[Question #13716] Risk from breast penis contact
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1 months ago
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Dear Doctors,
I would appreciate your opinion on a possible STI exposure.
I had a single non-penetrative sexual encounter with a csw. There was no vaginal, anal, or oral sex. The only contact was genital–skin contact: my uncovered penis and glans were in contact with her hand and breasts during a breast massage (Titjob) for approximately 10 minutes. No condom was used.
I did not observe any obvious sores, ulcers, or lesions on her breasts at the time, although lighting was limited and I did not examine so closely (also because I’m not a professional). I have no information suggesting that she has syphilis or HSV; this concern is hypothetical due to her activities.
Immediately after the encounter, I washed my penis and glans with soap and water.
I understand that this type of contact does not pose a risk for HIV, gonorrhea, or chlamydia. My questions are specifically about syphilis and HSV:
1) From a clinical standpoint, is transmission of syphilis or HSV realistically possible from this type of contact, especially in the absence of any clearly visible lesions?
2) Would this exposure normally be considered negligible, or would serologic testing (for syphilis and/or HSV) be recommended?
Thank you very much for your time and help
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Edward W. Hook M.D.
1 months ago
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Welcome back to the Frum. This question contains elements of our interaction 4 months ago at which time I indicated that in the absence of an obvious lesion (even is lighting was limited), there is virtually no risk of acquiring an STI, including herpes and syphilis from the breast masturbation you describe. This is not an exposure I would be concerned about. In nearly 50 years of sexual health focused research and clinical activity, I have never seen a case of syphilis or herpes (or any other STI) acquired in this way. Thus. in response to your specific questions:
1) From a clinical standpoint, is transmission of syphilis or HSV realistically possible from this type of contact, especially in the absence of any clearly visible lesions?
No- see above.
2) Would this exposure normally be considered negligible, or would serologic testing (for syphilis and/or HSV) be recommended?
Unless you were to develop an obviously suspicious lesion, I would recommend against testing for syphilis or herpes.
I hope this information is helpful. Please don't worry. EWH
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1 months ago
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Thank you very much for your clear and reassuring reply.
I would just like to clarify why I raised the question once more. Compared to the prior situation we discussed, this more recent contact lasted longer (approximately 10 minutes) and occurred in dim lighting. While I did not notice anything abnormal on her breasts, I cannot say with absolute certainty that there was nothing present, which is why I wondered whether duration and limited visibility could meaningfully change the risk.
I should also mention that this is a particularly sensitive period in my personal life, which has made me more cautious than usual about even very low-probability health concerns. After reading some medical articles describing rare cases of primary chancres developing on the breast and being initially subtle or mistaken for benign conditions (such as eczema), I found myself questioning my initial reassurance.
Given these additional details, I just wanted to confirm that, in your opinion, I can still be confident that I have not acquired syphilis, herpes, or any other STI from this encounter.
Thank you again for your time, experience, and reassurance.
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Edward W. Hook M.D.
1 months ago
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While I understand your concern, in the absence of a lesion I see no reason for concern. No change in my advice. The case reports you have found were published because they reported extraordinarily rare events. Try not to get sucked into a rabbit hole.
One follow up remaining. EWH
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1 months ago
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Thank you again for your patience.
Just to be sure I am interpreting your advice correctly: would you consider this exposure to represent effectively no risk, or a very low but still present risk, from a clinical standpoint?
If you were to consider it very low but non-zero, would there be any role at all for doxy-PEP in this situation, or would you advise against it?
My goal is simply to understand whether I can close this matter completely and put it out of mind.
Thank you very much for your time.
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Edward W. Hook M.D.
1 months ago
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I consider the event you describe to be no risk. My advice is to move forward without concern. EWH---
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1 months ago
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I apologize if I am insisting, and I would like to begin by saying that I have great respect for your experience and for the time you have dedicated to responding to me.
I fully understand your conclusion that the exposure I described represents no risk. However, for my own peace of mind, I would really appreciate a brief explanation of the clinical reasoning behind this certainty. What elements of the scenario make it possible to confidently classify it as non-risk considering that the encounter did not take place in very good lighting and that there was a fair amount of friction between the glans and the breast.
I am asking this because understanding the rationale would help me personally close the matter and move on calmly. This would also help me make a rational decision, rather than an anxiety-driven one, given that I am still technically within the time window in which doxypep could be considered.
Thank you again for your patience.
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Edward W. Hook M.D.
1 months ago
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Final response. You engaged in a form of masturbation using your partner’s breasts rather than hands. Consensus of experts, the WHO, and CDC is that mutual masturbation is a no risk event, even when partners get each others secretions on one another. As I said in the absence of an obvious lesion on the breast, there is no risk even theoretically. Your internet search turned up exceedingly rare events.
You really need to move forward. I suspect that Doxy-PEP would only further fuel your unwarranted concerns.
This completes this thread. EWH
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