[Question #3980] General Sex Health

32 months ago
Hello Dr. Handsfield, in coming across an thread answer of yours a number of years back it had me thinking I should gain some extra knowledge around sti transmission.  The two scenarios would be French kissing with a girl, me fingering her and her giving oral. No penetration and no visible blood in her mouth or afterwards. A test for all was done about 2.5 -3 weeks after that exposure and negative. What are the risks?

The second would be just French kissing and me fingering her and my clothes stayed on.. just in this case the I got home I noticed what looked to just be the area around my finger nail being red as I think there was a small spot down to try second layer of skin.. did not seem to bleed even with me poking at it to see if it was an open wound. Any risks here?

Lastly, noticed a small red bump at the top of my mouth about 5.5 months after exposure one and about 2 months after exposure two.. did have my doctor take a quick look and he said it looks like maybe a cyst. Any chance it could be  syphlisis bump. Did not seem to be an open sore of any sort, just a little red and non painful bump? 

Any need for further testing or stoping of sex with other partners from these? Oh and the old Post I saw of yours was relating to you stating there have been rare cases of gohnorrea and herpes passed to a finger.. is this true and if so my understanding of those is that they were local to an area(throat, mouth, genitals) how would they respread from a finger?

Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum. Thanks for your confidence in our services.

FYI, it's only by chance that I am replying and not Dr. Hook. We take questions without regard to requests for one or the other. We have been close colleagues for over 3 decades and although our styles differ, our professional opinions and advice almost always are identical.

You ask about 3 different kinds of exposure:  kissing, cunnlingus (oral-vaginal contact), and fingering or hand-genital contact. All are risk free for STIs, for all practical purposes. Brand new data, presented at a scientific conference and not yet published (or peer reviewed) and hence very preliminary, suggest occasional transmission of oral gonorrhea by kissing among men having sex with men. But any risk for this or any other STI is too low to measure or worry about. Cunnilingus can occasionally result in gonorrhea transmission to the throat, but this too is rare. Herpes is potentially transmitted by such contact (and yes, I once saw a patient with herpes of the finger after fingering an infected partner), and probably HPV, and certainly syphilis would be possible. However, all these are so uncommon in most sexually active women that the risk can be considered zero. There are no reported cases of chlamydia, HIV, or viral hepatitis being so transmitted. Finally, hand-genital contact is also risk free, with virtually no reported cases of transmission of any STD. For all these sorts of contact, one can imagine scenarios in which STI transmission is biologically plausible -- but even the busiest STD clinics rarely if ever see infected persons whose only exposures were these. Finally, having torn skin or other minor wounds or skin conditions of the exposed sites is one of those biologically plausible settings -- but such things are extremely common, so there must have been billions of sexual events with such exposures, and still virtually no known infections.

As for your "red bump", I think you can rely on your doctor's advice. No STI is a likely cause of such a thing, including syphilis.

So all in all, these events to not warrant testing for any infection, and I see no reason you cannot safely continue your usual sexual lifestyle without risk of transmitting anything to your current partner(s). On the other hand, since you are sexually active (apparently with other/current partners), like all sexually active persons, it would be wise to have routine testing from time to time, like once a year -- but only for gonorrhea, chlamydia, HIV, and syphilis. If you haven't been tested in the past year, perhaps this would be a good time, while it's on your mind. But not because of your "red bump" or the particular events described above.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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32 months ago
Thanks Doc, that was great information. Just to quickly make sure I'm getting it all, oral contact either male to female or female to male as well as hand contact both ways is extremely low risk? With probably herpes and gohnorrea in female to male oral being the most likely transmission?

I did want to ask a little more on your herpes to finger case. I think you mentioned that syphilis could also fit there. Ive always read that those infections are symtomatic to the area of infection i.e mouth or genitals.. in a case like you speak of, is the symptom site now the finger? Would this person pass herpes or spyhilis via regular or oral sex now or have sores show up on genitals or in mouth even with infection having happened to the finger?

Lastly, just something I always wondered out of curiosity.. in cases with say UFC fighters and boxers who are often both bleeding greatly and rubbing heads together with large open wounds on each... Even though I know blood testing is done on them, given the 3 month window period on something like HIV, how is this not more of an issue? Maybe I'm missing something in the transmission effectivness, Air exposure maybe.  Also, are they finally getting close to a cure HIV? I know the Hep C cure has really made its way into the public and commercials lately.

Thanks again for all your knowledge!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
The most common STDs from fellatio, oral to penis, probably nongonococcal urethritis (NGU), often (it is believed but not proved) caused by entirely normal oral bacteria and probably harmless to both affected men and their regular partners. Gonorrhea and herpes due to HSV1 probably are the next most frequent. But all are quite uncommon for any single exposure.

I don't recall any details at all about the herpes finger patient I saw; it was 30+ years ago. All initial STD lesions show up only at the site(s) of inoculation. You can't get a genital lesion by exposure of the mouth, for example. (By the same token, when someone has had an oral or rectal exposure to gonorrhea or chlamydia, the mouth or rectum must be tested. Urine or urethral testing would be pointless.

Sports with blood exposure certainly could transmit HIV. However, the per-exposure risk probably is numerically very low, and few such athletes actually acquire HIV.  The biological reasons for low risk have to do with the amount of virus in the blood of infected persons, plus the large amounts of blood typically required to bring sufficient virus into contact with susceptible cells. Drying or virus survival, e.g. air exposure, probably is less important. But there's not been any research on any of this, so we're just dealing with common sense professional guesswork. Whatever the reasons, such infections are rare. Hepatitis B and C probably carry more risk. Also herpes due to HSV1 is sometimes transmitted among athletes with close physical exposure; it's an unavoidable occupational risk of wrestling, for example.

Cure for HIV? Maybe someday, but doubtful in the next 5-10 years.

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