[Question #4355] HIV / Genital Warts / Rubbing

30 months ago
Dear Doctors

I would like to have your views and assessment on a potential exposure.

A weeks ago, I went to a massage parlor where I had body to body contact incl. sex apposition and intense rubbing of my penis with both her vagina and anus  (but without penetration). 

I realized a few days later that I had genital warts (foreskin) and presumably before that event.

I understand that rubbing and sex apposition does not imply any risk of HIV transmission. However, to what extend the fact I have genital warts increased the risk of being infected from this event? Do warts are a potential entry to the virus? 

Many thanks for your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome back to the forum. Thanks again for your confidence in our services.

Genital skin to skin contact can be an STD risk, particularly for HPV, HSV2, and syphilis. There are no data on the numerical risk, but undoubtedly it is very low for all these infections. It is very rare, if ever, that even the busiest STD clinics see patients with these or any other STD whose only exposure was genital contact without penetration. So for practical purposes, you were not at significant risk for any infection. Some STDs increase the risk of catching others (e.g., having HSV2 or gonorrhea raises the risk of HIV if exposed). However, there are no data to suggest that having HPV or genital warts raises the risk. So your apparent genital warts did not make this event any more risky for HIV (or any other infections) than otherwise. This was a zero risk event in regard to HIV.

Self diagnosis of genital warts often is wrong. There are other causes of genital bumps than warts. You should seek medical care to confirm whether or not you have GWs.

If you do have genital warts, you should be in touch with your massage partner and tell her about your infection. (Don't assume that she accepts such risks when they are avoidable. Such persons deserve to be informed of all potential STD exposures.)

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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30 months ago
Many thanks for your prompt answer.
You are absolutely right. I'll  get in touch with her.

I am a little bit confused because I read that according to a recent study, untreated GWs may increase HIV transmission. That's why I thought this event could carry some risks of HIV transmission i.e. rubbing and genital fluid on GWs...

Many thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
There have been several studies of warts and HPV in relation to HIV transmission. It is rare that any single study is conclusive in such a difficult to research area. Some have shown a relationship but most did not, and the consensus is that HPV or warts are not significant factors in HIV transmission. Contrast this with genital HSV2 infection, for which there are 20+ studies, almost all of which showed a strong relationship. If HPV or warts have any effect on HIV transmission risk, it must be quite small.

Even for HSV2, the impact on any single exposure is small. HSV2 roughly doubles the HIV risk if exposed. So let's say the chance of catching HIV is 1 in a million, taking into account both the probability that one partner is infected and the chance of transmission for any one exposure (pretty typical for the scenarios most common on this forum). Doubling that risk means the risk is one chance in 500,000. In other words, doubling a very low chance still leaves a very low chance. Stated another way, the key determinants of transmission -- the chance a partner is infected and the transmission risk for a particular sex act -- are far more important than cofactors like herpes or circumcision status. On a population basis, i.e. the total risk and prevalence of HIV in an entire community or nation, the cofactors are important. For example, it has been calculated that half of all HIV infections world wide would be prevented if all men were circumcised; and that half would be prevented if nobody had HSV2. But for any particular person with a single exposure, neither circumcision status nor herpes has any effect on the need for testing.

Makes sense, right? Perhaps another take-home message is to not overreact to media stories based on probability and statistics. The same concepts are important in regard to the hundreds of stories each year about various cancer risks. (Which, by the way, should influence how people react to stories about higher risk of throat cancer due to oral HPV acquired by oral sex.)
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30 months ago
Ok that's very clear thanks.
And to conclude, in this specific case, GWs or not what only makes a difference is penetration vs no penetration. Correct? Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Correct, assuming you are referring primarily to HIV risk.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe!
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