[Question #2662] std transmission , extremely worried, Dr. Handsfield.

41 months ago
Dear Doctor Handsfield,  I am 30 years old virgin and I had 2 sexual exposures in my life. The first one was 7 years ago ; received oral sex for few minutes. Second exposure was 1.5 years ago ; mutual masturbation twice, he masturbated himself and then masturbated me with precum.  This man has many sexual contacts . A year later I noticed a red irritated skin near the urethra and vaginal lips and it burned when urine touches the skin. Also I had sharp pain in vagina when I walk. I always had vaginal discharge since I was 12 and I still have it. The red skin and pain in vagina went away with Doxycycline 100 mg 10 days. The discharge remained.  GYN tested my urine and the discharge. Urine had many WBC, and the discharge came out negative for trich and candida but it showed puss (++)cells and epithelial cells. (++). Please Doctor, since that exposure I started to research online and I am horrified, worried and extremely anxious.1) What's the chance I have contracted any std from these two encounters (oral and mutual masturbation).  2) If the chance is extremely low that I have contracted anything, how would you explain the vaginal pain and red patch that has been cured with DOxy? Does it mean that I had an std ? Or can Doxycycline also cure non std genital issues?  3) Do you think that the presence of WBC in urine and puss cells in vaginal discharge indicate that I might have contracted an STD ? If not, how would you explain there presence ? Am so worried and confused. 4) I have noticed a flesh colored very small bump in vaginal opening. Its just one, doesn't spread and doesn't grow.  could it be a wart ? I know that there are cases where they have found HPV in virgins. Could you please explain if I can get high risk HPV from this encounter? If so, how can the HPV reach my cervix if I never had vaginal intercourse or genital to genital exposure ? 5) Can a quick kiss on the head of penis without condom transmit std? Should I get tested? Thanks Doctor.
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago

Welcome to the Forum.  As you probably know clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.  Overall, your risk for any STI is low.  STIs are not transmitted through masturbation, even when partners transfer genital secretions to one another and oral sex is a biologically inefficient means of transmitting STIs.  I think additional answers will be apparent as I address your questions one-by-one.


1) What's the chance I have contracted any std from these two encounters (oral and mutual masturbation). 
As I mentioned above, these were each quite low risk exposures.  Low risk is not the same as no risk however and as you have abnormal findings (increased WBCs in your vaginal discharge), testing is warranted.  I anticipate that tests would be negative but still be to be tested for gonorrhea, chlamydia and trichamonas. 

2) If the chance is extremely low that I have contracted anything, how would you explain the vaginal pain and red patch that has been cured with DOxy? Does it mean that I had an std ? Or can Doxycycline also cure non std genital issues? 
The findings you note could be clues to an infection or could be normal.  for that reason testing is warranted.  Women normally have a vaginal discharge which can vary in appearance and amount depending on the menstrual cycle and day-to-day variation.    Your response to doxycycline is non-specific and could represent resolution of some sort of non-STI problem (such as a urinary tract infection) or even be coincidental. 

3) Do you think that the presence of WBC in urine and puss cells in vaginal discharge indicate that I might have contracted an STD ? If not, how would you explain there presence ? Am so worried and confused.
It is confusing and even some doctors misunderstand the significance of SBCs present in vaginal discharge.  In many women with increased WBCs in their vaginal discharge there is no STI and the WBC represent normal variation as well as the absence of STI.  On the other hand, as noted above, their presence warrants testing to be sure.  If the tests are normal, I would not worry unless other symptoms do occur. 

4) I have noticed a flesh colored very small bump in vaginal opening. Its just one, doesn't spread and doesn't grow.  could it be a wart ? I know that there are cases where they have found HPV in virgins. Could you please explain if I can get high risk HPV from this encounter? If so, how can the HPV reach my cervix if I never had vaginal intercourse or genital to genital exposure ?
The genitals have many normal "bumps" and irregularities and there is still more to learn about how HPV is transmitted in those rare instances in which there is no penetrative sex.  Rather than assuming this is HPV I would suggest you see your gynecologist and have the lesion you noted evaluated. that would also be a good time for testing as suggested above and perhaps the HPV vaccine. 

5) Can a quick kiss on the head of penis without condom transmit std? Should I get tested?
This is not a risk factor for STI.  You do not need oral tests for STI.

I hope these comments are helpful.  If not, up to two follow-up questions are permitted.  EWH

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41 months ago
Thank you for you quick reply . I am still worried and anxious Doctor.  I did read many messages from you on the medhelp forum saying that mutual masturbation ( even with genital secretion as lubricant) is a low risk for hpv and  herpes , and not a risk for chlamydia, gonorrhea and Trich.  Either you or Doctor Hands field said that enough viruses or bacteria need to have access to mucous membrane which is deep in vagina in order to cause infection and that transmission through hand is not effective way of spreading an infection. It' also said that even for herpes and HPV it's unlikely for transmission to occur through mutual masturbation . Could you please clarify this and why do you think that there is still a small chance of contracting an STI such as Chlamydia/Gonorrhea/Trich

In regards to the oral exposure ; as per my understanding the oral infection is mostly deep in the throat and it might be most unlikely to contract NGU or gonorrhea from a single brief exposure (especially from mouth to vagina) .  Chlamydia and trich are rarely transmitted through mouth to vagina. Please correct me Doctor if I am wrong but I did read many replies from you and Doctor Handsfield regarding this and they were quiet reassuring regarding this.

The  vaginal pain and the red irritated lesion was almost 1 year after the mutual masturbation. Don't you think it's a long time for an infection to show symptoms after 1 year? I also forgot to mention that the these symptoms started to occur when I started to practice more self masturbation (without a partner) . Could this masturbation caused the vaginal pain (even though i didn't insert anything inside) and the red irritated lesion near the urethra ?

Do you think that this irritated lesion that has occured 1 year after mutual masturbation could be cause by irritation of self masturbation or by herpes ? The lesion was only red and it burned when urine passes No scabbing, or pimples filled with fluid. Do you think that Doxycycline has cured the red lesion since its an antibiotic for skin infections as well ???

Let's assume I have contracted an STI from the oral exposure 7 years ago and have just treated it with Doxycycline. Could this infection stay in the body for so many years without showing any symptoms or could it have been cleared by its own? DO you think that this infection might have caused PID (and even made me infertile)  in these years without noticing anything ( no abdominal pain, no bleeding, no irregular periods).

WBC in discharge : My doctor prescribed flagyl for the presence of WBC . Do you think it's effective even if there are no bacteria shown in the culture ?  You are saying that many woman have WBC without an STi and that I should only worry if other symptoms occur . What other symptoms should I worry about other than the heavy discharge ?

Is doxycycline effective treatment for Trich, Chlamydia and Gonorrhea ?

What is the percentage of a negative test result ? My local STD clinic are testing the urine with PCR.  The STD nurse said that they can catch an sti with the urine without the discharge but they would ass the vaginal swab if i want to. Could you explain how they can catch any STI in the urine of females? Do you recommend collecting the vagina discharge as well or is the urine enough? Does the vaginal swab has to be from the cervix or is a swab from the vaginal walls or even the external discharge enough ?The reason why I ask this is because i don't feel comfortable inserting anything in vagina as am still a virgin.

I must say that I am extremely worried Doctor, I lost a lot of weight because of this and hope you can give me some reassurance.

Thank u, your advice is much appreciated.

Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
I understand your concern but without testing we cannot provide complete assurance that you are not infected.   In science there is no such thing as 100%.  new things continue to be discovered every day.  Having said that, I have never seen an infection transmitted in the way you describe in nearly 40years of practice.  You will not be the first.

I agree with your summary of your virtually zero risk for infection.

Your question about your lesion is repetitive.  In retrospect there is no way to know what happened.  There is little chance that the lesion you describe was herpes.  That just is not a realistic concern.

Your concerns about your oral infection are unrealistic.  The exposure you describe was a very low risk exposure.  Oral infections do not spread beyond the throat to cause PID.

Regarding your vaginal discharge- asking "what if" questions does little good.  Get tested.  As for the flagyl this is effective treatment for trichamonas and a common non-STI problem called bacterial vaginosis.  In my opinion, you should be tested to find out what is going on rather than just taking medications.

Doxycycline is effective therapy for chlamydia and much but not all gonorrhea.  It is not effective therapy for trichamonas. 

If you had a urine test for STI, this will provide accurate results regarding the presence or absence of STIs.  Urine tests typically miss 1 or 2% of infections that would be detected with a swab but, in your case, when considering your history, I would have confidence in your test results.

I hope these comments are helpful.  The repetitive nature of your questions suggests that you are quite and probably inappropriately worried about STIs.  EWH
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