Condom slip off

[JamesT123]

Dear doctors,

6 days ago I was drunk and ended up in a brothel. I paid for a female sex worker and I had protected oral sex from her with her rolling the condom on my penis by using her mouth and hand. While she was rolling down the condom, she actually tore the skin on the shaft of the penis (near to the head of penis but no blood). We then have sexual intercourse for about 15-20 mins and I actually noted that the condom slip off during the sexual intercourse, exposing the shaft of the penis, probably still covering 50% of the penis (I was too drunk to put the condom back in place).

The next day, there is some redness on my penis and itchiness on the shaft of the penis (in fact, very itchy) till today. I began to worry and since then, i have sore throat, night sweat (every night) and swollen lymph node. My anxiety is driving me mad.

Now, here's my question:
i) Am I at risk for HIV or any potential STD based on the above situation (condom slip off and skin tore)?
ii) Would it be possible for the virginal fluids flowing into the condom and reach the tip of the penis During the intercourse since the uncovered area is also inserted into the vagina and the condom only covers 50% of my penis and hence putting me at risk?
iii) Should I get tested?
iv) Should i refrain from having sex with my gf?

Thanks in advance for your help doctor. Your valuable advise is very much appreciated.

[Edward W Hook, MD]

Yes  a 28 day DUO test is defintive and proves that your diarrhea is not related to HIV. The recommendation that you need another test  in three months is overly conservative and not needed for routine medical care such as yours. EWH

[JamesT123]

Also, The local GP advise me to do another testing after 3 months

[JamesT123]

Hi Dr,

I have done another test at 28 days and it is negative. Is this conclusive? I have a chronic diarrhea for about a week recently.

[Edward W Hook, MD]

The test you mention is a DUO test.  A negative test at 22 days is strong evidence that you were not infected however there are not precise data on how many infections might be missed by testing at 22 days rather than the recommended time however I doubt that it would be many. My 28 day recommendation is based on available scientific data.  Given the low risk of your contact, there is little chance that further testing would show that you were infected.  EWH

[JamesT123]

Hi Doctor,

I have taken a HIV 1 and 2 AG/AB screen assay based on CMIA principle at 22 days and it is negative. Is this a duo test? How reliable is it to do it at 22days.

[Edward W Hook, MD]

PCR testing is not recommended for HIV diagnosis.  The DUO test is. I suggest a DUO test at 28 days.  EWH

[JamesT123]

Apologize if you feel offended Dr. Just curious, if someone accidentally tore the skin/tissue of the shaft of the penis, would you feel itchy on that particular area the next day?

Also, would you recommend a PCR RNA test at 10 days or a HIV duo testing at 28 days?

[Edward W Hook, MD]

Commercial sex workers in brothels typically know they are at risk and take measures to protect themselves including regular check ups.  They are professioanls and STIs are bad for business.  You are more likey to be havng sex with an infected person picked up for a "one night stand" in a bar than as a client in a brothel.

Your second question is a bit offensive. Are you suggesting that I would live different advice here than I would to a patient I was seeing.   Of course not.  If you test, you are doing it for your own peace of mind, something it seems you are in need of.  EWH

[JamesT123]

Dear doctor,

Just wondering, why would you say that most commercial sex workers do not have STIs?

Under a normal circumstances, would you recommend your patient to do test based on the above event?

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to comment.  Condom protected sex is safe sex and in terms of the most common STIs (HIV, gonorrhea, chlamydia, NGU, trich) that is the case as long as the condom covers the tip of the penis.  Less common STIs such as syphilis and herpes can be transmitted despite even perfect condom use but even for these infections, condoms markedly reduce the risk for infection.  Since most commercial sex workers do not have STIs, since most exposures to infected partners do not result in infection and since you used a condom, your risk for infection with any STI (including HIV) is very low.  There is not no risk at all but the absence of symptoms now, 6 days after the exposure also makes it somewhat more unlikely that you were infected through the exposure you describe.  So, the question then becomes just how worried are you?  This is a personal decision.  given your circumstances I would estimate your risk for infection as being somewhat less than 1%/

In answer to your specific questions:
i) Am I at risk for HIV or any potential STD based on the above situation (condom slip off and skin tore)?
See above.  The tearing/chaffing of your skin does not change my estimates.

ii) Would it be possible for the virginal fluids flowing into the condom and reach the tip of the penis During the intercourse since the uncovered area is also inserted into the vagina and the condom only covers 50% of my penis and hence putting me at risk?
We get this question often. There is no evidence that vaginal secretions can work their way up, into a condom that has slipped down on the penis.

iii) Should I get tested?
This is a personal choice.  Your risk for infection from this encounter is low.  On the other hand, you describe considerable anxiety and anxiety-related symptoms, thus testing (and an examination) might be helpful.

iv) Should i refrain from having sex with my gf?
Again, a personal decision.  Is a less than 1% chance of infection low enough for you?  It would be for many people.

I hope this perspective is helpful to you. EWH