[Question #4866] Massage Parlour risk

25 months ago
Hello Doctors

I'm looking for a risk assessment on an event that occurred 23 days ago. 

I visited a massage parlour during which the female of South East Asian origin... Singapore i believe... stripped off entirely and mutually masturbated both herself and me. For the vast majority of the time i stimulated myself, however there will, I'm sure, have been times both my hands and hers contacted our respective sexual organs, potentially spreading secretions. 

No penetrative or oral sex occurred and I've never paid for sex per say and i wouldn't even normally do anything like this. I guess ordinarily i wouldn't have been worried, however during this session my frenulam picked up a pretty significant graze which "stung" (annoyingly i didn't notice until later) and I'm assuming was a result of either my vigorous efforts or perhaps something she was wearing. Either way I've now become convinced that this graze presented an avenue for any potential infection, HIV specifically. 

For the last week or so I've had a sore throat although no major fever, perhaps 37.3 at times. Anyway, maybe last week it was a bad cold/cough and i didn't feel great but now the sore throat has lingered quite strongly. Slightly panicked so attended the sexual health clinic which has established that as of the 23rd day the usual STD checks run at a british GUM clinic are clear. Unfortunately even though I've had a vein drawn, 4th gen, laboratory HIV blood test, which was non-reactive, i can't relax.  It's too early for a conclusive result and I've still got this bloody sore throat and malaise... should i be worried? Can i take any significant reassurance from my clear 23 day duo? 

I've a partner and of course i don't want to pass on any infections, so I'm practising abstinence at the moment. Can't really risk another person's health over a reckless decision I've made. 

Kind regards 
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Welcome to our Forum.  I'll be glad to comment.  I would not worry at all and see no need for further testing.  Remember, masturbation, no matter who is doing it, involves friction and friction in turn leads to abrasion.  Sometimes the abrasion is more obvious than others.  Despite the friction involved, mutual masturbation, even when participants get each others genital secretions on one another, is considered safe sex by all experts with no risk for HIV.  thus i would urge you not to worry.

To provide more detail which, I hope, will be also helpful, please remember:
1.  Most masseuses, even those who are also commercial sex workers, do not have HIV, including those from South East Asia.   
2.  Your symptoms do not suggest recently acquired HIV (the so-called ARS) as fever is typically present and your reported, temperature is not considered a fever, cough is not part of the ARS and with he ARS other symptoms, particularly severe muscle and joint aches are typically present.
3.  If your sore throat was present when your HIV blood test was performed, it would have been positive (i.e. when persons have ARS Symptoms their blood tests are typically positive a day or two after the onset of symptoms)
4.  Your 23 day blood test would have detected about 90% of recent HIV infections even if you had not had symptoms.

Considering all of this, I would urge you not to worry.  In my opinion, there is no medical reason for further testing.  If you do choose to test, th generation, combination HIV antigen/antibody tests are more than 99% sensitive at 4 weeks after an exposure and entirely reliable at six weeks

I hope this information is helpful.  EWH
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25 months ago
Thanks for the comprehensive response, i really do appreciate it.  I also appreciate that my further questions will undoubtably not change your medical opinion, however, anxiety is often a disagreeable bedfellow with the rational part of a mind. With that in mind could I ask a number of further questions to attempt to calm my nerves. 

1. The graze itself was pretty noteworthy, took approx. a week, to a week &1/2 to heal, would that change your opinion?

2. I know you're right about the cough/cold, i think i've just managed to convince myself that i was unlucky to have a concurrent bug at the same time as the onset of ARS... now the sore throat remains even though my other symptoms have cleared and worryingly if anything it is worse?...i feel like I'm just constructing scenarios to justify my fears. 

3. My partner and I had a 3 month "break". During this period she had a couple of other partners whilst i had none, although she stated, and i believe, that she'd not had full sex with either. Initially, when i noticed the graze i became worried that she'd perhaps aquired hsv and passed it on to, inadvertantly, to me (realise this is all starting to sound paranoid).

I headed to the GUM clinic to have it assessed, seemingly sparking this hyper anxious episode. 
The Dr ventured the opinion that they were 85% certain it looked like a tear,  but performed a HSV PCR swab test; this was negative. Was this accurate 3 days after i noticed the graze and does it confirm it was a result of the episode of mutual masturbation as opposed to herpes?

Again, thanks for your response and advice.  I think you can probably tell I'll be a test again kinda character but i want to be sure i don't pass anything on, not sure i can wait 6 weeks though, so basing my action plan on what you've said, would i be correct in saying a 4 week 4th gen would be medically conclusive considering my exposure? 
I don't think the TDL use the Determine Alere POCT which seems to have been the basis behind the reason to revert to the 6 week advice.. although i may have misunderstood why the testing advice changed on that last point.
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
1.   You are correct no change in my assessment. 
2.    I'm sorry you're sore throat persists. Nonetheless there is no reason to worry about HIV OR the ARS
3.  It sounds like your anxiety is getting to you. You have a cause and effect relationship, timing wise with the scrape you have described.  Your PCR proves this was not herpes.

 My advice about test sensitivity and timing reflects recent data. Again, a four week test results will be more than 99% conclusive but for absolute confidence a six week result is needed with any fourth generation test. EWH
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25 months ago
Well, I tested again at 28 days; results are still coming up clear and yet my awful sore throat and moderate malaise persists.... which means I'm extremely worried.. I've never felt like this and I'm convinced there's a link to my actions. GUM clinic aren't particularly keen to see me again and yet I'm not sure i can or should let this go?
25 months ago
Also,  I didn't mention i was uncircumcised..don't know if that increases any risk from my above episode.

Could i also ask what the accuracy the HSV PCR swab would be on any area, assuming  it was 3 days old and relatively wet....i.e not scabbed? 

Kindest regards

Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
I have told you on several occasions that your exposure was no risk and that your test proved that your sore throat was not due to HIV. You have now tested again, same result, same assessment.  You need to accept that your sore throat is NOT due to HIV and that you did NOT acquire HIV form the encounter you described.  Your sore throat is coincidental.  

I am guessing that you are going to the internet had this is feeding your unwarranted fears.  I suggest you stay off the internet as well.

HSV PCR tests perform similarly irrespective of where they are taken.  

As I trust you know, we provide up to three responses to questions. This is my 3rd response.  Thus the thread will now be closed.  Given your unwillingness to believe my assessment, the GUM clinicians, and your test results, I must also warn you that returning to the forum with continuing anxiety-driven questions regarding the encounter you described above may be deleted without comment and without return of your posting fee.  Please move on from your unwarranted fears.  EWH
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