HI

[gtx10]

Dear Doctor, thanks in advance for your help. Last week i had an encounter with a transexual csw which left we extremely worried. It is a somewhat complicated sequence of events, so i ask for your patience.

To start off, i had performed protected oral sex on the csw. further in the encounter. After this was done, she had taken off the condom and left it aside for about 5 to 10 minutes. following this, she proceeded to use the same condom, which she had taken off earlier and undoubtedly made contact with her penis, and covered her fingers and inserted her fingers into my anus.

This contact went on for a reasonable period of time. from the mechanics of it, it is likely that the side of the condom which made contact inside my anus also made contact with her penis. she did not ejaculate during the earlier oral sex, but i do not know if there were any pre-ejaculation fluids.

my question is, is there a high risk of transmission in this case, should she be hiv positive? the condom had been left in the open air for a few minutes, but could still have semenal fluids on it. I am normally very cautious but have been careless in this process. I will be getting tested anyway, but It is severely distressing and i really hope you can help me. many thanks

[Edward W Hook, MD]

I understood your description.The repeat summary does not change my assessment. EWH

[gtx10]

Hi Dr Hook, thank you for your very prompt response, and i apologise for the badly written question. I accept and acknowledge your clear response, at the same time, i would just like to restate the seqeunce in case i was not clear.

1. i performed oral sex on the transexual csw - she wore a condom
2. she removed the same condom, and left it aside for a few minutes - she did not ejaculate but there might be seminal fluids.
3. she then "wore" the same condom over her fingers and fingered me anally for several minutes
4. its likely that the surface in contact wiith my anus was also the same surface in contact with her penis.

Given the sequence re-stated is this format, would your opinion be any different? I will not have further questions after this.

Thanks again Dr, your warning on condom re-use is well-taken and noted.

[Edward W Hook, MD]

As you can imagine there are absolutely NO data to scientifically answer your questions about the risk of this event however when one considers the steps involved, we can assume that there was no risk.  The reasons I say this include:

1.  condom protected sex is safe sex.
2.  The condom was initially used for you to perform oral sex on your partner.  Any secretions from your partner should have stayed inside the condom.
3.  HIV dies very quickly on exposure to air and room temperature.
4.  Transfer of infectious materials from one person to another, directly or indirectly (as on a condom) dramatically reduces the amount and viability of any microorganism present, including HIV.
5.  Odds are your partner was not infected.

Putting all of these facts together, there is no meaningful risk of HIV transmission to be associated with the events you describe.  At the same time, for further reference, please don't reuse, or permit partners to re-use condoms. It increases risk for breakage.  EWH

[gtx10]

i would add that the csw also applied lubricant to the condom before it was inserted into my anus

[gtx10]

apologies the title should read "HIV exposure through used condom"