I'm a gay mail with a low risk tolerance. I now mostly keep my experiences to mutual masturbation, massagage, & kissing. I try to limit cross contamination to avoid any flulid transfer on the skin.

You've said many times that mutual masturbation is virtually no STI risk. But if I am doing this regularly does that eventually add up to risk? Do these events necessitate that I test regularly? Or can I continue without concern for ongoing risk?

If there is no insertion and no genetial to genital/mouth/anus touching, is it okay for my penis to rub against other body parts so long as there is no rash on the area? Or is that risky and it's better to keep it without rubbing to avoid skin-to-skin STIs?

4 weeks ago I kissed another male. There was <30 seconds of french kissing. He had no visable sores. 4 days ago I developed a small (about 0.3cm) round raised whitish lesion on the inside of my front lip near the gum line. Day 3 there was some blood when I rubbed my finger over it and it looked like it had ulcerated and turned more pink. It is not painful. It does not feel firm. I have no fever. Today (day 4) it is improving and harder to see. It doesn't look like the syphilis pics I see online but I am sure those are bad cases and many sites say chancres can be unnoticeable. The medical descriptions I read seem simimlar to mine but are also all over the place. Is this syphillis? If so can I test now?

Basically you are asking if low-risk (even near zero risk) events can add up to higher risk over time. Obviously, yes. If a particular sexual practice has an STI risk of, say, one in a million, then after 100 such events the risk mathematically becomes one chance in 10,000. Still extremely low -- most people could have such exposures three times a week for a lifetime and never become infected. But the science of the response to risk is very clear:  fear, concern and anxiety are minimally related to numerical risk. And low numerical risk does not mean testing has no value:  the psychological value of negative test results can be very important.

So I definitely would not advise STI/HIV testing after any individual exposure of the sort you have had or intend in the future. However, it would not be unreasonable for you to be tested from time to time, maybe once a year or thereabouts. But even then, don't go overboard. Probably the only reasonable tests would be gonorrhea and chlamydia (urine, rectal swab, throat  swab -- depending on sites potentially exposed -- and blood tests for HIV and syphilis. I would avoid "comprehensive" test panels that include tests of low reliability (like herpes) or truly zero risk.

The sort of oral lesion you describe is not uncommon -- maybe a small cyst or irritated mucus gland? Or conceivably you had an episode of recurrent oral herpes -- in which case it most likely dates back to a nonsexual infection in childhood. It wasn't a syphilitic chancre, which would not already be healing. started too long after the kissing event to have been acquired at that time. A general lesson here is to avoid the assumption that every little itch, tingle or other sensation is related to your sexual experiences. 

However, if you go ahead with periodic testing, you certainly can can do it after particular events or symptoms that concern you. In other words, given your concern about the oral lesion, maybe this is a good time for syphilis and HIV blood tests, primarily just for their reassurrance value.

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

HHH, MD

I do test about once a year for HIV/Syph. My struggle is feeling like I should test after every encounter. To clarify your response, given that I stick to massage, body contact, and kissing, the only STD test I really need to do annually is syphillis right? (I am vaxxed for HPV). If those are the only encounters i'm having then no HIV/Gon/Clam testing is needed correct because no insertion? I will always test for HIV because im so scared of it but thats partially why I limit what I do, so as to never get HIV.

Given what I do (massage, body contact, kissing) do you think Doxy Pep is something I should have and use? Or only if theres insertion? Do you have any concerns about frequent and/or long term use? I've only recently heard of it but it seems to be growing quickly in popularity in MSM circles and i'm not sure when its good to use or not.

And finally, I am mpox vaxxed and I know mpox is not as prevalant in the U.S. as it once was, but does my vax fully protect me? How likely is it to get mpox from the things I do (massage, body contact, kissing)?

3) How much do I really need to worry about getting syphilis or gonorrhea from kissing? I assume pecks on the lips are not an issue but what about deep kissing?

4) Last week I used a guys fleshlight and only after did I read online that it can transmit all the STDs. He did not use it while I was there but I do not know when he last cleaned it. I did use a condom which remained intact so it did not touch any of my skin. That made this a safe encounter right? Or was this risky? Any guidance on using someone elses sex toy?

Thanks for your advice. 

2) The amoxicillin would have cured or prevented syphilis if you were exposed, preventing any future test from becoming positive. Given this treatment, your syphilis blood test was unnecessary.

3) Deep kissing potentially can transmit syphilis and gonorrhea. Social kissing (like "a peck on the lips") is entirely risk free.

4) Dildos, fleshlights etc can transmit infection only if used by other persons within minutes, but even this is low risk. Given the probable time from its prior use, I would consider this risk free. I suggest using previously used sex toys only if you know they have been cleaned between uses.

That concludes this thread. I hope the discussion has been helpful.