[Question #103] Risk of any std (including HPV) from sex worker

38 months ago

What kind of a risk (for ANY STD) is there from a female sex worker (third world country) masterbating herself WITH lube just prior to grabbing penis and masterbating it, with lube and likely vaginal secretions on her hand?  I've read through the forums and found many threads with replies from both doctors stating the risk of HPV and ANY OTHER STDs is essentially zero and that neither doctor has seen or heard of such occurrence between 70 years combined experience.  Other threads, however, state that there have been cases of exactly this happening, including "technical" virgins who have HPV.  I'm a little confused on which reply to go with.  Is such an exposure a valid thing to be concerned about, HPV included?  Could Mycoplasma/Ureaplasma be transmitted this way as well?

2.  Random question.... I know you guys have mentioned that the majority of people have had HPV at some point and most people clear it.  Wouldn't sex workers (especially in third world countries where condom use is rare) be likely to have MANY MANY strains of HPV active at any time, given they are frequently being exposed to different strains of the virus?  Wouldn't this put someone with an exposure to said sex worker at a much higher risk of acquiring countless strains of HPV at once, and therefore less likely to clear the HPV?

Thank kindly for your time and all that you do to make people's lives better!  Sorry if my question is so similar to many others which you have already taken the time to answer. 

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Welcome to the Forum.  I am not sure where on the internet you have heard that hand to genital transfer of genital secretion can result in STI transmission but I can assure you that you did not hear it from us.  Direct (as opposed to indirect with hands as the transferring agent) contact is a requirement for STI transmission, even when a person has genital secretions and/or lubricant on their hands-this includes HPV (as well as mycoplasmas or ureaplasmas).  The exposure you describe did not put you at any meaningful risk for STI, is not a reason to seek testing, and is not a reason for concern.

As for your second question, your are correct that commercial sex workers would reasonably be likely to have HPV infection with multiple HPV strains over time and there are epidemiological studies which indicate that CSWs do have higher rates of cervical cancer.  Even so, there are no data to suggest that a single or even multiple exposures to a CSW is associated with persistent HPV.  There are no scientific data to prove or disprove this point but again, as we have said here on multiple occasions the proper approach to possible HPV for males is to be on the lookout for lesions and have them evaluated if they should occur.  for women, regular gynecological check ups as recommended are the way to go.  There is no data to suggest that any sort of single or even occasional exposure to at risk partners warrants special conerns or HPV testing.

I hope these comments are helpful.  Nothing mentioned in this post suggests you need to worry.  EWH

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38 months ago

Thanks for the reply!   I've read many threads where you or Dr. Handsfield state there is ZERO risk of HPV from mutual masterbation and that you've never heard a valid case, read a valid case, nor seen a valid case of it happening with over 70 years combined experience in clinics.  There are a couple other threads where you guys acknowledge such events though.  Here are a couple threads that I found where it is stated that hand-genital contact CAN cause HPV transmission(there are a couple more, but I figured these would suffice).   Please don't take offense to this, I'm just showing where my concern is coming from.  I respect your knowledge greatly and know I should take your reply as the final answer, but finding replies like the ones below leave a little nagging concern.  Is it possible that we don't really know if its transmitted by mutual masturbation because of lack of symptoms?  Are such cases dismissible/likely caused by oral sex?  Has there been enough study/knowledge/awareness of the virus to truly call it a "no risk" exposure at this point?  I understand that "everyone" gets, but I guess I'm a little overly concerned with this case as the person likely had countless strains of it.

A) "hand genital contact may transmit some cases"  http://www.medhelp.org/posts/STDs/Virgin-with-Hpv/show/379795

B)"Hand-genital contact might transmit HPV, especially if genital fluids were used as lubricant and if, as you sort of imply above, one or both persons handles their own genitals as well as their partners' "  http://www.medhelp.org/posts/STDs/Transmission-of-Genital-Warts-with-Mutual-Masterbation/show/2064813


2.  What is your opinion on females who have been vaccinated with the Gardasil 4 vaccine many years ago, who now seek extra protection of the Gardasil 9, providing they are still under 26 years of age?   Is there any danger/downside (other than money and pain) of receiving the new vaccine series many years after completing the Gardasil 4 series? 

Thank you again for sharing your vast knowledge on this subject and for being accessible to the masses.  You guys are amazing!

38 months ago

Sorry, couldn't edit my last reply.  Here are some studies which stated hand-genital infection as well.   Am I reading these wrong or missing something? 

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB4QFjAAahUKEwitmvC169HHAhXEkw0KHTSiCLc&url=http%3A%2F%2Fwwwnc.cdc.gov%2Feid%2Farticle%2F14%2F6%2Fpdfs%2F07-06162.pdf&ei=f4HjVe3eH8SnNrTEorgL&usg=AFQjCNGk3RFRiONCWxxm1I3X_WiisNMEQA

Study called "Transmission of Human Papillomavirus in Heterosexual Couples"

From a small 25 couple study--- "There were 4 instances of transmission from the woman’s hands to the man’s genitals, including 1 case in which it was the sole source (couple I). " 

And

"3 involved genital-to-hand transmission. Most genital-to-genital events involved transmission between penis subsites. In 3 instances, male self-inoculation immediately preceded transmission of HPV to female partners (couples A and B). "

https://www.womenshealth.gov/publications/our-publications/fact-sheet/human-papillomavirus.html#d

It is most often passed during vaginal and anal sex. Although much less common, it is possible to pass HPV during oral sex or hand to genital contact.

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Thanks for your follow-up.  I had not seen the article you refer to- it was published in a minor medical journal (nearly a decade ago) and as the authors indicate, there are a number of methodological limitations to their study, small numbers of participants being amongst them.  I would, at best, consider such reports the "exceptions that prove the rule" and stand by my original reply to you.  In science we can never say "never", just as I cannot tell you that you will not be struck by a meteor from space (someone was once) but such events are so rare and of such little consequence that they are not a meaningful concern.  This is the case regarding the exposure you describe, despite your contention that your patnet may have had "countless" HPV infections.

Regarding your second question, clearly there is no meaningful risk for previously vaccinated persons being vaccinated with the newer, nonavalent HPV vaccine however, as of now, there is also no formal recommendation that previously vaccinated persons benefit from vaccination with the newer vaccine either.  While the addition of five more HPV strains to the vaccine been judged to have sufficient additional benefit as to be cost-effective for persons who are not yet vaccinated, this increment does not translate to sufficiently broader coverage, compared to the protection derived from the quadrivalent vaccine to warrant repeat vaccination.  The increment is relatively small.

Hope these comments help.  EWH

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38 months ago

Thank you again for your replies.   It seems like 3 out of 25 study participants with genital-hand and 4 out of 25 study participants with hand-genital transfer is significantly more than rare, doesn't it?  Have there been any larger studies that show different results?  This study seems awfully concerning and seems to go against the safe mutual masturbation rule.


How soon after exposure is HPV contagious?  IE: Can it be spread the very next day? The next week?


Thank you again for your replies and the amazing service you are providing the community. 


Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

I tried to infer the answer in my earlier answer.  In recent years, there has been a proliferation of fee for publication journals in which the review process may be less rigorous than for better know journals.  A single small study in a less well know journal nine years ago without corroborating data since that time suggests that the authors findings may not be accurate.  I would discount this study. 

Whether HPV is spread by fomites without establishing infection is not clear.  Infection itself takes weeks to establish itself and become contagious.  A week would be too soon.  EWH

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