[Question #5530] Risk of this encounter

20 months ago
I am a straight man and had a sexual encounter with a woman. There was kissing, mutual masturbation and me receiving condom protected fellatio from her. I am not worried at all about any of these activities. 

But with one part of encounter there was body to body massaging involved. With the massage she had rubbed her buttocks (just her butt cheeks) on my penis for maybe 10-20 seconds. It was dark and then I noticed lesions on her buttocks and lower back.  I stopped and turned on the light and inspected her back and buttocks closely. They were bilateral small (maybe 5-10 mm), round, brown healed appearing lesions covering much of her lower back and both butt cheeks (maybe 1/2 to 3/4 of a square foot of surface area in total). They did NOT look like fresh, red open sores or oozing and were not particularly localized nor appearing in a dermatomal pattern.  

She said she had had the issue once before in her life after changing detergents and saw a dermatologist who prescribed her a topical medicine. This was the second time she had this issue and she said that she did change detergents again and believes that is what caused it again. I'm not totally certain, but it sounded like it may have occured in the same part of her body last time she had it. She said that they are no longer bothering her, but initially when they popped up they were very itchy. But she said they did not cause any pain. 

My sense is it is some kind of contact dermatitis she had and unlikely to be shingles or HSV 2. But I wanted to get the expert opinion and determine if I need to take any action out of medical necessity. Is any action indicated from a medical standpoint based on the situation?

Thank you so much.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
 Welcome to our forum and thanks for your confidence in our services. Congratulations as well for your practice of safe sex during your interactions with this new partner.    I'll focus my comments on my thoughts and impressions as they relate to the rash on her buttocks and lower back that you describe.   I'll try to be comprehensive in my response. Please don't let that make you anxious. 

 For starters, it sounds like the rash that you witnessed was bilateral and a dry discoloration of intact skin with no open lesions.   If that were the case, it is unlikely that it would represent a transmissible infection including STI of any sort.    Obviously I did not get to observe lesions but from your description this could be any number of processes. One possibility is that these are the healed, scarred remains of a previous rash-perhaps acne, perhaps an allergic reaction as she suggested, or perhaps folliculitis.   They certainly do not sound like herpes in the least.   Finally in order to provide a comprehensive answer it is important that I also acknowledge that Syphilis can present with a wide wide variety of different skin rashes. While the rash you describe is not typical of Syphilis in the least, it is of course always a consideration I'll be at a very unlikely one.   Your partner, irrespective of her past activities would be unlikely to have syphilis.    Finally there are numerous other dermatologic conditions which can cause skin rashes and discoloration's. 

 From the sounds of things your partner was not concerned or worried about her rash and I would suggest that you need not be either. I see no reason for concern and no reason for testing related to your contact with the skin lesions you describe. I hope my comments are helpful. EWH 
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20 months ago
Thank you so much, Dr. Hook, your input is very helpful and reassuring. 
20 months ago
Dr. Hook, could I ask for clarification for something for general reference purposes?

As a frequent reader of these forums, I am familiar with the recommendation you and Dr. Handsfield provide that anyone who is sexually active not in a monogomous relationship, should be getting tested about every year, even if if always/consistently using condoms. Is this based on potential unrecognized condom failure or misuse? Or is there another mechanism for fluid transmission even with a complete condom coverage during an encounter, maybe fluid getting into the condom at the base?With respect to vaginal (or anal) sex, is it accurate to say that on a per encounter basis, if the condom is worn during the whole time and does not break, it is no risk for fluid transmitted diseases such as HIV? For skin to skin diseases such as herpes, the area not covered by the condom could be susceptible, but very low risk.  Is my understanding correct? 

Also, when discussing condom protection for STIs, besides animal skin, are there other non-latex condoms (such as polyurethane) which are considered incomplete protection?

Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
We suggest annual check-ups for persons with multiple partners, even in the context of 100% condom use out of an abundance of caution.  In large studies of condom effectiveness, there are typically a very small number (less than 1%) of person who acquire STIs despite claiming perfect condom use.  Whether they are misstating their condom use, perhaps not putting the condom on throughout sex or some other misstep.  There is no way to scientifically measure condom use other than self report.  

Polyurethane condoms are equally effective as latex condoms.  EWH
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20 months ago


I had a 4th gen Ab/Ag HIV test  in late May of this year (about 4 weeks ago). However, I did have very brief fully condom protected anal sex (about 30 seconds) with a woman I met online a few days before this test and then a couple weeks after the test, brief (About 1 minute) of fully condom protected vaginal sex with a different woman I met online. With both of these encounters, I did not fully insert my penis, basically just the glans and distal shaft. The condoms were on during the entirety of both encounters and for sure did not break. These 2 encounters are the only ones  not falling into the window for my test. Is it medically indicated to get re-tested with 4th gen HIV test 6 weeks subsequent to the more recent encounter?
20 months ago
Oh sorry, I of course should mention my HIV test was negative.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
I think you are worrying more than you need to be.  Following the two brief condom-protected encounters you describe, in the absence of symptoms, I would not seek testing myself.  The frequency with which you test is a personal decision and the guidelines you asked about reflected our recommendations and were consistent with guidelines from other experts.

This is my 3rd response to your questions, thus, as per Forum guidelines  this thread will be closed without further responses shortly.  I hope that you have found my comments helpful.  EWH
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