[Question #2378] STI from Body Massage Contact

45 months ago
I have a concern regarding skin-to-skin contact with a CSW that I was hoping you could help me with.  Essentially two days ago I visited a CSW for something like an 'erotic massage'.  During the course of the session the CSW masturbated me and I also had hand contact with her genitals - however there was no penetrative sex (oral or vaginal).  We also had no direct genital-to-genital contact.What concerns me though is that for a considerable part of the massage the CSW was effectively sitting on my thigh while masturbating me (we were both totally naked) and for a bit was rubbing her vagina against the top of my thigh.  I understand from this contact there is no risk for most STD but what really worries me is any risk for herpes or HPV / genital warts. I've seen posts on other websites responded to by Drs Hook and Handsfield where similar situations (and even situation where genital-to-gential contact) have been described as virtually no risk but this is causing me significant anxiety so wanted to ask specifically in this scenario.  I also visited a GP locally (London - UK) who said there was a risk of herpes being contracted from this contact and also HPV.  On the HPV side they were a bit unclear - but implied that there is no risk from 'high-risk' strains being transmitted to my thigh but that if the CSW had genital warts these could.  The GP advised I speak with a specialist in sexual health though as they were not expert in this area - but felt that overall the risk was real but probably low.Can you advise if this is a real or low risk from contracting Herpes or HPV / genital warts from this contact?  My main concern is a have a regular partner who I have unprotected sex with and I don't want to put them at risk.  I'm unsure whether I should refrain from sexual contact with them for a period of time or whether this is something that I should forget about and not be concerned with.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thank you for your confidence in our services.

Some questions can be answered accurately from the title of the question. Having not yet read any further, I can say that "body massage contact" never transmits any STD. In theory this could happen with syphils, herpes, or perhaps HPV. But in my 40 years in the STD business I have never seen or even heard of such a case. This also applies to hand-genital contact (i.e. masturbation by the massager), fingering (vaginal or anal, for either partner), and kissing. So assuming your massage did not progress to unprotected vaginal, anal or oral sex, you can safely assume you are at no risk for any STD.

Now I have read the question itself. Guess what? I'm glad to see you have more or less predcited my response (and thanks for reviewing other discussions on these topics by me and Dr. Hook). The main thing I will add about this particular exposure is that cornified (typically dry) skin, such as on the thigh, is generally believed to be pretty much impervious to STDs, including HPV. While this specific sort of contact in a massage parlor probably isn't very common, certainly routine sexual exposures commonly involved genital contact, sometimes with vigorous rubbing, with thighs, buttocks, arms, feet, and of course hands -- and yet in sexually active persons, even busy STD clinics never see cases of warts or other evidence of HPV infection in those locations. (Of course this is different than common, non-STD warts of the hands and elsewhere in children. Those HPV types are not sexually transmitted, and some such strains may be more likely to infect intact skin on those body parts.)

So I really don't think you are at risk at all from this event. I do not recommend testing nor any change in your sexual practices with your regular partner. I couldn't have said it better than you did in your closing comment:  forget about it and go forward without concern.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes and stay safe--

HHH, MD

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45 months ago
Many thanks for your quick response Dr,

I should add that I never asked the CSW or looked to see if she had any warts / legions. 

Part of my mind is making me think I should go back to ask her or check - but I don't know if this is being overly anxious / paranoid (and may increase my anxiety if she did ) or would have any real effect in the risk?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Asking about active STDs before sex with a CSW isn't a bad idea, as it may help some as a reminder of their responsibility to take preventive steps and get checked frequently. However, checking for visible warts or other problems is useless and would provide no significant protection against HPV or other STDs. (This would be true even for a physicians and even a highly trained STD specialist, let alone cllients without medical training.) I would not recommend you say anything to her at this point, especially given the virtually zero risk nature of your contact with her.

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45 months ago
Thanks again Dr Handsfield for your clarifying and quick reply.

I appreciate this is last follow up question on the thread.  Regarding the virtually zero risk of contact with the thigh - is this also true for inner thigh skin?  I'm sure there was no genital-to-genital contact, and also I'm sure no contact with my upper inner thigh (groin area) but possibly with inner thigh lower down.

I understand this probably sounds paranoid but I have a lot of anxiety around HPV.  As I've had many partners in the past - though my current partner has had very few - and it worries me a lot about putting her at risk (based on both this incident and my previous sexual history).    
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
My comments about type of skin apply to the entire body except places like the head of the penis, under the foreskin, labia and vaginal opening in women. Even with the penile skin itself, this sort of exposure would not have been risky.

Since you have "had many partners in the past", you be sure you already have (or have had) HPV many times. Everybody gets genital HPV, usually more than once. (Recent new research shows the virus can be detected on genital skin in about half of all males below age 60 in the U.) Compared with your past sex life, this more recent event makes no difference. You should try to look at genital HPV as a normal event -- not desirable, but normal in every way. It's an expected and unavoidable consequence of having sex. Don't let it rule your life or emotions.

Best wishes and stay safe.
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