Exposure While Removing Condom

[nycguy1975]

Hello Dr.  I visited an escort for the first time a few days ago and have been very anxious about HIV.  Here is what happened.  The escort performed oral sex on me WITH a condom.  After I ejaculated, the escort handed me a clean sheet of paper towel and I used it to remove the condom.  As far as I remember the used condom was completely wrapped in the paper towel.  The thing I'm worried about is that I used the same paper towel to briefly wipe the head and shaft of my penis.  Is there any risk of me wiping my penis with the same paper towel I used to wrap the condom in?  I think I remember bunching up the paper towel a bit but I'm not sure if that makes any difference at all.  I'm just worried that she might have trace elements of HIV in her saliva (or possibly blood) that were on the outside of the condom that could have come in contact with my penis via the paper towel.  Do I have a valid concern or am I just being paranoid?  Thanks for your input.

[H. Hunter Handsfield, M.D.]

How a condom is removed does not significantly change HIV risk.  The important thing is that a condom was in place when the penis was in place for all genital contact.  Even with condoms, usually there is at least some contact with a partner's genital secretions -- it is very difficult to prevent entirely, especially with the male condom, which doesn't cover the base of the penis.  (The female condom probably provides better coverage.)  And yet, HIV transmission doesn't occur with properly used condoms that don't rupture.

So you need to stop over-thinking the details of how the condom was removed, cleaning up afterward, and stuff like that.  Those things make no known difference.

And on top of that, it is very rare for a female escort in the US or most industrialized countries to have HIV.  That she requires her customers to use condoms provides an additional measure of insurance:  It means she isn't infected and wants to remain that way.  In general, commercial sex workers are at higher risk from their customers, not the other way around.

All is well.  You don't need HIV testing on account of this event.  Of course feel free to do it if my reassurance doesn't settle your fears and you will sleep better knowing your test is negative.

Regards--   HHH, MD

[H. Hunter Handsfield, M.D.]

"if I squeeze hard enough small amounts of fluid eventually come out":  Good grief.  If I squeeze normal skin hard enough and long enough, I can make tissue fluids come out.  But what does it matter??  You cannot infect your wife with something you don't have, no matter what sorts of sexual contact you have with her.

This thread is over.  No more comments will be accepted.

[nycguy1975]

Thank you Dr.  I am working hard to accept this reassurance from you.  I told my wife about the incident and we decided to put it past us and not have any sex for the next month or so until I got tested.  However, the other night, we engaged in mutual masturbation and I fingered her for a few minutes.  The problem is that I suffer from eczema and the finger that I was using on my girlfriend had a tiny "weeping" wound just above my fingernail.  I don't usually notice these wounds unless I come into contact with something acidic (lemon juice, some soaps, etc).  As I was fingering her my finger started to sting and I knew that I must have had some sort of eczema outbreak.  So I stopped right away.  My question is could have I put my wife at risk by fingering her?  The tiny eczema wound on my finger wasn't gushing blood or ooze or anything.  But if I squeeze hard enough small amounts of fluid eventually come out.  Is there any risk in this situation presuming that I could be infected?  Please respond.  Thanks.

[H. Hunter Handsfield, M.D.]

I don't know and it doesn't matter.  If nobody has ever been infected this way, what does it matter how long the virus survives?  Getting HIV requres more than exposure to "just one virus".  It takes lots of virus that get exposed to the right kind of cells.  That is why even with unprotected vaginal sex, the average transmission risk -- if one person has HIV -- averages once for every 1,000-2,000 exposures.

You came here for reassuarnce.  I gave it.  Stop trying to convince me (and yourself) that some risk existed.  None did, regardless of virus survival.  Please accept the reassurance and move on.

[nycguy1975]

Dr.  Could you address my last concern for me regarding whether or not HIV would remain infectious during the situation I described?

[nycguy1975]

Thanks again, Dr.  I guess my only last concern would be whether or not the time between ejaculation and clean-up would be long enough for any possible trace amounts of HIV on the paper towel to remain infectious outside the body.  Should I even be worried about that sort of thing?  Or is that irrelevant as well?  Last question, promise!

[H. Hunter Handsfield, M.D.]

I missed the oral sex part.  Oral sex carries no HIV risk even without a condom, and how saliva or oral secretions are cleaned up can make no difference.  And if toilet paper contamination could spread HIV, don't you think at least one nonsexual household partner of an HIV infected person would have become infected during the course of the AIDS epidemic?  It has never happened.  And my comment about yoru partner not having HIV still remains valid.

In summary, no risk and no worries.

[nycguy1975]

Thanks for the input, Dr.  Just to clarify all the escort did was perform oral sex on me.  We did not have vaginal sex.  And just to wrap things up (no pun intended), would you classify this incident as "NO risk" despite the possiblity of cross contamination via the toilet paper?  Thanks again.