[Question #11197] Hiv, Syphilis

16 months ago

Hi Dr.Hunter

I am very worried. I went to a massage parlor in Dubai, I received a massage from a Thai ladyboy. During 40 min I received a normal massage on my back and legs. The worker had long nails.

At the end, I took of my underwear and the worker too, and she layer on her belly and I frotted my genitals over her butt but at no time my penis touched her anus.

Then we put a condom each and did mutual oral.

I also rubbed my penis wearing condom against her penis wearing condom too and surrounding areas, I also touched her penis earlier for few seconds without condom and her testicles.

I noticed she had like one bump or like a skin just at her anus, I'm not sure what was that.

What are my risks for HIV, Syphilus, Hepatitis and Herpes? I am married and I'm dead worried.

The worker said she tested 3 months ago before she arrived and she's taking some medicine for protection if I understood well but I'm not sure what it could be

Thank you

H. Hunter Handsfield, MD

16 months ago

Welcome to the forum. Thank you for your confidence in our services.

You describe a zero risk exposure, or very close to zero. You did not have penile penetration, either by you or your "ladyboy" partner. That means there was no risk for HIV, viral hepatitis, or other STIs transmitted primarily through body fluids. There could be slight risk for those transmitted by sexual skin-to-skin contact, i.e. herpes, syphilis and HPV. But even these are very low and I do not advise you be tested for anything.

And it sounds like she is at low risk anyway. Presumably her recent tests included HIV and common STIs like gonorrhea, chlamyida and syphilis. "Medicine for protection" could be pre-exposure HIV prophylaxis (PrEP) to prevent HIV, or perhaps post-exposure prophylaxis with doxycycline (doxy-PEP) to prevent syphilis, chlamydia and gonorrhea -- or both. In any case, either or both of these greatly lower her risk of being infected even if exposed.

All things considered, I see no cause for worry!

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

HHH, MD

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16 months ago

Dr. Handsfield,

Thank you for your detailed answer. I understand that there was no risk for HIV as there was no penetration.

I'd appreciate if you could clarify the following points.

1. For the mutual oral, we've used an extra safe condom that I bought the same day, but I'm wondering there were micro holes that could put me at risk while I gave oral and receive it, although the condoms seemed solid and didn't notice any holes or breaks.

2. Is it true that syphilis is contacted by direct contact with the lesion? If so, and assuming that thing I saw in her anus was a syphilis lesion, and I didn't touch it with my penile nor hands, is there a risk of getting syphilis?

3. The skin to skin contact was pubis to pubis, testicles to testicles, and the surrounding areas, but our penises were all the time covered.

4. When is the soonest I can get tested for Syphilis, herpes and HPV? And what kind of tests.

I feel guilty and I need to resume sex with my wife but I'm scared to infect her.

Thank you for your service and patience.

H. Hunter Handsfield, MD

16 months ago

Thanks for the thanks. I'm happy to have helped -- so far.

1. There is no such thing as microscopic defects or holes in condoms that permit transmission of any infection. That's an urban myth. (For that reason, we recommend against "water testing" to check for leaks. If a condom doesn't break wide open, protection was complete.

2. Yes, syphilis transmission requires direct contact with an infected lesion. However, many syphilis lesion are difficult to see in fact most probably are invisible. If there was a syphilis lesion in your partner's anal area, then you can assume any sex with her was very high risk for syphilis. However, a "skin bump" doesn't sound like syphilis.

3. I knew this. No risk.

4. There is no test for newly acquired HPV infection; and even if they were, if you caught HPV it likely would not show up for several months. The herpes blood tests are not sufficiently accurate for you to be tested in this situation. A negative result will not prove you didn't catch HSV, and positive results often are unreliable. That leaves syphilis. The risk was low enough that you really don't need testing, assuming you don't develop a genital sore in the next 2-3 weeks. But if you feel you need a confirmatory test, have either an RPR or an EIA test 6 weeks after the exposure.

In the meantime, re-read my initial reply above. You are at very low risk of any and all STDs. There is no reason you should not continue unprotected sex with your wife. There is almost no chance you have anything from the event described.

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16 months ago

Dr. Handsfield, thanks again for your explanation.

Just a couple of points to clarify.

1. What do you mean by "assuming she had a syphilis lesion in her anal area, any sex would be high risk, what did you mean by any sex? It includes penis to penis rubbing with condoms? Because my skin never touched her anal area, only her cheeks.

2. I know you (almost) never use the word never or zero risk, but is it in theory only?

3. Is it possible to take the adequate antibiotic for syphilis now before I resume sex with my wife just in case? If yes, do you recommend it?

3. In your respected opinion, from this encounter what is the probability I caught HPV and HSV if she was infected? In percentage

4. In HSV, it is required to get in contact with the lesion to get infected, same as syphilis?

5. Lastly, does HPV clear from the body with the immune system if the person is healthy and does exercise regularly?

Thank you again for your patience.

H. Hunter Handsfield, MD

16 months ago

1. I meant primarily insertive sex. However, if you know with high certainty that a partner is likely to have syphilis, I would advise no sex of any kind: no oral, no kissing, no massage, no body contact of any kind. The risks of those activities are extremely low but not zero, and syphilis is a dangerous infection. Do not look for a middle ground: syphilis (like untreated HIV) means no sex of any kind, period.

2. It's more than theory, the risks are real. They are low, but real.

3. You do not know your partner had syphilis and, given her testing history, almost certainly she did not. All this discussion is in case some partner in the future might have syphilis. If somehow I were in your current situation, I would be continuing unprotected sex with my wife.

4. Yes.

5. Most HPV infections are controlled by the immune system over time, but that control is incomplete. All HPV infections persist for life in latent (undetectable) form, but have the potential to reactivate.

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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