[Question #3234] Clarification about "technical potentiality" of STD/HIV from hand->genital/anal

40 months ago

Hello Doctor.  I apologize in advance this is an oft repeated question, yet under the tension of anxiety it is immensely helpful to obtain a personalized response.


In last years I have relied on the consensual remarks from Dr’s HHH, Hook, Gonzalez-Garcia, and multiple other prominent on-line MDs in this field, as well as public sites like Vancouver and New Zealand Health, that hand-to-genital/anal contact (i.e., no penile penetration nor oral sex of any variation), with or without lubrication from partner’s saliva or genital fluid  “carries no STD risk”, (except a minutely rare chance of HPV or herpes it seems), certainly NOT for HIV transmission. But, a qualifier frequently appears, saying “other than theoretical risk”. It is about this ‘theoretical risk’ I inquire.


What is empirical not theoretical:  I occasionally cause a small tear in my cuticle to point that drop of blood emits, lasting maybe a few minutes. It is easy to occur. If a woman had a tiny open cut on hand or finger, which would be hard to see without very close inspection, and then she put her finger in or around the anus or grazed the urethra, wouldn't this be the equivalent of blood exposure of the first order? Doesn't this contradict the “safe-hands” principle?


I comprehend that in theory any bizarre thing can happen…a person can use a hypodermic needle with infected blood as a weapon on a train, say, but we cannot attribute this to “train travel danger” per se. However, in regard to  “hand-sex” (and secondarily kissing), I am struggling to understand why the comments can be so unequivocal, when it is so easy to get a small cut which releases some blood. Yet Dr’s HHH and Hook tell us that, in their combined 70 years experience they have not nor know of one plausible instance of hand/finger contact transmitting HIV; to quote Dr Hook, “there is no risk for infection at all from receipt of masturbation.”  


(1)  Could you please help me reconcile what seems a flaw in the logic of “no risk from manual sex”? 


(2) With #1 above addressed, may I be assured that so long as no obvious fresh wounds of dripping/oozing blood are apparent, I am medically safe to get “happy ending massages” and do mutual masturbation? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

It sounds like you have been correctly interpreting most of the resources you mention. I'm not sure how to say it any better:  there have been no known cases of HIV acquired by hand-gential contact., i.e. no reported cases in which such infected persons reported such contact as the only possible source of their infections. And if you consider how common it is for people to have various nicks and cuts on their hands and fingers, we can assume there have been billions of such exposures -- but still no reported HIV transmission events. In addition, all that is known about the biology of HIV and its transmission tell us that such events cannot expose enough virus to susceptible cells to permit transmission. This experience and biology are behind all statement of zero risk.

At the same time, as scientists, HIV and infectious diseases experts are rarely willing to make 100% absolute statements, at least not without qualification. I can't guarantee you won't be hit by a meteorite, but I would still advise you that it's zero risk -- perhaps with a qualifier like "for practical purposes". For HIV transmission, or course it is possible to evision a scenario in which infected blood or serum from a cut on a hand, or by vaginal fluid used as lubricant, gets massaged into the urethra or an inflammatory penile risk (herpes, eczema, etc), resulting in HIV transmission. Nobody can say that can never happen, or that it has not happened once in a while. However, the considerations above guarantee that it is at least extremely rare.

And so to your specific questions:

1) I disagree with the premise of this question, that the seemingly conflicting information represents a flaw in logic. I see no flaw. It's just a question of the words used, sometimes with and other times without qualifiations like "for practical purposes", or "no risk except theoretcial".

2) I remain confident you could have happy ending massages twice daily for the rest of your life without ever giving HIV risk a thought. The risk may not be truly zero, but it's low enough that you should behave as if it is.

I'll close by quoting a statistic that I use from time to time on the forum. According to the National Safety Council, the average American citizen has 1 chance in 1,756 of dying within the next 12 months of an accident (vehicular, fall, drowning, firearms, etc, etc). Contrast that with say, 1 chance in 10 million you might someday catch HIV in the next year from handjob in a massage parlor:  the chance of HIV is almost 6,000 times lower. So my advice is to disregard that risk -- but definitely don't forget your seat belt!

Does that help?  HHH, MD

40 months ago
Yes, your response does help greatly,  thank you, in revealing  that my problem is mental rather than medical.  To re-word what I take it you're telling me; yes, airplanes do crash, buildings suddenly collapse, things fall from the sky, etc,  but far too infrequently to justify constant worrying.  From a statistical/rational view, it is an epistemological error to do so.  (This is why OCD is so pernicious, the suffer "knows" his concern is irrational yet cannot stop the terror he feels.)  For phobic/anxiety prone individuals like myself it is extremely difficult to align the emotions with the probabilities.  Fear is powerful, rational thought is weak, psychologically speaking. I understand what I must work on now, and will continue to follow your guidelines on safe (and unsafe) sex.  Thanks again.