[Question #6073] Recent event and questions

19 months ago

Hello Doctors:

I find myself questioning an act from two weeks ago and I was hoping to get some clarity on the risks, if any, involved.

I visited a female massage person in Chicago, and during the massage, she provided a hand release.  Before the hand to penis contact, which I know is no risk for any STD, she licked my scrotum for 1 to 3 minutes as I can recollect.  I do not think she put my scrotum into her mouth, but not entirely sure, I do not think so though.  I did call her afterwards out of concern, and she told me she is OCD about cleanliness and gets tested every three months, her last clean bill of STD health was end of July, and she never does anything uncovered, whatever that really means.

My concern is skin to skin contact STDs, although I do have HSV-1 and HPV I am certain from years ago.  I am 51 years of age.

My specific questions are (1) if I got syphilis from this, would there HAVE to necessarily be a chancre that appears on my scrotum, and then (2) if there is not one that appears, and I am checking, could I infect my wife and until one appears, if it does, can I continue normal relations with her?  Also, in your opinion, what are the statistical chances I got syphilis from this event?  I have read on previous questions that licking of intact skin is no risk for any STDs, like licking an elbow, or neck, but does that include the scrotum skin, or is that genitalia and therefore risky?  Obviously I am hoping for: ‘no risk, forget about it’

Thank you for your services.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your confidence in our services.

Hand-genital conact is risk free for STDs, as you already understand. And so is oral or saliva contact with skin anywhere on the body, including the scrotum. Having had HSV1, you are immune to a new infection, anywhere on your body. The risk of syphilis probably is exceedingly low:  the likelihood a female sex worker (or massage worker giving sex) in the US is very low. As for HPV, it is rarely transmited by oral sex. Finally, all three of the main skin-to-skin STDs (syphilis, HSV, HPV) generally require the organism, i.e. infected fluids, to be massaged into the tissues; relatively superficial contact is zero risk or close to it. On top of all that, you have good evidence that your massage partner is unlikely to have an active STD.

So all things considered, you can look at this as a zero risk event. I do not recommend any testing and see no reason you cannot safely continue sex at home without putting your wife at risk. That's what I would do if somehow I were in your situation.

To answer your specific questions, syphilitic chancre occurs only at the site of direct inoculation, and until the seconday stage of syphilis (weeks to months later) cannot be transmitted except by direct exposure to it. Howver, once someone develops a chancre, anywhere on the body, s/he should definitely avoid sex of any kind with other partners until tested and possibly treated. But this isn't going to happen in your case. Finally, as implied above, the skin of the scrotum is no more susceptible to STDs than skin anywhere else on the body.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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19 months ago
Thank you, very helpful indeed. 

Am i correct that if someone is infected with syphilis there need be, must be, a chancre at the site or infection?

And when after infection would it appear?

On a visible part of the body such as the scrotum, if one does not appear, is that ultimately evidence one was not infected?

And if my scrotum was in her mouth briefly, which i doubt, is that also superficial contact not worthy of any concern whatsoever?

Thank you again for the valuable information    
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Some primary syphilis infections cause no visible chancre, but that's mostly because of infection acquired at hidden sites, e.g. in the vagina or rectum. Absence of a a sore at visible site(s) of expousrby 3 weeks is strong evidence against infection, although not 100% proof. However, given the essentailly riaks free nature of the exposure described, you really needn't be concerned. Your last question was answered above:  correct, "not worthy of any concern whatsoever".---
19 months ago
Thank you.  

I will use my final question. 

In this case, the only area of possible exposure is my visible scrotum. 

My question is if there was a syphilis infection there at that location, a chancre must present itself, correct?  Syphilis has to have visible point of entry in this case?  If that’s true, after 90 days of checking, if no chancre, no infection?

Or is it possible that even at a visible spot like the scrotum there could be a syphilis infection absent a chancre?

Lastly, shall I assume based on this possible exposure no syphilis testing is needed?

Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Without a visible chancre, there is little chance someone caught syphilis. The main reason chancres seeming haven't been present is when exposure is in a hidden or hard to see location (vagina, rectum, etc). That said, there probably are rare cases when syphilis is acquired without visible chancre even on easily observed sites. That said, you had an essentially zero risk exposure with a partner who is exceedingly unlikely to have syphilis, and I see no cause for worry. That said, you of course are welcome to have a syphilis blood test 6+ weeks after the event, if the negative result will reassure you beyond what my wy words cn do. But I certainly would not do it if somehow I were in your circumstance.

That cndludes this thead. I hope the discussion was helpful.
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