[Question #10523] Oral and Frottage
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22 months ago
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I am a male and Yesterday I received oral sex from another man which included 2 mins of frottage. The frottage was mostly him rubbing his penis between my thighs and buttocks, but also my torso. I don’t believe our penis touched but I can guarantee that they didn’t during the torso rubbing.
There was no intentional penis to penis contact, but I did feel his penis on my scrotum and possible next to my penis at one point.
I am concerned about STI’s. What bacterial STI’s should I be concerned about?
I received 2 of the 3 HPV vaccines when I was 26 but not sure if that protects me.
I have HSV1 and I know that HSV2 is not a risk for receipt of oral but what about frottage?
I am currently taking 750mg per day of levofloxacin for an unrelated issue if that matters .
Can I continue unprotected sex with my regular partner?
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H. Hunter Handsfield, MD
22 months ago
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Welcome back to the forum. I reviewed your recent discussion with Dr. Hook and agree with his evaluation and advice. Since this new exposure is essentially the same as the ones discussed then, I would encourage you to re-read that thread. Most of your questions now were addressed then, or at least the answers should be obvious from that discussion. This exposure is entirely free of any significant STI risk, including HPV. To your specific questions:
"What bacterial STI's should I be concerned about?" Levofloxacin in that dose would prevent chlamydia, and most but not all gonorrhea; it has no effect on syphilis. However, the exposure itself was risk free for all these infections, even if you were not taking levo.
HPV vaccination and risk: Although three doses is officially recommended, it is now known that two doses is equally good. You are immune to new infection with any of the nine HPV types covered by the vaccine. (These types cause ~90% of all HPV related cancers and genital or anal warts.) And the exposure was little or no risk for HPV anyway, even if you had not been immunized.
HSV risk: HSV2 is rarely if ever transmitted by frottage.
You can safely continue unprotected sex with your partner. No worries at all!
While I'm glad to have helped this time, please note our policy against repeated questions on the same topic. This being your second thread about non-penetrating quasi-sexual exposures, it should be the last. You can be sure the answers won't change until and unless you have insertive sex outside your regular partnership.
Best wishes. Let me know if anything isn't clear.
HHH, MD
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22 months ago
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Thank you for the information Dr. Handsfield. I will review the previous post and ensure that i no longer post about a similar topic. The only area where I need a little clarification is around:
“"What bacterial STI's should I be concerned about?" Levofloxacin in that dose would prevent chlamydia, and most but not all gonorrhea; it has no effect on syphilis. However, the exposure itself was risk free for all these infections, even if you were not taking levo.”
I thought that there is some risk of gonorrhea from receiving oral?
Syphilis shouldn’t be a concern from oral just vaginal or anal sex?
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H. Hunter Handsfield, MD
22 months ago
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You're right -- I was focused primarily on the frottage. Yes, gonorrhea can be transmitted oral to penis, but the odds for any particular exposure are probably under one chance in several thousand: most partners don't have oral infection; and even when present, infection is transmitted inefficiently. And the levofloxacin further reduces the chance. Syphilis is probably even less common from oral sex.
Absence of obvious symptoms (dripping pus, painful urination) within a week is nearly 100% reassurance against gonorrhea; and lack of a chancre (painless sore) of your penis within 2-3 weeks will mean you didn't acquire syphilis. If you feel you would be more reassured by negative testing, you could have a urethral or urine test for gonorrhea any time more than 2-3 days after the event; and a syphilis blood test after 6 weeks. However, I would not advise holding off that long on sex with your regular partner.
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22 months ago
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Thank you.
My primary care physician previously prescribed me doxy as pep for exposures such as these. I didn’t take it yesterday as I was completing the course of Levo , but plan to take it today within 24hrs of the oral event.
My final questions are:
With taking 200mg of doxy within 24hrs should I still be concerned about syphilis?
Is it reasonably safe to continue unprotected sex with my regular partner this weekend?
Thank you for the help. I will be sure to reference this if I find myself in a similar situation in the future.
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H. Hunter Handsfield, MD
22 months ago
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Doxy-PEP is newly recommended -- nice to know your doc is already on board with it. (My colleagues at UW are the investigators on one of the two main research studies supporting Doxy-PEP, the senior one my former trainee, so I know the details intimately.) Doxy-PEP is recommended for higher risk scenarios than yours, primarily for men having unprotected anal (either top or bottom), and I wouldn't have prescribed it had you been my patient. As already noted, you're not at risk for chlamydia at all, and for gonorrhea prevention doxycycline is even less effective than levofloxacin. It would be effective in preventing syphilis, but that's very low risk as discussed above. However, it won't be harmful and it would free you from the need for syphilis testing in a few weeks, so feel free.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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