[Question #261] Follow Up Dr Hook

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102 months ago
Dr Hook,

I know you are a very smart man and an expert in sexually transmitted diseases. I posted a question to you yesterday and you provided a very professional and specific response...I should have stopped there and been satisfied. But dumb me and the worrier I am I got back on the Internet and started searching more like I was going to find a better answer...stupid am I. What I did find were a few articles like this:The truth: There are a lot of ways to contract STDs, and there are STDs that don't require intercourse or the exchange of fluids. "You can contract HPV by just general contact — you know, grinding," says Ross. Manual stimulation can spread HPV, pubic lice, or crabs too. Eliminating bodily fluid exchange does minimize risk of transferring some of the more serious STDs, like HIV, but "it's completely a myth that you cannot contract an STD from fingering or oral because you absolutely can," says Ross. This Dr and a few others say you can get and STD or STI or other things from fingering. Here's my question: Are they simply trying to scare people, or they don't have their facts straight or are they putting a possibility out there for 1 in a 1,000,000? I'm sorry once again for taking up your time as I know you must be doing this gratis. Thank you for helping me. Duke Hale Refer to fingering case yesterday with small cut on finger.
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H. Hunter Handsfield, MD
102 months ago
Welcome back to the forum. You did not need to start a new question and pay a new fee; this could have been a follow-up comment in yesterday's thread with Dr. Hook. However, as stated clearly on the forum home page, users do not have the privilege of requesting or expecting replies from a specific effort. We answer them as they come in and/or based on our personal availability. Dr. Hook's and my views and advice never differ significantly, even if our styles have their differences.

I looked at your previous question and agree with Dr. Hook's reply. But this question is more general -- nearly philosophical in nature. My reply is similar, and primarily take the form of some generalizations.

First, be careful searching the internet; always keep the source in mind. You'll be less likely to be led astray if you restrict searching about STD or HIV symptoms, risks, etc to professional sites, such as those of health departments, academic institutions, etc, or professionally moderated sites like this one -- and stay away from those run infected persons and persons at risk.

Second, you are citing sources that address whether there is a theoretical risk from certain kinds of exposure -- i.e. CAN it transmit HIV or STD -- but not necessarily whether they really DO SO with any measurable frequency. For example, shared razors are cited as potential risks of HIV, hepatitis B, or other blood borne viruses, but I am unaware of a single report in the medical literature that a shared razor actually was a documented source of transmission. Same for oral sex, oral to penile transmission, or cunnilingus (oral-vaginal) in either direction. There are some people with genital HPV who believably deny intercourse including oral sex, and may have acquired their infections by hand-genital contact. However, there also are cases in which the infected person even denies that sort of contact. Should we thus conclude that HPV isn't an STD after all, even though 99.9% of cases are acquired by intercourse with infected partners? Can genital apposition without intercourse transmit HPV, HSV, or syphilis? Yes in theory, and probably rarely in the real world. But of all the examples I have just given, in 40 years working in the STD field, including 25 years working daily in a busy STD clinic, I never saw a patient who had acquired HIV, hep B, gonorrhea, chlamydia, genital herpes, or genital HPV without having had direct genital contact, usually unprotected insertive sex. (Or of course direct blood contact, e.g. shared injection equipment, for HIV and hep B.) 

Third, absolutely the worst kind of "evidence" comes from people who believe or claim that they acquired their infection from a non-traditional exposure. The fact is that the large majority of people with HIV or STDs cannot say with certainty exactly which partner or which exposure was the source of his or her infection. As one simple example, consider the woman with newly diagnosed STD or HIV who blames the her single dalliance during a business trip, or a public toilet, not knowing her husband has multiple partners or is a deeply closeted gay man.

I have no clue who the person named Ross is and what his or her credentials are in infectious diseases, STDs, HIV, public health, or preventive medicine. Or who "Duke Hale" is. Depending on context, their statements may be correct. And they aren't necessarily intending to mislead people. But that doesn't mean they are truthful, or that their advice can appropriately be assumed to apply to most people at potential risk for HIV or other STDs. And as you mention yourself, there are indeed some people who are simply ignorant, and an even smaller number who deliberately exaggerate or misstate the facts. As a common example, consider the extremely biased STD/HIV prevention advice many kids receive at school if they're red states where social conservatism and religion badly distort sex education. (It's not a coincidence that the highest rates of STD and unwanted pregnancy in teens occurs in red states other politically conservative communities, and not in blue states or more educated settings.)

When Dr. Hook and I answer questions about STD/HIV risk and symptoms, we do our best to put the question into context and give advice based on the likely scenarios. Usually we will qualify statments like "you can't get it by fingering" with additional comments like "or so rarely you can ignore it". But the qualification is always impled even if we don't remember to write it down -- it often depends on the context, the apparent mood and perspectives of the questioner, etc. As for your particular exposure, any risk that in theory could be conferred by fingering is almost always from the fingers to a partner's genital tract, not the other direction. I have never seen or even heard stories of someone acquring an STD by contact of his or her fingers with another person's genital area. In my opinion, you should just ignore that event and move on with your life. (I would suggest you don't do it again, but not because of any real risk, but to avoid future anxieties about it. "If you can't stand the heat, stay out of the kitchen.")

I hope this information is useful to you. Best wishes and stay safe--   HHH, MD