Hi Doctors. Forgive me but I am a little conflicted regarding two statements made. I read a post from Dr. Handsfield explaining that STIs are not transmitted by any sort of contact that does not include penetration. That if there is not direct penile entry into a partner's vagina, rectum, or (more rarely) mouth, it can be safely assumed there is no risk of STI transmission. However, in reference to a post from Dr. Hook and myself, he explained that friction is part of sex and that micro-abrasions could facilitate transmission. Friction is outside the body and does not involve penetration as far as I understand. If I may, could I have clarification on this matter? The friction that is relevant for STI transmission, is it the type that exists during penetration only? Thank you. Respectfully, Mike.

You continue to seriously overthink all this. These details are irrelevant. There are no data on friction as an STI risk factor, just common sense and knowing that in animal research (for example with herpes or HPV), simply painting the virus on genital tissues is not effective in infecting them -- the virus must be rubbed into the tissues. But no data exist to estimate whether an how much friction might be required for humans in real sexual situations to become infected if exposed. The important thing is that in the busiest STI and HIV/AIDS clinics, we never see patients who have not had penetrating intercourse or other exposure far more intensive than, say, genital rubbing during petting, from a massage worker, etc. The other important take-home message is to be rational in selection of sex partners and, if any uncertainty about their sexual history or likelihood of infection, to use condoms for vaginal or anal sex -- i.e. to reduce the chance of exposure in the first place. And then stop worrying about it, without considering such irrelevant details like friction during personal contact.---

Hi Dr. Handsfield,

 

I understand what you are saying. Your organization is the sole source of where I get my sex education. I read a lot of the threads from other posts. Until this, I had little and vague understanding based off ambiguous websites and blank statements from older family members as far as I could remember. My anxiety is largely caused by not having a clear understanding of the science and the how behinds STIs. Removing this ignorance secures my comfort and allows me to adequately manage risk in the activities I engage in. With that being said, with the exception of one encounter over 10 years ago -actual vaginal sex with a sex worker (my first time)-and one encounter years later of protected and unprotected oral sex, the only actual sex (vaginal, anal, and oral) I had was with two women in a relationship. Perhaps surprisingly, the real concern I have is with massage parlors but I only received hand jobs and at times, anal fingering. One quick instance during one visit at a massage place the woman put her head down attempting to give oral but I stopped her. She didn’t even get to touch me with her mouth or tongue; I didn’t feel anything. The mere thought of the possibility that she simply licked or put her mouth on my testicles would concern me with no clear understanding of the sufficient mechanisms of what causes STI transmission. I am more concerned with giving others STIs. Knowing that I am not at risk in doing so I am less anxious. The disgust I have of going to these places I can deal with as I approach a new relationship, but thinking that I am at risk of giving an STI to another woman because of these places I cannot. I only go when I am single in need. I am about to approach a new relationship so I am a little more anxious now. I do however, thanks to you and Dr. Hook have a basis and better understanding although I am still a little conflicted with the nature of symptoms. Symptoms are what I rely on as an indication when something is wrong – even with allergies or a cold, or even inflammation for that matter. The fact that some types of STIS are asymptomatic confuses me unless I interpreted this wrong and that only mild cases of infection do not cause symptoms because they are simply too mild to make an impact. I assumed that there was a causal relationship – if I am highly infected the symptoms would progress and/or become more severe. Then again, I had a family member pass of cancer and supposedly had no symptoms. Dr. Hook explained to me there is no causal relationship.

 

-Mike

The large majority of human infections cause more cases without than with symptoms. That's true for colds, influenza, malaria, tuberculosis, poliomyelitis, and most STDs. Symptoms can clue the presence of certain STDs. Lack of symptoms indeed lowers the chance an infection is present, but only slightly and almost never conclusively.---
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I really appreciate the sincere and helpful guidance. It is not easy to come by. I will look into some type of therapy, I do agree that it could benefit me. If I may conclude with one last bit: I was with a woman two nights ago. She was not ready to have vaginal sex yet although in the heat of the moment I believe she asked me to do it unprotected. Fortunately, I decided not to without a condom. So, we did not have vaginal sex but she did use my penis to rub her vagina and the head I believe did go in for a moment - couldn't have been more than 3 seconds. Would that even be considered penetration in context? Nonetheless, it seems practical that this incident is not close to being sufficient for the spread of infection even if fluids were exchanged. Thanks again.

-Respectfully, Mike

Hi,

Sorry that somehow I missed your earlier follow-up question. I agree that incident was extremely low risk for transmission of any STI.---