[Question #530] HSV/HPV concern

38 months ago
I'm a 35/m

On Jan 15 I picked up a CSW. Unknown status.

She performed condom protected oral on me. No contact passed condom.

I used a water bottle to perform a self enema.

Used personal dildo that was condom protected and lubed to anally masturbate the CSW. No penetration passed condom. Believe no fluids passed condom.

Took dildo to sink. Superficially rinsed tip of condom. Used finger and thumb to remove condom. Possibly transfered anal fluids to hand.

Inserted condomless dildo anally into myself with lube. While doing this I twice inserted finger anally that came into contact with her used condom fluids. Remaining enema water leaked out.

Again received condom protected oral. Not passed condom protected areas.  Also protected boob job.

Removed condom and used same hand that contacted fluids to masturbated myself to orgasm. 

New condoms were used each time.

Questions.

1. Am I at risk for HSV or HPV? (Either from protected oral or fluids)
2. Is this hand genital/mutual masturbation or something more? (Excluding protected oral)
3. Should I worry about any blemishes I had in that area afterwards?
4. Based on this incident is it safe to resume unrotected sex with my partner?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

You really needn't worry. The main thing by far is that you used condoms for all penetrating sex. STDs, including HPV and HSV, are rarely if ever spread by hand-genital contact, fingering, or by getting genital fluids on intact skin. Sex is messy business, with fluids often spread around quite a bit, as I'm sure you have experienced. Those sorts of exposure don't transmit STDs. The evidence? New HSV or HPV infections generally don't first show up on places like the pubic area, hands, buttocks, scrotum, etc. They almost always are on the penis, vaginal opening, minor labia, etc -- those areas that get maximum friction during sex. That's because secrestions alone aren't enough; the virus usually must be "massaged" into susceptible tissues.

The other thing to remember is that even when a partner is infected, all STDs are transmitted with low efficiency. In other words, even with unprotected intercourse with an infected partner, most exposures don't result in transmission.

To your speicific questions:

1) Nobody can say the risk of HSV or HPV is zero in this situation, but it is extremely low. We're talking about risks in the lightning strike range. Nothing to worry about.

2) From your description, these exposures were no more risky than hand-genital contact, probably less so.

3) I'm not sure what you're asking. No "blemishes in that area afterward" are likely due to any STD. If you're asking if preexisting skin lesions (e.g. a pimple) might increase your risk of infection if exposed, the answer is no. Any slightly increased risk would be theoretical, with little if any actual risk.

4) You took all proper precautions, plus some that weren't needed. I would not recommend any testing and believe you can safely resume unprotected sex at home. That's definitely what I would do if somehow I were in your situation.

I hope this has been helpful. Best wishes and stay safe--  HHH, MD

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38 months ago
Regarding #3. After the encounter in the 2-21 day range I had some things that concerned me.

1. A small blemish appeared between my anus and scrotum. It was dark and I was able to squeeze something out of it. It last maybe 3-5 days.

2. I had blood spotting when I wiped after a bowel movement. Perhaps from an anal fissure I've had in the past. Did not see any sores when I examined myself. No pain during the bowel movement.

3. I had a sore at the base of my penis next to my public hair. It broke open when I scraped across it. It may have been a hair growing in. It looked like an open sore, but did not scab and healed in 3-4 days.

I'm mostly concerned about inserting my finger anally with possible anal secretions of the CSW on it from the prior condom removal.

Does any of this increase the cause for concern or should I still move on with my life?

Thank you very much for this service.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
None of this changes my opinions or advice. I cannot say the causes of the various blemishes and symptoms you describe, but I am confident that their presence did not significantly raise the risk of acquiring HIV or other STDs.

In the busiest HIV/AIDS and infectious diseases clinics. every HIV infected person has a clear history of typical high risk exposures, like unprotected sex with a high risk partner or injection drug use with shared injection equipment. Nobody with HIV denies these things; or when they do, it is always found they were being untruthful, whether intentionally or because they were unaware (for example) that an apparently monogamous partner was high risk and had HIV. If events like yours could transmit HIV with meaningful frequency, obviously there would be at least a few patients in busy clinics who didn't have documented high risk exposures. But there are none. This is the same kind of evidence that allowed CDC to confidently and correctly tell the public back in 1981-82, when AIDS was brand new and before the causative virus was discovered, that there is no risk from non-intimate contact like shaking hands, sharing eating utensils, and so on.

Indeed you "should still move on with [your] life".

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38 months ago
I don't understand all of the HIV talk after my last response. I simply was asking if the 3 possible sores/symptoms after the incident changed your opinion on HSV or HPV.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Sorry if I went into more detail than you wanted. Just skip the middle paragraph. I answered your question in the opening paragraph and the last sentence. (You still might find it interesting. It's not all that complicated; just read it through carefully. It explains why my opinion didn't change.)

That completes the two follow-up replies included with each question, and so ends this thread. Best wishes, stay safe, and don't worry!
 
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