[Question #10417] Male Masseuse , HIV risk?

23 months ago

Hello Doctors, I am a gay man and last week I went to a male masseuse who gives relaxing, descontracturant and sensitive massages. I chose the sensitive massage. He started massaging my body very gently and then he started fingering my anus with 1 and 2 fingers I remember. I was laying with my face down. Then with the other hand, he started masturbating my penis. Later, he took his penis out of his shorts, and he made me grab his penis with my hand. I didn't masturbate him but I did hold his penis. I felt his torso on my back sometimes while massaging with his hands. Then I turned around with my face up, and he continued fingering my anus while masturbating my penis. I finished in his mouth.
My concerns are these:
1) He did masturbate himself and then he fingered my anus and masturbated my penis, is this a risk for HIV and STIs if his precum or cum got inside my anus or urethra?
2) At one moment I felt his penis touching my butt cheek, and then some oily liquid pour on my cheek and leg, he assured me it was the oil he was using, but what if he came there? Is this a risk for HIV or other STIs?
3) My anus was a bit sensitive from before because 2 hours ago I pooped and I cleaned too much and saw tiny stains of blood on the toilet paper, not deep red, more like light red/pink blood, then my anus remained sensitive. Is this a risk for HIV/STIs since he fingered me with my anus being like this?
4) What if he did penetrate my anus with his penis, and I thought it was a finger or 2 or 3?? I grabbed his penis with my hand and of course it had a different texture, size & temperature. Fingers feel different but I don't know if it's possible to not notice the difference. Please Help, Thank you.

H. Hunter Handsfield, MD

23 months ago

Greetings. Welcome and thanks for your confidence in our services. I'm happy to help.

You describe a risk-free exposure for all practical purposes, especially if there was no anal penetration. From your description, I'm inclined to believe that didn't happen -- assuming you weren't drunk or high as a kite, I have difficulty understanding how it could have happened without your knowledge. Neither HIV nor any other STIs is ever transmitted by frontage (body-body contact), massage, or hand-genital contact including anal fingering. The only aspect of this that carries modest risk was fellatio, i.e. your penis in his mouth. Even that is virtually zero risk for HIV (there has never been a scientifically documented case) and zero to low risk for STIs.

Those comments come close to answering your numbered questions, but here are my responses:

1. These are zero risk events, with no known instances of actual infection even when genital fluids are used for lubrication. While that doesn't in itself prove the risk is truly zero, it is low enough to ignore entirely.

2. Also no risk at all.

3. Hmm.... I don't see that this raises your risk, since there probably was no penile penetration. However, Have to wonder why you have anal sensitivity or slight bleeding -- and maybe slight discharge as well ("light red/pink" suggests blood diluted by mucus or inflammatory discharge). Having sex with other men, if you have had receptive anal sex ("bottom"), even with a regular partner and even if not very recent, I would suggest gonorrhea/chlamydia testing. But not on account of the exposure described here.

4. See my comments above. However, if there was penile penetration, your risk is higher -- although still very low since it couldn't have lasted more than a few seconds. Still, since you're uncertain, perhaps you now have two reasons to be tested for gonorrhea and chlamydia (at least 4 days after the possible exposure).

I really see no need for any other tests. But if you are tested for gonorrhea and chlamydia, maybe consider syphilis and HIV blood tests as well -- which should be done from time to time in MSM assuming at least occasional sexual activity involving your rectum.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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23 months ago

Thank you Dr. Hunter, first of all, I think it's my OCD making me doubt the situation, I know there was no penetration, I only felt fingers and since STIs are scary my OCD makes me doubt everything.
Actually, i'm a "top" I never receive anal penetration, I have a boyfriend and it's been long since the last time he fingered me. Maybe that's why I don't know how a penis feels inside the rectum.
The pink/red stains on the toilet paper come just after wiping too much after pooping. I don't have discharge regularly, and when I wipe the anus with paper these stains don't appear immediately, they appear after a lot of wiping, I think I just make microtears by wiping too much. My anus was sensitive because of that and maybe because the poop that I made wasn't very solid that day.

1) Would you still recommend those tests?

2) I still wanna test for HIV and syphilis? What is the window period? For HIV 4th gen it's 4 weeks or 6 weeks?

Thank you very much

H. Hunter Handsfield, MD

23 months ago

Thanks for the clarifications.

1) Nope: there's no point in rectal STI testing if no receptive anal sex.

2) HIV is pretty much impossible in this scenario, although syphilis conceivably could be acquired by oral contact with your penis. However, in that case in the next 1-2 weeks you would develop an obvious chancre (syphilitic ulcer); it would be hard to miss on the penis, right? Absent such an occurrence, from a medical/risk perspective there is no need for syphilis testing. Having said all that, I certainly understand that some anxious persons (perhaps especially those with OCD) feel more confident in lab test results than in professional opinion, no matter how expert. (We don't take it personally!) So feel free to be tested if you wish. The HIV AgAb (4th generation) blood tests detect 98-99% of infections at 4 weeks, 100% after 6 weeks. Syphilis blood tests also are conclusive at 6 weeks.

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