Dear Dr Hook,
Many thanks for your assessment and I am sorry for the delay in my response. It took me a while to try and understand your assessments. I assume the following as your reasons:
The condom could not have come out of the vaginal cana unless still on my penis and the last area to lose contact with the condom before it slips off is the glans.
The condom lay along the length of my penis, nore or less straight (on top of it) when I saw it, so I assume therefore that I could not have thrust back in without cover (if so it would have crumpled up)?
Am I reasoning correctly?
Thank you so much for your help
Welcome back to our Forum. I'll be pleased to address your questions. The exposure you describe was quite low risk. Condom protected sex is no risk as long as the condom did not break and yours did not (if it had there would be no doubt). When condoms come off as in the situation you describe, this is typically because the condom stays behind as the man removes his penis form his partner. In such situations the condom has done its job and there is no reason for concern. If the condom had come off during sex it would have worked its way up into your partner's vaginal and not been outside as you removed yourself.
As for your specific questions:
1.Please comment on the risk.
See above. I would not be worried about this exposure.
2, Please comment on the fact that she was West African
HIV is more common in sub-Saharan Africa than in other parts of the world. In West Africa while most HIV is caused by HIV-1, the type of HIV present across the globe, a small proportion of infections are caused by HIV-2. In your case, that your partner was from West Africa makes it slightly more likely that she had HIV but not much and does not in any way offset your condom use and its protective effect.
3. Please comment on the presence of menstrual blood in this equation
There is no evidence that, even with unprotected sex, that the presence of menstrual blood increases risk for infection. I would not be worried at all.
4. Please comment on STD / HIV testing and timing.
I would not be worried about STDs related to the exposure you report and see no particular need for testing because of it.
I hope my comments are helpful. EWH