[Question #5916] Mutual masturbation STI risk?

19 months ago
Earlier today I engaged in mutual masturbation with a gay man (I am male). He never actually masturbated me (I masturbated myself), and I did not touch his penis (I did rub his penis and testicles with his underwear on for a short time). But at one point, he got a small amount of his pre-cum on his fingers and then rubbed it on the shaft of my penis. I don't *THINK* any got on the head of my penis, but I may be wrong, so I suppose it's possible that some got into my urethra, but I don't *THINK* that happened. He also used a penis pump on me for a short period of time which he uses on himself. It appeared to have not been recently used, but I don't know if it was clean or not. He did rub my testicles for a bit with his hand. That's all we did. No kissing, no oral, no anal, nothing else at all. Am I at risk for any STI's (NOT just HIV, but any others)? I do not have any broken skin on my penis.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your confidence in our services.

Even if your partner had masturbated you -- which is what I first assumed from the title you chose for this question -- there would have been no risk. HIV has never been known to be transmitted by hand-genital contact, even when genital fluids are used for lubrication. Look at it this way:  the sexual practice with the highest risk of HIV is unprotected receptive anal sex (i.e. bottoming) with an infected partner, not on HIV treatment, who ejaculates in the rectum. In this situation -- with a load of HIV infected semen being deposited in the rectum -- the risk of HIV is once for every 72 events. For the insertive (top) partner -- i.e. unprotected penis inside a partner's rectum, thrusting for maybe several minutes -- the estimated risk is 1 chance in 900, which is equivalent to such sex once daily for 2 ½ years before infection might be likely. Given these statistics, what can it possibly be by getting a little infected pre-cum or semen on the penis? Or even in the meatus (urethral opening)?

Those comments directly address HIV, but the concepts also apply to all STDs. There simply is no risk, or virtually no risk, from the sorts of events you have described. That would be the case even if you had any broken skin on your penis.

So all is well. If these are your only potential STD/HIV risks, you needn't worry at all and should not be tested for anything.

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

HHH, MD
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19 months ago
Hello, Dr. Handsfield. Thank you so much for your quick reply! You have helped relieve my anxiety greatly!

To clarify: I am not necessarily concerned about HIV. I am aware that HIV infection this way is basically impossible. And this man tells me that he is 100% free of any STIs including HIV (although, a person can say whatever they want; doesn't make it true).

Specifically, I am concerned more about Chlamydia and Gonorrhea. I have read much (MUCH!) conflicting information stating that those two bugs can potentially be transmitted this way. Some websites I've read say basically no, others say it's possible due to the pre-cum issue.

If I am understanding your reply correctly, you are telling me that there is essentially a 0% chance of Chlamydia/Gonorrhea infection this way, and also a 0% chance of other STI infections. Am I reading you correctly?

Also, in an abundance of caution, what IF his pre-cum DID actually get on the urethral opening, or in my urethra? Again, I don't think it did, but let's face it, it's hard to know for sure. I actually did pay attention to what he was doing, but I just don't have absolute certainty on this. I think it was at least CLOSE to the head of my penis, and thus the urethral opening.

I have a regular partner, and obviously don't want to risk spreading an infection. Based on everything we've discussed here, you really do not think I should be tested for any STI's at all?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
You won't find so much conflicting information if you limit your searching to scientific websites like academic institutions, CDC, other public health agencies, and professionally moderated websites, like this one. Any site that says gon/chl can be transmitted by non-penetration contact with pre-ejaculate fluid is mistaken; or in some cases might be making assumptions based on theory, with regard to data showing no STD transmission without insertive sex.

Yes you are reading me correctly. As for your last question, see the last line of the main paragraph of my reply above. I haven't changed my mind in the last few minutes! Or about lack of need for STD testing. Of course you're always free to be tested if the negative redsults will be reassuring; anxious persons often are more reassured by test results than by expert opinion (and knowing that, I don't take it personally).

The other consideration is that all men having sex with other men -- including many in committed, intended monogamous relationships -- should be tested for common STDs (gonorrhea, chlamydia, syphilis, HIV) from time to time; many experts recommend once a year, minimum. I'll also remind you of the obivous fact that when one member of a couple finds a need for outside partnerships, the other has often done so as well -- and this dynamic is probably most common among MSM. (That's based on data, not a statement of bias. I'm not assuming your partner has had sex with others. You know him and I don't.) So if it has been a while since you were tested, maybe do iit now, when it's on your mind. But definitely not because of the events described above.
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19 months ago
Thank you again, very much. You have really, really helped me, and I do sincerely appreciate it!

One thing I would like clarification on: I understand what you're saying about the various websites (if it's on the internet, it must be truth, right? NOT!), and I do trust your expert opinion, hence the reason that I feel MUCH more relaxed and calm.

Having said that...

I would like to know: I understand that gonorrhea and chlamydia can be transmitted via unprotected oral sex and penetrative sex (more so from penetrative sex, of course). I believe the CDC confirms the oral sex connection. So knowing that, if his pre-cum did enter my urethra, why then is it impossible to get it that way, if it is possible to get it via unprotected oral sex?

Thank you, Doctor.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Half right:  gonorrhea can be transmitted by oral sex. Chlamydia not so much. If transmitted by oral sex, it is very rare. Chlamydia rarely infects the oral cavity, and if not there, obviously cannot be transmitted by such contact. And when there, not certain it is transmissible. I have been one of the major researchers of this topic, and I am unaware of any documented cases of oral to genital chlamydia transmission. If it occurs, it is very rare. CDC may talk of a hypthetical risk, but no more than that.

It is a common misonception, about infectous diseease in general, that "just one bacteria {or virus]" is enough to transmit. Almost never true. The STDs are inherently inefficiently transmitted:  that's why they're sexually transmtited in the first place. Without intimate contact, with transfer of millions of viruses or bacteria, infection doesn't take hold. Gonorrhea is more transmissible than chlamydia, but both are very different than, say, the common cold, influenza, or tuberculosis. Could it happen? Probably yes. Does it occur ofen enough to actually be an important problem? For sure not.
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19 months ago
Thank you again for your response but I’m still somewhat confused. I am so sorry to feel the need to continue to follow-up. 

Just to clarify: Even if some of his pre-cum did touch the tip of my penis and therefore potentially entered my urethra, you believe that there is no concern and no reason to be tested for gonorrhea or chlamydia. Is this correct? How long does gon/chl last outside the body? Does it die quickly like HIV? And what about the penis pump he used on me? I have no clue when he last used it on himself or if he cleaned it. 

If I choose to be tested to put my mind at ease, how long would I need to wait to get an accurate result? This event occurred yesterday. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
You just can't accept the reassurance, can you? OK, you win:  if that happened, there would be a chance of infection. However, it must have happened billions of times to other men in your situation, but nobody ever shows up in busy STD clinics with gonorrhea or chlamydia if they didn't have penetrative sex. What do YOU conclude from that?

The low rate of infection probably has nothing to do with the organisms dying:  they don't die so soon after air exposure. Please re-read the second paragraph of my reply yesterday, which explains the reason the risk is low.

Gonorrhe/chlamydia testing is valid any time 4-5 days or more after exposure.

We're beyond the two follow-up comments and replies included with each thread and so ends this discussion. I hope it has been helpful.
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