[Question #2001] Blood with Body Rub

48 months ago
I recently received a body to body erotic massage. When asked to flip over, the masseuse rubbed her vagina several times lightly against my penis. I told her I wasn't comfortable with direct contact. Don't know if head was directly exposed but I think so briefly--1 or 2 seconds. There was none from that point forward. However, while urinating afterwards I noticed the tissue she placed in the trash basket was lightly spotted. When I asked her about it she was not defensive and said she has no bloodborne diseases--namely HIV, which is my main concern. Pretty anxious even though I know there is little risk here. Is there a reason to be alarmed? Should I protect my wife and get tested? I know the relational risk of doing that. How would you advise if I came to your clinic? Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back to the forum. Thanks for your question.

Your intellectual side ("I know there is little risk here") is exactly right -- in contrast to your emotional side. My main advice, therefore, is to separate your shame, guilt, and/or embarrassment over a sexual exposure you regret from the medical consequences of that event. They aren't the same. Deal with the former as you need to, but you can dismiss the latter.

Here is why. Genital apposition -- i.e. contact without penetration -- carries little or no STD risk. In theory, those STDs transmitted skin to skin (syphilis, HPV, herpes) could be so transmitted, but this is uncommon and is especially rare, if it occurs at all, with the relatively brief contact you had. And for sure there is no risk for HIV, which definitely requires more direct and prolonged contact for transmission. Even with unprotected vaginal intercourse lasting several minutes, if the woman is infected, the estimated average risk to her male partner is roughly once for every 2,000 exposures -- in your case, far lower than that, since there was no penetration and contact was brief. Finally, HIV is less prevalent in heterosexual populations in the US than you might assume based on media attention. Even if we consider your massage partner to be a commercial sex worker, the chance she has HIV is well under 1% (1 in a hundred) and probably closer to 1 in 1,000.

If you were in my clinic, we would recommend testing. But that's mostly because a) you would already be there, so why not? And b) even with highly expert opinion, negative test results might be more reassuring than advice based on probability and statistics. In that spirit, you could be tested if you wish. However, if somehow I were in your situation, I would not feel a need for testing and would not do it; and I would continue unprotected sex with my wife without worry. But I'm not you, and the final decision must be yours. If you do so, I would advise a urine test for gonorrhea and chlamydia (valid any time more than 3-4 days after exposure) and syphilis and HIV blood tests, done about 6 weeks after the event. (Actually, 4 weeks is sufficient time for HIV, using a 4th generation blood test. But syphilis blood testing isn't conclusive until ~6 weeks.)

Changing the topic:  I'm curious what became of your wife's vaginal discharge, as discussed in your previous thread 4 months ago.

I hope this information is helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
I forgot to mention your masseuse's blood. Presumably she was menstruating. Even with intercourse, sex during menstruation does not significantly raise the risk of HIV compared with vaginal sex without blood contact. Slight blood contact in this setting does not change my opinion and advice as above.

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47 months ago
Dr. Handsfield, thank you very much for your response. Sorry it took me so long to answer your thoughtful question about my wife's situation that I relayed a few months ago. As you suspected, it was unrelated to any STD. Regarding my question in this thread I am appreciative of your advice. I also am grateful for your non-judgmental approach. Following up, my wife and I are in the process of deciding to forego intercourse die to the extreme pain it causes her. Already, there is little frequency. Needless to say, it is a difficult and emotional time for both of us. Of course, there are many ways to maintain intimacy in the absence of penetrative sex. To be very honest, I am concerned about my ability to make this adjustment. I love my wife and would not hurt her intentionally for anything. As my posts reveal, I already struggle with maintaining absolute fidelity, not assisted by a heavy travel itineray. Encounters are few and far between and mainly consist of massage (or body rubs), for which I have felt obviously guilty. Out of respect, I plan to make every effort to remain faithful despite the difficulties (and would never stray w/o protection) but my follow up question is: In the unlikely event that I ever acquired a reportable STD (gonorrhea, chlamydia, syphilis), would it require spousal notification if we were no longer active sexual partners or had not engaged in sexual activity since an infection had taken place? It's a terrible question to ask, I know, but I am curious. Knowing the answer to that question would help me consider establishing boundaries moving forward. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
See reply in your new thread.---