chapped knuckles/condom shifting HIV/STD risk

[tony_88]

Hi doctor,
I had condom-protected oral and vaginal intercourse with a female CSW yesterday. I felt I used the condom correctly, as there was no breakage (I water-tested it after the act).

I had dry, chapped knuckles the day of the event. A couple of hours before the sex act, I washed my hands with soap and the skin near my left knuckle produced a small, open cut (reddish spot with some blood coming out).

During the vaginal intercourse, I withdrew my penis with my left hand twice to check if the condom was still in tact, before continuing. My left fingers and palm touched the outside of condom, which had her vaginal fluids on it.

After the act, I took condom off with napkin and washed my hands with soap. My question are the following.

1) Is there a possibility that some of her vaginal fluid on my left hand, when washing my hand with water could have transmitted the HIV virus to my chapped, red spot on my knuckle? Is this a route for HIV transmission?

2) During parts of the vaginal intercourse, I felt that my condom was possibly slipping. At those times, I stopped and checked and it seemed in tact. In fact, when I entered, the CSW used her hands to help guide my penis into her. At the end of the intercourse, when I withdrew, the condom was fully intact and rolled down near base of my penis. Is there any possibility that the condom could have been rolled and then unrolled again during intercourse? Is this a HIV/STD risk? Why?

3) Please assess my risk for HIV/STDs doctor. Is HIV/STD testing warranted from this exposure?

Thank you.

[tony_88]

Thank you Dr. Hook!

[Edward W Hook, MD]

Good question.  You are correct, condoms should be rolled down as far as possible onto the penis however, I should also point out that it is not at all uncommon for condoms to slip partially during use, leaving a portion of the penis uncovered.  As long as the head of the penis is covered, condoms tyically do their job. EWH

[tony_88]

Thank you Dr. Hook for your response! I trust your medical advice and appreciate your great work in helping the public! :)  

One final question: in the medical literature, correct condom usage recommends rolling the condom all the way down to base of penis. sometimes, during intercourse, the condom position may shift and cover say, 3/4 of the penis.

from a medical perspective, what portion of the penis (e.g. head, shaft) must be covered in order for the condom to be effective against HIV/STD prevention?

That is my final question. Thank you Dr. Hook!

[Edward W Hook, MD]

Welcome to the Forum.  My answer will be brief but to the point.  Your questions suggest a misunderstanding about how HIV is transmitted.  HIV is transmitted in adults only through unprotected genital or ano-gential intercourse or injection of infected materials deep into tissue.  Not through touching, kissing or surface contamination, even when there are sores or abrasions present.  You do not know that your partner had HIV or an STD and even if they did, most exposures to infected partners do not lead to infection

In your case, you have done the right thing by using a condom to protect yourself.  Having done so, there is virtually no risk whatsoever for HIV or other common STDs.  The condom remained intact and did its job.  Contamination of surface scrapes and cuts with genital secretions does not pose a risk for HIV and should not concern you.

Related to your exposure, there is no reason for concern and no reason for testing.

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