[Question #13293] Syphilis or another STI hand genital?

19 days ago

Ola doctors,

Thank you again for your help with the other issues discussed. I learned more about HIV in real life and understood that my concerns were really about situations with practically no risk.

Now I am writing to you about a different matter. Last week, during an erotic massage, the masseuse lay down next to me and while she was stimulating my genitals with her hands, I also began to touch her vagina, which was very very wet. but my concern stems from the fact that I noticed a sore, pimple, or something similar next to her labia. Unfortunately, there was little light, so I couldn't see what it was. In the worst case scenario, if it was a chancre, what would my risk be? I only touched it with my three fingers, which have no wounds, but one of them has a cuticle with redder skin next to the nail. I don't know how this disease works or how it is transmitted, so I would like to ask experts like you.

Would there be a risk of any other STI? This happened in Portugal. In theory, she is an erotic masseuse but not an escort. She seems to take care of herself, but I understand she will have her personal life.

There was no contact or rubbing between our intime parts, only with our hands, and she also touched mine with her breasts.

Thank you very much again.

H. Hunter Handsfield, MD

18 days ago

Welcome back, but I'm sorry you remain so concerned. Unfortunately, I really can't say much. That you noticed some sort of skin irregularity of your partner's genital area does not sound alarming. But even if it was a syphilitic chancre, I would judge your risk of infection from the contact you describe as very low. Syphilis is not known to be transmitted by hand-genital contact. I would not advise testing, but of course you are free to do that if a negative test result would give you additional reassurance. In that case, feel free to have a syphilis blood test in 3-4 weeks (by which time 90% of newly infected people would test positive) and again after 6 weeks for 100% assurance. (From a more personal perspective, if somehow I were in your situation, I would not feel a need for testing and would continue unprotected sex with my wife without worry.)

HHH, MD

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18 days ago

Thanks Dr HH for your reply

Of course I thought that syphilis was only transmitted via sexual contact either vaginal, anal or oral but then looking on the internet about my concern I found information that if you touched the chancre with your hands there could be a risk, so I preferred to ask experts like you with experience.

Because in theory there should be a wound for this bacteria to enter or how does it work? I have also subtly asked the masseuse to notice a wound or grain and her literal answer was (it seemed to you...) as I know I'm fine or I have nothing I do not know... I also suppose that in Portugal this disease is not very common in women.

I don't want to become paranoid doctor I want to be confindent and not take the test, if you tell me that there is practically no risk, it was only contact with my hand, mostly two fingers without any big cuts, if any one red cuticle

Obrigado

H. Hunter Handsfield, MD

18 days ago

"how does it work?" Syphilis bacteria must be massaged into the tissues for infection to take hold, which is why chancres usually appear at sites of maximum friction during sex, like the penis, vaginal opening, etc. Also the bacteria are not carried on the hands, and there are not enough bacteria to be transmitted even if genital fluid is used for lubrication. I also suspect you are right that syphilis is rare in women in Portugal, but I do not have direct knowledge about it.

In my 50 years in the STD business, I have never seen a patient with syphilis who had not had vaginal, anal or oral sex.

I suggest you be tested, not because you truly are at risk -- you are not -- but many anxious persons are more reassured by negative test results than by expert opinion. You're probably going to keep worrying until you have tested negative.

I also suggest you stop searching online about syphilis risks. If you feel compelled to keep doing so, at least limit yourself to professionally run or moderated sites, and especially stay away from sites run by and for people with syphilis or at risk for it. Those are the most unreliable sorts of online sites.

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17 days ago

Thanks again doctor Hunter

I understand what you are saying, and I am reassured by your comment that in all your years of experience you have never seen anyone become infected by hand genital touching, so I guess I would not be the first one... not going to test then.

I would like to take advantage of this last question, as it is not easy to find a professional like you to ask whether, in your 50 years of experience, you have seen many men who have contracted HIV through brief vaginal sex with, let's say, a person who is not considered high risk... I asked on another occasion about a possible body body erotic massage with accidental penetration and whether the risk would be minimal for this, even that I am uncircumcised

Obrigado

H. Hunter Handsfield, MD

17 days ago

The risk for HIV in this situation is not zero, but it is extremely low. With unprotected vaginal sex to completion (5-10 minutes), with an HIV infected female partner, the risk to the male is around one chance in 2,500. Your risk was a lot lower, because it was very brief. And probably your partner doesn't have HIV. Your risk of HIV might have been one chance in a million or even lower. Being uncircumcised is not as important as you may think. It roughly doubles the risk if sexually exposed to an infected person -- which means your risk might have been one chance in 500,000 instead of one in a million. Still zero for all practical purposes.

And no, I have never seen anyone who acquired HIV in a situation like this.

That completes the two follow-up comments and replies 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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