[Question #5779] Fronttage and skin to skin contact risk for STI with no penetration

22 months ago
Hi Drs- What if any STI risks would be a concern by non penatrative foreplay and frontage? We were both naked, mutual masturbation (he digitally inserted fingers in my vagina, I stroked his penis), no oral sex or penatrative sex. Male hetero 23 year old verbally stated tested for all STI  3 months ago and is "Clean"  My main concern was at one point his naked penis brushed the outside of my vagina and my anus and there was some pre cum. Also, he put his uncovered penis between my closed legs up near but not in my vagina (Vulva)  to simulate penetration. I understand there could be risk for HPV or HSV ( no visible signs of either on his penis or crotch) but what is the exposure risk for that, high or low?  And are there any other STIs that I need to be concerned about and test for with the sexual activity we engaged in?   I will be requesting the HPV vaccine by my gyno next week. I am HPV negative and the same for all STIs ( pos for HSV1 cold sores which I disclosed to him). Also, just to clear my mind, am I correct in assuming no risk for pregnancy with his pre cum from the tip of his penis brushing the outside of my vagina?
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome to our Forum and thanks for you questions.  I endorse your commitment to safe sex and am pleased that you will be getting the HPV vaccine.  the most common STIs are transmitted through penetrative sexual contact and, perhaps surprisingly, mutual masturbation and frottage do not put you at meaningful risk for chlamydia, trichomonas, or gonorrhea.  Further, both syphilis and HIV are very, very rare among heterosexual men and with your partner's assurance that he was recently tested, I would have little or no real concern about these infections.  That leaves HPV and HSV.  The risk for herpes. while theoretically possible is less than 1 in 1,000 and probably far less IF your partner has HSV and odds are that he does not.  For HPV, once again there is a very small, difficult to quantify risk but not something that is likely at all.  Were I you, I would not be the least bit worried about the activities you described and would not pursue testing. 

I would not worry about the risk of pregnancy from contact of pre-ejaculate with the outside of your vagina but unless this was a most unusual encounter, my advice would be to consider planning for some sort of birth control unless you wish to become pregnant.  

I hope that this information is helpful to you. EWH
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22 months ago
Thank you Dr. - Re: " but unless this was a most unusual encounter"  Did you mean to say  "usual encounter"? I normally use condoms for birth control consistently, but on this occasion the condoms when we looked at them in the package, looked old/close to expiry date, so we opted to not take a chance with them and did not have any penetrative sex. Going forward we know to use condoms all the time, as that is my bottom line with penetrative sex regardless of STD test results known. With condom use consistently for penetrative sex of any kind, (excluding giving oral by me) is the risk for HPV considered very low? I have had penetrative sex with a condom once in 3.5 years, and the conversations about HPV risks are very confusing and sort of the last issue that concerns me because there isnt a way for men to be tested. With condom use what is the risk for being exposed to HPV from a man that hasn't been vaccinated and doesn't know his status because there is no test? Oh one last point, I asked him if he was vaccinated for HPV and he said no. I feel like the preventative burden and risk for HPV really falls to the woman, as there is no way to conclusively know if a man has it or not. Aside from celibacy, I just want to do whatever I can to take care of my sexual health in the best way possible.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Thanks for the additional information, my comment related to whether or not this was a singular event.  Condoms work, both for STI prevention and for pregnancy prevention.  Glad to hear of your commitment to using them.   Consistent use is associated with about a 50% reduction in HPV acquisition but the infection remains common is persons who use them.  you decision to seek the vaccine will lower your HPV risk far more- about 99% o the nine most common HPV types which are found in the vaccine.  

Unfortunately there is no recommended test for HPV in men.  OTOH, the vaccine is recommended for males as well as females.  There is no good way to quantify the risk of HPV other than to once again emphasize that it is common.

Regarding your comment about the burden of sexual health, I have to sadly agree with you.  OTOH, services for women are far better organized for women than for men and as a result, in my opinion, women benefit.  On this forum we endorse the concept of sexual health and regular check-ups for men but also must agree with you that women do a far better job of getting regular check ups than men.  It is to your benefit.  EWH
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22 months ago
Oh and point of clarity when he"put his uncovered penis between my closed legs up near but not in my vagina (Vulva)  to simulate penetration." we engaged in this for about 5 mins with simulated thrusting movement but no penetration and we both we lubricated from what I assume to be my vaginal secretions and potentially his pre cum-  I think this behavior has me the most concerned because we shared bodily fluids
22 months ago
Just saw the reply about the HPV risks and thank you- Final concern that I didnt fully explain was that when we were doing fronttage penis to vagina rubbing on each other unprotected he at on point thrust his penis and it hit my anus pretty hard. Not enough to penetrate but it hurt and I jumped away. With precum potentially there from him Im a little more concerned about HIV and syphilis( even though he stated he was "clean" and hetero.) Do you think I should not consider PEP? Is HIV exposure even possible with what we did?
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Thanks for the additional clarification regarding his placing his penis between your legs.  Still no risk and no reason for concern.

Regarding the contact of his penis with your anus, I still would not be worried.  If you came to my clinic asking for PEP, I would decline to provide it.  HIV is not a concern.

Thanks again for your thoughtful questions.  I hope the information I have provided has been helpful   As I suspect you know, since we provide up to three responses to each client's questions and this is my 3rd reply, this thread will be closed shortly without further replies.  EWH
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22 months ago
THANK YOU!!