[Question #1963] Mutual masturbation concern

48 months ago
Hello dr.,

I am a married bi-sexual male from the us, visiting Amsterdam for work.  Last night I met a gay man at a bar and had a mutual masturbation exposure with him.  We did the following: he kissed the inside of my ear, we masterbated, he ejaculated on my chest and I got his fluids on my hands and were very likely present with I masturbated myself.  He licked my testicles, I did the same to his slightly and the head of his penis and urethra touched my closed lips, but did not go into my mouth.  He rubbed my anus, and I am unsure if fluids were on his hands at this point. 

I am a wreck with guilt over this experience and have a lot of anxiety.  I am married and have unprotected sex with my wife.  I am petrified of giving her anything.  What are my risk, for HIV, chlamydia, ghonnerhea, herpes, syphallus, etc.  do I need to worry about any stds in my throat or anus?  What testing should I receive? Should I abstain from sex with my wife?  My apologies for the poor spelling of the disease names, but I hope they are clear.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Welcome to the Forum.  I'll be happy to comment.  While you may be feeling guilty about the encounter that you have described, the good news is that the activities you describe were safe sex.  Several comments:

1.  The casual nature of your encounter does suggest that your partner is at higher than average risk for HIV and STIs than most people but, nonetheless, it is statistically more likely than not that he did not have any STIs, including HIV.

2.  No STIs, including HIV are transmitted by kissing, including kissing of a partner's genitals and scrotum.  The single exception to this would be herpes simplex virus type-1, the virus that causes cold sored.  Here in the U.S. whether they know it or not, about 60% of adults have HSV-1.  If you get colds sores, you certainly have HSV-1 already.  If you do not, you probably still have the infection.  If you have HSV-1, there is no additional risk of acquiring HSV-1 again, anywhere on your body.  Blood testing for HSV is not recommended and would take months to provide information.  If you do not develop HSV type lesions (small 1-2 mm blisters) in the next 10-14 days, you can be confident that you did not get HSV from the encounter you have described.  (The risk of having gotten HSV is very, very low - less than 1/10th of 1%)

3.  Mutual masturbation, even when it involves the transfer of genital secretions between partners is considered safe sex by the CDC and WHO.  This is the case no matter what part of your body was touched or by whether or not there were your partner's genital secretions in his hands.  STD testing is not required for participants in safe sex.  Certainly nothing you describe warranted testing for HIV, gonorrhea or chlamydia.

4.  Finally, IF he had a syphilis sore present and it contacted you, there is a small risk of infection.  Syphilis however is uncommon and if you did not observe a genital sore during your encounter, it is unlikely that he had syphilis which might have been transmitted to you.  If you acquired syphilis, you would develop a lesion at the site of contact 3-4 weeks after your exposure.  Further, a blood test for syphilis would be definitive a month after your exposure.

Personally, I see no need for testing of any sort.  I have tried to provide you with detailed information for any "what if" questions you might have.  I hope this information is helpful.  EWH
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48 months ago
Thanks you, Dr. Hook for your detailed reply.  Just to clarify, as I get put as ease when I am reassured explicitly:

There is no need to abstain from unprotected sex with my wife, and having unprotected sex with her would not put her at any risk for std's as I was never at risk.  Is this correct?

The anal touching of him, potentially with secretions is not a risk as, even though the rubbing was rough, it was not a true insertion of his finger, so no risk (even if his finger did insert, I would suspect the risk would be minimal) is this correct?

I plan on getting a full panel of std testing at 30 days.  I am doing his for personal peace, not for any unclarity in your comments.  When my pcp has ordered this in the past, it was a blood/urine sample.  At 30 days, can I DEFINITIVELY rule out std's (hiv, syphilis, chlamydia, gonnorhrea, etc.) or should I wait longer than 30 days to get this test.  Even bough I will get this test for personal health a don wellness, it appears that you opinion is, as I read, that paying money for an oral or anal culture is both a waste of time and money, that I am 0 risk for anything in my throats or anus, and can be comfortable moving on with just the routine blood/urine test. Is this correct.

Also, I just found this forum, and I think it is really a noble service that you and HHH are providing to give reassurance and objective scientific facts to people, like me, who are scared and , like fear has a tendency to do, are thinking subjectively, and not objectively.  You are providing comfort to people who are at their brink with fear, and that is making a difference.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Correct, I see no reason to abstain from unprotected sex with your wife related to the activities you have described.

I also understand your decision to  get tested.  Your results at 30 days will be definitive and as you indicate, I see no reason for additional throat or rectal tests.  I am confident that when you are tested, your tests will indicate that you did not get an STI of any sort from your dalliance.

Thanks as well for your thanks.  We do our best to help our clients and it is always nice to hear that we are succeeding.  EWH
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48 months ago
Thank you, Dr. Hook.  I just have a follow up question about sphilis.  Is it only transmitted by genital to genital contact? Or can it be transmitted from hand to genital, etc. I.e. He touches his genital with sore, then touches my genitals.  Is sphilis rare only in the us, or is it also rare in he Netherlands?  I heard it is making a "comeback".  Is there any reason for legitimate concern based on my experience?  Finally regarding testing, you had mentioned that I can be comforted conclusively by testing at 30 days - does this included sypilis? I had read that I need to be re- tested at 12 weeks - is this just antiquated advice like with the standard hiv advice of 6 months to be conclusive (i.e. Testing has come a long way so that 30 days is conclusive, but the official advice can not be changed without prohibitively expensive clinical tests) or can I consider a negative blood test at 30 days conclusive?

Thank you, and happy Holiday.
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
You are asking good follow-up questions.  Indeed syphilis is making a "comeback" in both the U.S. and Western Europe (including Amsterdam), particularly among men who have sex with other men.  At he same time, all things are relative and compared to other STIs like chlamydia or gonorrhea is it far, far less common.  Syphilis is sexually transmitted by direct (not indirect) contact with a syphilis lesion and while these lesions are by far most common in the ano-genital area, they can occur at most any location.  Syphilis lesions are typically easily seen and the infection is not transferred passively on the hands such as when a person touches a lesion with their hand and then another body site.  The exposure you describe is very, very low risk for syphilis.  I can understand that you might want he reassurance that a negative test might provide however.  If you acquired syphilis, you would be expected to develop a lesion at a site of direct contact and nearly all persons would have a syphilis blood test by 4-6 weeks after exposure.  Give the nature of your exposure, a negative test would be very, very strong evidence that you did not acquire syphilis in the exposure you have described. The idea that you need to wait for 12 weeks to rule out syphilis is overly conservative.

As you know, we provide up to three total responses to each question. This is the 3rd and therefore, this thread will be closed later today.  I hope this information has been helpful to you.  Happy holidays.  EWh
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