[Question #6308] STD / HIV Transmission Risk Assessment (Hand to Genital)

16 months ago
Hi Doctors

I am a male in my 30s. Wanted to get an assessment of two possible exposures:

1) 5 weeks ago at a massage parlor, the masseuse inserted her finger a few cms into my anus. Her finger probably had some massage oil but I don’t know if she had any cuts on it or other fluids (which I doubt but it was dark). The penetration lasted for around a minute total

2) 3 weeks ago at a strip club, a dancer rubbed her clitoris / vagina externally and a few minutes later rubbed that hand on my penis head for a minute but I stopped her after that. I don’t think she was “wet” but i am not certain. 

For the last 2-3 days I am getting some mild fever, scratchy throat type symptoms (I’ve had the flu vaccine) but no runny / stuffy nose which I get worried about it not being a cold. 

Q1) What is my risk of HIV from the 2 exposures?

Q2) What is my risk of any other STI / STD from the 2 exposures?

Q3) I read a comment that if your initial viral exposure is lower (e.g., just precum) then your ARS is milder which is feeding into my anxiety. Could you please comment on this?

Thank you and have a nice day!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome to the forum. Thanks for your confidence in our services.

STDs are rarely if ever transmitted without penetration. Fingering and hand-genital contact are risk free. To your specific quesitons:

Q1) HIV for sure is zero risk from these events. There has never been a reported case of HIV from such contact. And staistically, it is very unlikely (under 1 chance in 100, probably closer to 1 in 1,000) that your massage partners had HIV.

Q2) Also zero or close to it -- low enough that you do not need testing and can safely continue unprotected sex if you have a regular partner.

Q3) The amount of HIV during exposure has no known effect on likelihood of ARS symptoms. In any case, symptomsof ARS are useless in judging whether or not someone has caught HIV. The ONLY way to judge possible HIV infection is to be tested. Your risk for HIV is zero, so there is no need for testing. However, perhaps you should consider it. Anxious persons often are more reassured by negative test results than by expert opinion. (I don't take it personally!)

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

HHH, MD
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16 months ago
Thanks so much Dr. Handsfield for such a quick reply. I appreciate it knowing that you must be very busy!

Just a couple of quick follow ups:
1) For HIV (and I ask this not just because of my incident) - is it true that vaginal fluids close to the labia have less viral titre / infectivity than fluids close to the cervix?

2) For other STDs - You mentioned a “close to 0” risk. Are there any STDs specifically that you might recommend getting tested for in this case? The only one I was thinking about was HPV but don’t think they do Genital HPV tests in men without the presence of a wart? 

Thanks again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
1) This sounds like an urban myth. All HIV in the female genital tract originates in the cervix, and It makes sense that HIV levels would be lower as those fluids mix with other moisture, leading to lower levels at the vaginal opening and labia than in a swab from the cervix. However, I am unaware of any actual research on this. It doesn't matter (except perhaps as a contributor to anxiety in exposed persons) and would be a low priority for research.

2) I can't say it any more clearly than I did above:  "low enough that you do not need testing and can safely continue unprotected sex if you have a regular partner." Yes, HPV could be a risk. However, you and your wife already have (or have had) genital HPV, since everyone gets it, often more than once. Any potential HPV exposure from this event does not elevate your or your wife's risk. And if and when HPV ever shows up, it probably won't be from this event -- but in any case, it's almost never possible to know when and from whom any particular HPV infection was acquired. This aspect isn't worth a moment of worry.
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16 months ago
Thanks again Doctor Handsfield. The last follow-ups are about the first incident (masseuse inserting finger a few cms in to the anus with massage oil for around a minute):

1) Can you please give me your assessment of anal HPV risk from this ( I have never had any other anal exposure so this would be the only one). Just trying to understand the long-term fragility of HPV on hands (maybe from the “body fluids” of a previous client). There was a Lancet: Infectious Disease paper this year stating that hand-to-genital HPV maybe very rare but wanted your opinion for this scenario. 

2) I also happen to have hemorrhoids / fissures but they weren’t actively bleeding/paining at the time. Does that add any caveats to your assessment of HPV or any other STD?

Again, what you are doing is tremendous service here. I am really grateful. Have a nice weekend. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
1) HIV is not known to be transmitted by fingering or other hand-genital (or finger-anal) contact. The Lancet and other papers reporting detectable HPV DNA under fingernails raises the possibilty of such transmission. However, detectable DNA does not necessarily denote transmissible infection, and the fact remains that virtually every patient with genital or anal HPV report standard risks, i.e. intercourse or other very direct contact. In my 40+ years in the STD business, I have never had a patient, or heard of a patient, with genital ro anal HPV whose only potential exposure had been hand-genital contact or fingering. Anyway, anal HPV is fairly frequent in straight men with no rectal sexual activity, so if any such problem ever shows up, almost certainly it will not be the result of this event. 

2) Of course there are not data, but I don't see how hemorrhoids would increase the risk of catching anal HPV or any other STD.

That completes the two follow-up exchanges included with each question and so concludes this thread. I hope the discussion has been helpfu and that you'll move long with no further worries. You had a trivial exposure with almost no risk of anything important. Do you best to let it go.
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