[Question #13310] STI risk from this contacts?

15 days ago

Hello Doctors,

Two days ago I had an encounter with a sex worker where I was naked on the bed, she was wearing only underwear.

She placed her bare breasts (skin appeared normal, no visible sores or redness — but I’m not a doctor) on my penis with the glans exposed, rubbing for about 2–3 minutes of breast sex without oil or saliva.

She then put on a condom and performed oral sex until ejaculation. The condom remained intact and the glans was always covered.

At one point, the condom was covering only about 80-90% of the shaft. I adjusted it with my fingers, possibly touching saliva from her mouth on the condom. With those same fingers, I may have touched the uncovered shaft and a minor superficial burn/abrasion on my finger (caused by an oven 20 hours earlier, with only minimal clear exudate, no bleeding).

After ejaculation, I removed the condom, cleaned my hands and penis with tissue, washed quickly with intimate soap, and took a shower about one hour later.

My questions:

Does this possible transfer of saliva from condom → fingers → uncovered shaft and minor abrasion carry any clinically risk for STDs such as HSV, syphilis, HPV, or molluscum?
Can breast sex be considered at risk for skin-to-skin STIs such as HSV, HPV, or syphilis?

Thank you for your guidance.

Edward W. Hook M.D.

15 days ago

Welcome back to the Forum. I’ll be glad to comment. The encounter you describe was virtually no risk. Most CSWs do not have STIs, most single exposures to infected partners do not result in transmission of infection, condoms provide excellent protection from STI, STIs are not transmitted through transfer of secretions on someone’s hands, and experiencing masturbation with a partner’s breasts is a no risk activity. From a scientific perspective I see no need for testing. Thus:

1. No, no risk.

2. No, not if an obvious lesion is not present.

I hope that this information is helpful. Please don’t worry. EWH

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15 days ago

thank you for your reply.

Just one thing I would really like to understand: why do you and other doctors here consistently consider situations like mine as no risk even when, in theory, there is some possible transmission route?

I’ve noticed that highly reliable sources sometimes describe these as “theoretical risk” situations, where it could happen, while your clinical approach is to almost always exclude them in real life.

1.Could you explain the reasons for this difference in evaluation? In my specific case, there was still contact with saliva.

2.Regarding your reply to my initial second question: during the breast contact I looked carefully and saw no visible sores or redness on her skin, so is it correct to assume from your reply that if nothing obvious was present, I was not at risk — also to a non-medical eye?

3.Finally, based on your medical assessment, can I completely put this episode behind me and resume unprotected sex with my wife without any concern for HSV, HPV, molluscum contagiosum, or syphilis?

Thank you so much for your time.

Edward W. Hook M.D.

15 days ago

I’m not sure what you mean by “highly reliable”. I hope it is not the internet.

1. Our replies are based on our combined approximately 100 years of almost entirely sexual health focused experience, our continuous review of the medical literature, attendance at scientific meetings and discussions with colleagues, our own nearly 1000 published research papers and reviews and application and epidemiological principles. New knowledge is generated nearly every day and there is a THEORETICAL risk that you will be struck by a meteorite from space while reading this reply but I am confident that this will not happen. Application of these principles is the basis of my reply. You are free to disagree

2. Yes. As I said in my reply, in the absence of an OBVIOUS lesion, I would have no concern. Even most known direct lesion contacts do not lead to transmission of infection.

3. Yes

You have one follow up remaining. EWH

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