Most FSW do not have STIs however, as you know, there are risks related to their work and as a result, steps to stay safe are quite appropriate.  You are correct, mutual masturbation, erotic massage, body rubbing (frottage), and kissing are all virtually no risk activities.  Fingering, which is a form or masturbation is safe sex as well.  Somewhat recently there has been evidence that some STIs, specifically gonorrhea can occasionally be transmitted through oral sex (fellatio or cunnilingus) and occasionally a male receiving oral sex can experience irritation due to introduction of a partner's oral bacteria in to the urethra- this is referred to as non-chlamydial NGU.  The risk for gonorrhea from oral sex is certainly lower than other sorts of penetrative sexual activities and non-chlamydial NGU is generally considered to not represent a risk for complications or transmission to partners.  Thus as a generalization, the activities you describe are all either no risk (erotic massage, frottage, mutual masturbation) while receipt of oral sex is low risk.

In terms of HIV, the CC estimates that oral sex (fellatio or cunnilingus) can with an untreated, HIV infected partner leads to HIV transmission about once in every 10,000 exposures however we know of no instances in which HIV has resulted from receipt of oral sex by a male and acquisition of HIV through cunnilingus is very, very rare.  I really would have few concerns about these activities.

As you move forward, in identifying the FSW to participate in the activities you describe, you may want to ask them about their status and testing history.  Most FSWs do not have HIV or STIs and most people do tell the truth.

I hope this information is helpful.  EWH

A few very quick clarifications:

1) When you mention 'virtually no risk' acitivites - does this mean there might be a theoretical risk but in reality this is not something to worry about in reality or simply isn't observed in the real world?

2) For receiving fellatio or receiving cunnilingus, you mention that 'occasionally' this can result in some STI transmission or NGU. To get a rough sense of the probabilities here, is this something very rarely seen in clinical practice? 

3) The CDC estimates you mention: is that for receiving, giving, or both?

4) If an individual has any STI infection in the mouth/throat (if that is how oral transmission occurs?), would they be likely to realise it/know about it? And would that show up in normal testing?

Thanks again.

1) When you mention 'virtually no risk' acitivites - does this mean there might be a theoretical risk but in reality this is not something to worry about in reality or simply isn't observed in the real world?

Correct.  In science we never say never.  New information comes to light regularly.  Thus virtually no risk in the situations I described are about the same as when I say that it is virtually certain that you will not be struck by lightening while reading this response.  

2) For receiving fellatio or receiving cunnilingus, you mention that 'occasionally' this can result in some STI transmission or NGU. To get a rough sense of the probabilities here, is this something very rarely seen in clinical practice? 

Clinicians who specialize in sexual health see this occasionally.  It's hard to give a specific value.  Most importantly however, as disruptions in the normal bacteria of the genital tract, these infections are not transmitted to partners and are not associated with complications.  They typically resolve without therapy although therapy for NGU may hasten resolution.

3) The CDC estimates you mention: is that for receiving, giving, or both?

Both.  In our opinion the CDC estimates are overly conservative.  As I mentioned we are not aware of a case of HIV proven to have been transmitted through receipt of fellatio.  Further, remember,  1 in 10,000 risk is like receiving a BJ from a person with untreated HIV daily for more than 27 years.

4) If an individual has any STI infection in the mouth/throat (if that is how oral transmission occurs?), would they be likely to realise it/know about it? And would that show up in normal testing?

Oral infections are typically asymptomatic and are detected through testing

EWH

1) Just a quick clarification on cunnilingus. For giving/receiving this, from what I can see on the forum, despite the potential risk, there is no actual recorded/documented case of HIV transmission - is that correct?

2) For other STDs, do we have any estimated/documented probabilities for transmission through giving/receiving cunnilingus/fellatio (1/100; 1/1000; 1/10,000 etc.): or is it simply classed as 'low-risk'. 

3) For kissing (mouth/body), is it correct the only possible risk is general colds/COVID etc and HSV-1? (Note: I think both my gf and I are HSV-1 positive as she has had a cold sore in the past, as did my ex-gf, so I would be really surprised if we both didn't already have this.) 

4) Normal body rubbing/grinding is zero-risk as you point out below. But for tribbing or a penis/vaginal rubbing/grinding without penetration: this would start entering potentially risky territory?

5) We have spoken to a CSW who says she has 'recently' had STI testing, which is reassuring. And given where we are, the individual almost certainly would have had mandated HIV-tests every 2-3 years for some time and tested negative repeatedly. However, my question is, what recent tests should she have done to be confident, and when precisely? There are some testing panels with 20+ tests/pathogens (most of which I have never heard of) and others with 5 or 6. And if negative tests have recently been received, are there any STIs which can be undetectable on testing but then become contagious shortly thereafter? I suppose am trying to understand when negative tests can be trusted in terms of timeframes and when further/repeat testing would be better? If someone has tested negative in the last 30 days then the risks must become very low?

1.  Actually there are a few, very few cases.  Cunnilingus is clearly biologically inefficient for HIV transmission 

2.  CDC estimates both fellatio and cunnilingus to be transmitted come on average less than once, and every 10,000 exposures to an untreated, infected partner.

3.  Correct 

4.  Body rubbing/ frottage is zero risk.  Don’t split hairs 

5. Negative tests are strong but never absolute assurances.  They are as good as it gets. Time intervals for STI incubation vary

End of thread.  EWH