[Question #1797] Unprotected oral, mutual masturbation, genital secretion... what are the risks?

91 months ago

On Friday evening I had a sexual encounter with a woman and I want to understand my exposure to STIs / HIV.

During this encounter we started kissing, we got undressed, and I received unprotected oral sex (this lasted a few minutes but I didn’t climax).

I then received a hand job and fingered the woman.

Finally I climaxed through self-masturbation.

During the course of the encounter and as mentioned we were both naked. The woman at one point sat on top of me naked and although no penetration took place, it is possible the end of my penis came into contact with the outside of her vagina, she was very wet at the time having already been stimulated.

I am also concern that given I fingered the woman I would have had her genital secretion on my hands prior to self-masturbation.

I have read your forums along with other websites and there is a lot of conflicting information out there, could you please set me straight and advise which tests I need to have and when. Whilst concern for all STI's I am most concerned about HIV.

I am in a relationship with another woman so feel ashamed for what I have done and worried that I could pass something on.

Thanks in advanced.

H. Hunter Handsfield, MD

91 months ago

Welcome to the forum. Thanks for your question. My first response is to congratulate you for having safe sex during this event.

STDs are not just infections that happen to involve the genitals. The bacteria and viruses that cause them evolved to require sex itself for transmission. The small amounts of fluids and the viruses/bacteria to which people might be exposed by indirect contact simply are not enough to allow transmission to occur. By "indirect contact", I mean hand-genital contact, fingering, body rubbing, and other kinds of sex, without penis entering vagina, rectum, or mouth. Online searching can easily find claims by people who believe they were infected by such contact, but it simply isn't true -- or, at least, the exceptions are so rare they can be ignored. Kissing is also zero risk for most STDs and only slight risk for others, such as syphilis.

Oral sex is a little riskier but still very low risk for all STDs and essentially zero risk for some. So that aspect of your exposure could have carried slight risk -- specifically for gonorrhea, nongonococcal urethritis (NGU), syphilis, and herpes due to HSV1 (but not HSV2). As noted above, no worries from kissing (except for common colds, influenza, etc), and no risk from fingering or the possible contact of your penis with vaginal fluids, without penetration. In summary, this was a very safe exposure with little or no risk.

Should you be tested? Since you are worried enough to come here to ask the quesiton, probably yes -- not because there was really much risk, but because the negative results may be more reassuring than my advice based on probability and statitistics. If you decide to do it, enough time already has passed for a valid urine gonorrhea/chlamydia test. Beyond that, you could consider a 4th generation (antigen-antibody) HIV test 4 weeks and a syphilis blood test 6 weeks after the exposure.

As for sex with your regular partner, it's up to you. The chance you were infected is low enough that if I were in your situation, I wouldn't worry about it -- i.e. I would be comfortable taking the very low risk. But I'm not you and cannot decide for you. But I definitely would not recommend avoiding sex for several weeks on the basis of this single event. A middle ground would be to have the urine test and also wait about 10 days to be sure you don't develop penile discharge or sores, and then resume sex if no such symptoms and gonorrhea/chlamydia negative, as expected.

I hope these comments have been helpful. Best wishes and stay safe-- HHH, MD

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91 months ago

Dr,

Thanks for the info but to be honest I am confused slightly by your response; initially you congratulate me on having safe sex but then go on to say that oral sex is in fact a little risky.

Based on the information I have provided what would you say are the chances that I contracted HIV, assuming of course she has it?

Wouldn't my penis touching the outside of her Vagina represent direct not indirect touching? Can you elaborate more as to why this isn't a risk as my layman's brain can't really understand why it wouldn't be.

Is receiving oral sex a risk for HIV?

If I do not develop any penile discharge or sores within the next ten days can I assume I am in the clear for gonorrhea/chlamydia?

Thanks.

H. Hunter Handsfield, MD

91 months ago

There is no conflict between having safe sex and oral sex being a little risky. "Safe sex" doesn't mean zero risk, any more than using seatbelts doesn't always prevent serious injury or death in an auto accident. Oral sex is considered safe sex because the overall risk is very low.

I already described the HIV risk from oral sex. Re-read my reply. There has never been a proved case of HIV transmitted by oral sex, mouth to penis. A CDC estimate, if the oral partner has HIV, was one transmission for every 20,000 exposures. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. That's zero for all practical purposes.

As for the biological reasons there was no significant HIV risk: Many people assume that "just one virus" is enough for transmission. Not true. For all infectious diseases, it takes a certain number of virus particles or bacteria to cause infection. As a non-STD example, consider two forms of bacterial intestinal infection, shigellosis and salmonella. In human research experiments, 50,000 salmonella bacteria have to be swalled to cause infection, but only 50 shigella bacteria -- a thousand fold different. For rabies, a single virus may be fatal. For HIV, it takes tens of thousands, perhaps millions of virus particles, for infection to take hold. The virus also has to come into contact with certain types of cells, typically deep inside the body or in the bloodstream. Even for entirely unprotected vaginal sex, the average transmission risk, female to male, is only once for ever 2,000 events. That's why many spouses of HIV infected people never catch it themselves (which maybe you didn't know). The kinds of contact you describe simply don't allow enough virus to come into contact with the kinds of tissues and cells necessary for infection to occur.

Having said all that, I think you should ignore the biological reasons. The important thing is that even the busiest HIV/AIDS clinics never see patients who were infected during exposures like yours. Everyone with HIV has had traditional risks, i.e. unprotected penile-vaginal or penile-anal intercourse, or shared drug injection equipment -- plus small numbers of health workers exposued in workplace accidents, kids born to infected moms, and so on. There simply are none with risks like yours. In my 40+ years in the STD/HIV business, I have seen no exceptions.

No penile discharge within 10 days will be highly reassuring about gonorrhea, but not perfect; a small percentage of gonorrhea causes no symptoms. Testing is necessary for 100% certainty. Chlamydia often causes no symptoms, but is rarely carried in the throat and therefore almost no risk from oral sex. No sores within that time also will be good evidence against herpes.

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91 months ago

Dr,

Thanks for the reply and the clarification.

I am happy to hear that the risks I have taken are low and essentially zero for HIV. On HIV and to summarize to ensure I have understood all the information correctly, fingering, handjobs, mutual masturbation, and my penis touching her vagina (without penetration) are all absolutely zero risk activities. Oral sex carries a theoretical risk of of 1/20,000 and as nice as it would be to get a BJ everyday for 55 years the reality is that HIV has never been transmitted this way. You recommend testing but not because you believe there to be any risk what so ever but do so for psychological reasons? Given that the only risk (and this is theoretical) was the BJ and this carries a risk of 1/20,000 that would represent my odds of having contracted HIV from this entire episode (assuming of course she is infected) or would you put it as even lower in reality?

One thing I did not find clear, in your response you say "Kissing is also zero risk for most STDs and only slight risk for others, such as syphilis" but later say "no worries from kissing (except for common colds, influenza, etc)". Can you therefore catch syphilis or any other STD from kissing?

I will monitor my discharge for the coming days and will get tested but like the HIV exposure could you give a rough indication of the odds of having caught each of the following from the exposure(s) I described.

gonorrhea,
nongonococcal urethritis (NGU),
syphilis,
herpes due to HSV1

I ask because the odds help me understand and help put things into perspective, Lord knows I have bet on enough loosing horses in my time. You said that getting a negative is more reassuring than your advice based on probability and statitistics, but I actually find the number very reassuring.

I understand this is my last response so again would like to thank you.

91 months ago

Dr,

One thing I found out having spoken with the woman earlier and having a open discussion. She had chlamydia some years back although it caused some complications she is clear now. My question is would a partner with an sti make the chances of transmission for hiv higher? Or are you only at more risk if you have an sti yourself?

Thanks

91 months ago

Sorry, I copy and pasted my earlier question and missed the bottom bit off.

How risky is rubbing an unprotected penis on the clit and stimulating a woman that way? Does this have significant sti / hiv risk? I mean rubbing only and not inserting the penis.

Thanks and apologies again for my admin error.

H. Hunter Handsfield, MD

91 months ago

Your summary above is correct.

I see no conflict between my two statements on syphilis risk from kissing. Theoretically possible, but syphilis is dominantly a problem these days among gay men and the chance your partner had it is very low. Altogether zero risk for practical purposes.

Since you didn't have insertive sex, the odds of all STDs are extremely low, one chance in many thousand maybe millions. No data available to be any more precise.

The penile-vaginal contact you describe would carry much lower risk of all STDs than penetrative sex, but can't say zero risk.

Your partner's past chlamydia does not imply significantly higher risk of HIV at this time.

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91 months ago

Thanks Dr.

The reason I am so worried is because following our discussion she admitted that she hasn't always been the most careful in the past and has in fact had unprotected sex on a number of occasions. When she told me this and then about her complications with having chlamydia my heart sank. I now think the worst which I know is judgemental but I can’t help it.

We have agreed to go to the clinic together, I was actually hoping to have the rapid finger prick test on the grounds that is she doesn’t have HIV then the chances are zero. Unfortunately there is certain criteria for this test in this country and they have refused to do it. We are going to do the regular test and a urine test for other STIs for peace of mind. Results are going to take two weeks which I imagine will be two of the longest weeks of my life.

Kissing – no risk (one chance in many thousand maybe millions for some STDs zero for HIV)

Mutual masturbation – (one chance in many thousand maybe millions for some STDs zero for HIV)

Genital secretion on hands - (one chance in many thousand maybe millions for some STDs zero for HIV)

Receiving oral – Low but some risk – approx. 1/20,000 for HIV

Rubbing penis on cliterous (don’t actually think this happened) – Low but some risk for HIV – stats unknown

Do I need to just relax, come down off the ceiling and move on? She wasn’t a CSW and is from UK originally which I know to be a fairly low risk area. My heart is racing all day, I didn’t sleep last night and have no appetite. I feel like I have thrown my life away.

H. Hunter Handsfield, MD

91 months ago

As discussed above, the chance you caught any STD is very low, as you correctly summarize. As a reminder, in my initial reply above, I didn't even recommend testing at all, except for reassurance. Had somehow I been in your situation, I would not be tested for anything, would not have asked my casual partner to be tested, and would have never stopped having sex with my wife.

You indeed should try to "just relax, come down off the ceiling and move on". In the meantime, I suggest you carefully re-read all my comments above. They were meant to be very reassuring and that's how you should take them.

Normally threads are closed after two follow-up comments and replies. However, I will keep this open until you post your test results in a couple of weeks. But please no additional comments or discussion until then. There is nothing you will think of that would change my opinions and advice.

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