[Question #1313] Wet Genital rubbing and HIV

46 months ago
Hi Dr, I hope you can help as I have been very anxious. 18 days ago I went to a masseuse and got a massage. She offered me body to body. We were both naked and covered in oil. 
She massaged my back and made me ejaculate by playing with my penis with her hands from reaching under.
She then 5mins later gave me frontal body to body and she was grinding my penis from tip to shaft between the labia and all over her vagina without a condom and also all over her tummy and breasts. There was no penetration but lots of sliding up and down my body with hers and naked and oiled genital rubbing/grinding. I had no cuts but my penis was a bit red and sore from handjob she had given me again for second time but I was anxious and unable to ejaculate. I had shower straight after and checked no open wounds or any blood just red from handjob all over and soreness at the balls end from pubes being tugged mainly during hand job. She does not offer anything else than massage and body to body with hand relief. 
I am extremely worried about HIV. Is it possible that I could have caught it with this episode? For last 2 days I have been peeing much more frequently but I think this is anxiety as no other symptoms of any STI.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

You can think of STDs in two groups: those transmitted primarily through infected fluids (gonorrhea, chlamydia, HIV, hepatitis B virus) and those transmitted by contact between infected surfaces (herpes, HPV, syphilis). Genital apposition, without penetration, is rarely if ever the source of the former; i.e. even the busiest STD or HIV/AIDS clinics never see infected patients whose only exposure was like yours. While nobody can say the risk is zero, the absence of recognized cases obviously indicates an exceedingly low risk, low enough to be considered zero for all practical purposes. However, genital contact without penetration is more commonly associated with the second group. However, even these are truly rare -- higher risk that for chlamydia, HIV etc, but still extremely low.

In addition to the inherently low risk of transmission, we can consider the chance the masseuse was infected. Assuming you're in the UK, she chance she has HIV is extremely low. Even among the most risky commercial sex workers in your country, fewer than 1 in a thousand have HIV. It could be higher in certain subgroups of CSWs, but for sure under a 1% chance. The chance she had other STDs probably is higher, but for all STDs, at any point in time most people at risk are not infected.

No STD causes increased urinary frequency as the only or main symptom. And this certainly is a very common occurrence with anxiety, especially anxiety over sexual exposures.

For those reasons, I don't recommend testing for HIV or any other STD. Certainly if somehow I had been in your situation, I would not be tested and would continue unprotected sex with my wife, without worry. That said, if you would like the extra reassurance of a negative test, you could have a 4th generation (antigen-antibody) HIV blood test at 4 weeks, by which time the result will be conclusive.

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD

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46 months ago
Hi and thanks for your time and quick feedback. 
In regards current symptoms for a couple of occasions I have felt heat (not very uncomfortable as such, not really burning pain) when peeing and also a bit sore and tingly burn today after ejaculating. Also this full feeling in my bladder as if pressure causing me to need to urinate after any drinks. However I have spent last 2 or 3 days opening my urethra to check for redness about 15 times per day so could this be irritating it? 
Also there was one other incident about 1 year ago with a call girl where I massaged her and fingered her to climax and then she gave me hand job to climax. No genital to genital contact.
I have just been back to the maessuse for 30 min appointment to ask her directly. This is why I ejaculated today as she gave me Swedish massage plus happy ending, no body to body. She was outright that she only uses stomach and thigh in that region as she does not want risk to her. She is from Romanian and sees her doctor whenever she returns every 6 to 12 months last time 7 months ago.
She has boyfriend who owns his own IT business as well and seeing him for 1 year and she has been in U.K. For 2 years. She was very clear that she only offers the massage and hand relief and I am only person she has had this way with anxiety. She was very relaxed and nice about my questions.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for the additional information. But it doesn't change my assessment or advice. Your symptoms aren't those of any STD: adding a sense of bladder "pressure" and the others things mention to increased urinary frequency still adds up as typical for genitally focused anxiety. As for your other exposures including the recent on and the one a year ago with a different partner, still no worries:  hand-genital contact for sure does not transmit HIV or other STDs.

Let's not mince words:  your masseuse is a commercial sex worker. However, it sounds like she looks after her health, and if she limits her commercial contacts to the kinds of exposure you have had, she is at no risk of HIV and little risk of other STDs. OTOH, I suspect many women in her situation are suscepible to bargaining higher risk practices (e.g. intercourse, perhaps without condoms) for higher prices, in which case she could be at higher risk. Still, given the exposures you describe, there still is no significant chance you have caught HIV from her, and low risk for other STDs.

So my overall assessment and advice are the same as above:  optional but for sure not definitely required testing for HIV and perhaps other STDs.

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46 months ago
So today at day 19 I went for a rapid duo antibody and p24 test at private doctor in London which was negative. Firstly is this reasonable timeframe even though guideline is 28 days. Of course it will be reduced by not being at 28 days but is it significantly reduced.
Also he used a needle in arm to draw blood rather than finger prick which I found strange. Anyhow is it ever possible to catch HIV from the having the blood taken if old needle. He told me fresh needle from packet but I wasn't watching plus he said I was his first HIV test of the day. The clinic I went to specialises in sexual health and travel vaccinations.
Your advice greatly appreciated.
46 months ago
I had all the other stis tested today and get results in a week.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
A duo test at 19 days probably is around 95% reliable. Blood draw from a vein is the usual specimen for HIV blood testing. Finger prick tests are much less common. Of course a fresh needle was used; nobody ever reuses needles. What does it matter whetehr it was his first or 500th HIV test that day??? I'm sure you had very expert advice at such a clinic. Undoubtedly they know as much or more as I do on these matters.

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46 months ago
What would be the timeframe as most common for acute symptoms to happen after infection and are they mainly fever. For example is the headache severe or just feels like tension headache?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
When acute HIV causes symptoms at all, generally they start ~10 days affer exposure and last 1-2 weeks. Usually several symptoms are present, including various combinations of fever, sore throat, enlarged lymph nodes in several locations, and skin rash; and sometimes diarrhea. Headache is not a promiment symptom. Further, even typical HIV symptoms are nonspecific, meaning that they occur in many other conditions.

You came herre for reassurance, and I've done my best with reasoned, science based facts and judgments. But all your comments are skeptical. Do your best to accept the scientific evidence and my expertise. Trust me on this: you were not at measurable risk of HIV. Any testing you continue to do will be negative.

We're beyond the two follow-up comments and replies included with each thread, and so this thread is closed. 
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