with call girl (unknown status). She put condom on my penis and performed fellatio, later I fingered her which took about 60 seconds. And then I had vaginal intercourse with her. I came very fast, I'm not sure if it took even 20 seconds. I started to go soft in her and when I took out my penis condom slipped off, but not all the way, my penis head was still covered. Then I layed down for like 5-10 minutes, I don't remember if I rolled foreskin all the way up imediately (I'm not circumcised). I washed my hands, dressed up and left. Then about hour and a half later I urinated and took shower.

1: I have dry and cracked hands something like these http://knolab.com/wp-content/uploads/2014/03/Cracked-Fingertips.jpg (but to lesser degree - no open wounds or something like that but dry cracked epidermis) and I have fingered her vigorously for 40-60 seconds, I'm pretty sure I went in her cervix with my fingers. Before that she gave me some hand sanitizer, I don't know if it matters. So my question is - How dangerous it was? What are the odds that I could contract HIV that way? I know that there was no case of contracting HIV through fingering but I'm worried and want to make sure. Also please tell me if hand sanitizer matters?

2: Like I mentioned earlier my condom slipped off but penis head was still covered. I don't remeber if I held my penis in hand directly afterwards or if I touched urethral opening. I'm also not circumcised which means I have more foreskin that roll over my penis head and urethral opening. My question is - is it possible that some vaginal fluid from my hands or foreskin (remember that condom slipped and most of shaft was uncovered) could go into urethra and infect me or infect me through skin on penis head?

I'd like to hear Your opinions as experts. Really appreciate all info.

[Edward W Hook, MD]

Welcome to the Forum.  I can see that you are concerned over the exposure you describe.  I hope that the reassurances that I provide will be helpful to you.  All of the activities you describe were safe sex with no risk for getting HIV.  Thus even if your partner had HIV (and this is unlikely- most commercial sex workers do not have HIV), there is no risk for infection.  With regard to your specific questions:

1.  Careful scientific study and the experience of millions of persons has proven without a doubt that there is no risk for HIV from masturbating (fingering) an HIV infected sexual partner even when there are cuts, scrapes or cracks on the hands.  

2.  Condom protected sex is safe sex,  Even when a condom slips down or even off the penis as a man is removing himself from a sexual partner, if the condom is left behind it has done its job, protecting from HIV and other STIs.  This is again the experience of millions of men and is true both for circumcised and uncircumcised men.

The information you quote in your follow-up sounds like something you picked up on the internet which puts two facts together to come to an incorrect conclusion.  There are more vulnerable cells present under an uncircumcised foreskin but that does not make condoms work less well.

I hope these comments are helpful to you.  Please do not worry.  EWH

[Edward W Hook, MD]

You are imagining things.  If your condom had come off during sex it would have been deep within her vagina, not on your penis.

If you wish to test for HIV, at 4 weeks you can test with a 4th generation, combination HIV antigen/HIV antibody test.  Results will be defintive at that time.

This will conclude this thread.  We have limited time for follow-up questions.  There will be no further answers and additonal questions will be deleted without comment.  EWH

[Freakedoutseriously]

Also I think I didn't described my situation well enough. After I ejaculated I made few more thrusts so it's quite possible condom slipped in her vagina rather than when I took penis out.

[Freakedoutseriously]

Thank You a lot and sorry for panicking. There's a lot of contradicting info on the internet. That's why I posted my concerns here, and that's why Your opinion as expert is so important for me. I read that skin on penis head is susceptible to HIV, so naturally I was concerned as I have no knowledge whatsoever about STD's. Your answers calmed me down, but for peace of mind I'll do test in 4 weeks. Which test would You recommend at that time, and do You know if Planned Parenthood offices perform it?

[Edward W Hook, MD]

If you stop to think about it, you will realize that trying to sort out precisely where the infection occurs in men who acquire HIV through heterosexual intercourse in not ethically possible.  The assumption however is that infections occur through the urethra or, if they occur through the skin, it is when the virus is massaged into the skin during intercourse.  On the other hand, we know with great confidence that the virus is not acquired through incidental contact of the sort you describe from studies that have proven that touching the penis with a hand which had genital secretions on it such as occurs with mutual masturbation, it which it is typical for partners to get each other’s secretions on one another.

You are worrying needlessly and manufacturing "what if" scenarios of the sort you have just done is not a healthy thing to do.  No change in my assessment.  EWH

[Freakedoutseriously]

Thank You so much for answers Dr. I'm still shaken up but calmed down a bit. Could You please express Your opinion on transmission through intact penis skin? Have You ever seen anyone who contracted HIV that way or maybe You know about any conclusive study? What would You say from perspective of Your experience? I wrote that condom covered head of penis but it's quite probable some vaginal fluid got on lower portion of it. I'm sorry for milling this through over and over again... I'll need some time before I calm down completely and put this behind.

[Freakedoutseriously]

I also read that you can contract HIV even when skin on penis is intact and is exposed to vaginal fluid containing HIV, beacause skin there is supposedly rich in immune cells that attract HIV virus. I'll quote "The urethra (pee hole) is a mucous membrane, and so is the foreskin on an uncircumcised penis. The foreskin is rich in dendritic cells which can help HIV cross through into the bloodstream. A circumcised penis has the dendritic-rich foreskin removed." - it's six years old info from guy who claimed to be HIV/STI Prevention and Outreach Educator with 6 years experience.