[Question #1371] Apposition

46 months ago
Hello Dr.  7 days ago I went to a massage place and the lady rubbed her vagina on my penis for a minute or so.  She was very wet. I never inserted my penis, but again it was rubbed for about a minute on her vagina.  We also french kissed.

My concern is my STD risk.  I realize that some STDs have only a theoretical risk but I would like for peace of mind purposes to read what you think the risk may be. Example:  1 out of 500,  1 out of 10,000 etc.  It´s already been 7 days and  I have been inspecting my penis and haven´t found anything. Although I must say that I question whether every bump from my circumcision was there before. I´m nervous and very anxious. I´m I clear for herpes in 7 days?  So please give me your opinion on odds for each one.

1) Herpes
2) Gonorrhea
3) HIV
4) Syphilis

Finally, is it safe to resume sex with my wife without risk?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

As you apparently know, genital apposition is not free of STD risk, but the chance is low compared with penile-vaginal (or anal) penetration. And even with unprotected intercourse, the large majority of exposures don't result in STD transmission, even if one partner is infected.

There are no data whatsosever on which to base numerical estimates of transmission risk. Of the STDs listed, herpes is probably most likely, but it's probably under one chance in a thousand for vaginal sex (for several minutes) with an infected partner, and substantially lower than that for apposition without penetration. So maybe guess one chance in ten thousand? Syphilis could be a slight risk if your massage partner were infected, but syphilis is currently so rare in heterosexual women in the US (including sex workers) that it's not a serious concern, and I would consider it zero risk for all practical purposes. The risk also is zero or close to it for HIV and gonorrhea (and chlamydia, which you didn't mention).  I do not advise any testing for any of these, and answering from a personal perspective, if somehow I were in your situation, I would continue sex with my wife without worry.

None of these infections could possibly cause a skin bump anything like the skin irregularities you attribute to circumcision. If you don't develop blisters or open penile sores within 10 days, that will further reduce the likelihood you acquired genital herpes.

I hope this has helped. Best wishes--  HHH, MD


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46 months ago
Thank you Dr. HHH.  Since it has now been 8 days now, I´m curious of the percentage of people who develop blisters, say in the first 10 days versus after 10 days. For example, using the very general guideline of 1 out of 10,000  for my apposition exposure and let´s say 2/3 of people develop within the first 10 days, I can assume that my risk has been lowered to 1 out of 30,000... What´s the general timeline for herpes and when would you say I´m ¨out of the woods¨, as they say.

For the ones with zero or close to zero (HIV being the main concern) would you place odds close to 1 out of a 100K? I´m sorry to go back to numbers, and I´m aware that there are no hard numbers, but your opinion on the odds would allow my rational mind to take over the emotional drive that´s currently on overdrive. 

Finally, thank you for covering chlamydia.. did I miss any others? Hepatitis ?

Many thanks! 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
All in all about half of all people with new genital herpes are said to develop symptoms. However, that's based on the fact that of all people with positive blood tests for HSV2, only about half recall initial herpes symptoms. But many of them undoubtedly had symptoms that were mild or that they didn't recognize as important, and forgot about them over the years. In fact, when those people without symptoms are told the tests show they have HSV2, about two thirds come to recognize outbreaks that always were occurring but they hadn't really thought about. Why is this important? Because it suggests that the minority of people at risk who, like you, are seriously anxious would recognize symptoms that others would not. For that reason, probably 90% of people in your situation would have noticeable symptoms if they had acquired herpes. When symptoms occur, they typically start within 3-5 days, rarely as long as 10 days. Probably no more than 1% of newly infected people would have their first symptoms more than 10 days after catching it.

As for numerical risk guesstimates, its a fools' errand in the absence of data. What if I agree with your analysis of 1 chance in 30,000? Could be. Or what if I say it were 10 times higher, say 1 in 3,000? My reaction is to point out the the National Safety Council (dedicated to preventing traumatic accidents) estimates that the average American has 1 chance in 1,756 of dying accidentally in the next 12 months (i.e. vehicular wrecks, drowning, falls, etc, etc). In other words, from twice to 20 times the chance you caught genital herpes. So my advice would be to keep your smoke alarm batteries up to date, wear your seatbelt, and don't point your golf club at the skin during a storm. But forget herpes.

I would put your risk of HIV as zero, certainly no higher than 1 chance in several millions -- since there has never been a reported case of HIV transmission by oral sex (oral to penis, that is) and no reported cases from genital apposition without penetration, and of course there must have been many millions (billions?) of oral sex or apposition events in HIV discordant couples in the course of the worldwide HIV/AIDS epidemic.

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46 months ago
Thank you Dr. for your very clear answer. I do feel a lot better.  To conclude you wrote: ¨I would put your risk of HIV as zero, certainly no higher than 1 chance in several millions ¨.. Is it safe to assume the odds of gonorrhea/chlamydia for my exposure are within that ballpark? If so, no need to go over symptoms. If not, would symptoms have been seen by now (9 days)?   

Finally, could you please address hepatitis risk for my exposure. I assume if you didn't address it was because you found it to be non-existent, however, just in case you missed the question, could you please address Hepatitis risk.    I´ll await your response.

Thank you for alleviating my anxiety and educating me.   

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
You correctly understand my comments and advice.

ALL STDs are low risk from this event, hepatitis even lower than most. We never test heterosexuals for people for viral hepatitis in my clinic -- the risk is vanishingly small for any one exposure.

That concludes the two follow-up comments and replies included with each question, and so ends this thread. Best wishes and stay safe.

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