[Question #14064] Mutual Masturbation/MSM Handjob

1 months ago

Dr. Handsfield and Dr. Hook,

I am a 50-year-old circumcised male. I had a one-time MSM encounter in which another man and I masturbated next to each other, and for about 2 minutes we masturbated each other. I would like to understand the real-world HIV transmission risk if he had his own pre-ejaculate on his hand while masturbating me.

There was nothing unusual about the encounter. He stated that he is married and that his only other sexual interaction with a man was oral sex. I have read similar questions you have answered and have also reviewed the scenario using CDC, OpenEvidence AI and Amboss Lisa AI. Across my research, the consensus appears to be negligible or no risk (I do get hung up on the term negligible), but I am an anxious person. I feel a direct response from experts in the field would help me understand the true risk and whether HIV testing is medically necessary.

H. Hunter Handsfield, MD

1 months ago

Welcome to the forum. Thank you for your confidence in our services.

Thanks as well for reviewing discussions of situations similar to yours and for researching the other sites. You have learned well: I endorse your understanding. "Negligible" really should not be an issue; it can be considered to mean zero risk for all practical purposes. Consider this scenario: a person is masturbated by a partner and also has vaginal or anal sex with that person, and soon tests positive for HIV. It isn't possible to know with certainty which event transmitted the virus -- the vaginal/anal vs hand-genital contact. Conceivably it was the latter. However, there are no known or scientifically reported cases of HIV in which hand-genital contact was the only possible exposure. But scientifically, the possibility may be there. Hence depending on the situation, one advisor might say "no risk" for hand-genital, whereas another might say "negligible". The bottom line is that this scenarios applies to the large majority of intimate contacts that do not include vaginal or anal sex.

In addition, you describe a partner who is extremely unlikely to have HIV or other active STD.

The bottom line is that I definitely consider the events you describe as carrying no risk for HIV or any other STD and I do not advise testing for anything.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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1 months ago

Thank you for your thorough answer. I understand anxiety is the main issue causing me to second guess the science and I could easily ask my primary physician and still "what if" their answer but having and expert in the field chime in is reassuring. I appreciate the work you do here and hope this will be the "final word" I need to put this lapse of judgement behind me.

1 months ago

One more question. About 2 weeks after the encounter I got the flu and Covid vaccines and the following day had flu like symptoms that lasted a couple of days. Does this change anything about your assessment or is it just a bad timing and coincidence? I feel like it is but just wanted your input.

H. Hunter Handsfield, MD

1 months ago

Probably just bad timing and coincidence. The term "flu like" is often confusing. The "flu-like" symptoms that can occur with acute HIV infection are headache, muscle aches, fever, and malaise (generally feeling unwell). The covid and influenza vaccines can cause exactly the same symptoms and the timing is perfect for one of those vaccines as the likely cause. HIV doesn't cause cough or nasal congestion, etc. And 2 weeks is usually too late for HIV/ARS symptoms. This shouldn't worry you at all.---