I’m a heterosexual male and my exposures (once a month on average) are limited to mutual masturbation with female masseuses at massage parlors (getting a handjob or being anally fingered and/or fingering the masseuse). Absolutely no oral or penetrative sex. I also try and be diligent about not exchanging genital fluids during the mutual masturbation. My questions:

1) What are my risk of HIV from these activities? 

2) What are the risk of Syphilis from these activities? The reason I ask about syphilis is that I have developed a rash on my hands (6-7 “spots” on each palm or side of fingers and half of them had a vesicular/blister like appearance surrounded by a red halo and were sensitive/painful to press  on). I also had a vesicular spot in my mouth which healed in a couple of days and may have a couple on my soles as well (I’m now seeking them). They look more like textbook “hand foot and mouth” rash (I do have two young kids in daycare - they did get HFM a few months ago but have been good since). The rash came up suddenly and has mostly healed / dried up in 3-4 days, with small red spots where the blisters or papule used to be. I am getting a full panel STD test (including syphilis) but wanted your opinion especially as I don’t want to transmit this disease to family and friends via this rash (through handshakes / casual contacts). 

Please let me know what your advice would be?

Looking back at your previous question 4 years ago, you asked pretty much the same questions. The answers haven't changed. (It was no. 6308, if you'd like to go back and see that discussion for more detail than my current reply.) The risk of STDs from hand-genital contact or fingering (either genital or anal) is extremely low, essentially zero. There has never been a case of HIV or syphilis documented to be transmitted in this fashion. Stated another way, based on your description, your sexual activities at massage parlors have been entirely safe.

I can't comment on possible causes of your skin rash, except to be confident it isn't syphilis because you have not been at significant risk. The absence of a previous chancre (syphilitic sore) at a site of exposure and quick resolution of most of the rash plus its blister-like appearance also argue against syphilis. However, since you are concerned about syphilis, why not have a blood test anyway? You can expect a negative result, which would prove syphilis isn't the cause.

Even if you had syphilis, it is never transmitted by the non-intimate kinds of personal contact you mention. Only by sex. However, a childhood type illness certainly could be transmitted in that manner -- so for the time being it's still wise to be careful about your friends, co-workers, etc. (But even here, transmission is not by hand- or skin contact, but through fluids like saliva.)

In other words, my advice is that you have a syphilis test, but only if you want additoinal reassurance about it -- not because I believe you have it, and not to protect family members or other personal contacts.

I hope these commetns are helpful. Let me know if anything isn't clear. Happy new year!

HHH, MD

Feel free to return with a final comment if you would like to report your test result. No others until then, however; threads are closed after two follow-up comments or questions.