Worring about infection

[Sabi2014]

Dear Doctor,
I'm a man from Russia, I'm circumcised. 10 days ago I have protected vaginal sex with a prostitute. (Elite prostitute, expensive). The act was protected, and before the ejaculation, I came out from the vagina. I mean the ejaculation was NOT in the vagina. When I was ejaculating, I broke the condom with my hand, and the half of the condom remained on the penis (the basis part). And now I'm worrying if there was fluid on the condom and came on the penis.
1. Tell me please, is there any risk of HIV infection in this case?
I want to repeat that ejaculation was out of the vagina.
2. And for my information, tell me please your opinion about the circumcision. Does it decrease the risk? I'm circumcised from childhood.
I will be thankful for your answer. I apologise for my bad english. Waiting for the answer.
3. what do you think about the reliability of Alere Determine™ HIV-1/2 Ag/Ab Combo tests?

[Edward W Hook, MD]

There are too many manufacturers of tests for HIV for us to be able to monito the performance of all of them however all commercially available tests are typically required to perfrom to standards set by the World Health Organization and the U.S. FDA.   I would have complete faith in the results of your tests when you get them, not that you need them.  EWH

[Sabi2014]

Thanks a lot for your answers doctor.
Would you mind asking you another question? I hope you answer me.
I want to do therefore a test on HIV after 4 weeks. Tell me please, What do you think, if I do a HIV 1,2 ag/ab combo test after 4 weeks, the result will be reliable?
I think, if for example, in the US the combo tests 4-the generation are reliable after 4 weeks, then what about in Russia? Possibly here the tests are not so qualified, or it doesn't matter, and 4-th generation tests are reliable everywhere?
You have completely answered to my first question, but I'm still nervous, whether the vaginal secretions from the outside of the condom came on my penis or not.

[Edward W Hook, MD]

There are no cases in which HIV has been transmitted to others by receipt of oral sex, including rimming.  EWH

[Sabi2014]

Dear Doctor, thank you very much for your answer.
I want to add that the prostitute gave me a blow job without the condom? is it risky? I want to know does HIV infection occur by rimming?
Please answer to these questions. I will be grateful

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to comment.  Let me first congratulate you on your commitment to safe, condom protected sex.  It will do much to keep you free of HIV and other STIs.  Unfortunately, condoms are not perfect and break about 1% of the time they are used.  In your own case, that the condom broke once you were outside of your partner is of no consequence and there is no associated risk to you from any of your partner's vaginal secretions that might have been on the outside of the condom at the time it broke once you had left your partner.

Thus, in answer to your specific questions:
1. Tell me please, is there any risk of HIV infection in this case?
I want to repeat that ejaculation was out of the vagina.
See above. This was a no risk event.

2. And for my information, tell me please your opinion about the circumcision. Does it decrease the risk? I'm circumcised from childhood.
I will be thankful for your answer. I apologise for my bad english. Waiting for the answer.
Your English is fine.  Circumcised men are about 50% less likely to acquired HIV, if exposed, than uncircumcised men.  This has been shown in several large studies.  

3. what do you think about the reliability of Alere Determine™ HIV-1/2 Ag/Ab Combo tests?
I am not familiar with this specific brand of test and, as a rule do not follow them brand by brand.  However, all WHO and FDA approved Combo tests perform about the same, giving entirely reliable test results at 4 weeks after exposure.

I hope these comments are helpful to you.  EWH