[Question #6337] Frottage vs. Apposition
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70 months ago
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Hello Doctors, I have a clarifying question. Almost 4 months ago, I engaged in a sexual encounter that did not include intercourse. I am female, the other person was male. We are both in our early 30s. I do not know much about his prior sexual history. We engaged in a few moments of sexual foreplay, running our bare genitals together, therefore secretions did come in contact with the genital skin. I have been tested for syphilis, hepatitis, hiv, chlamydia, gonorrhea, all negative, I also have been vaccinated years ago for hpv. I feel confident in these results. However, there’s the nagging Mycoplasma Genitalium fear that continues to pop up. Once I received my negative results, I resumed unprotected intercourse with my regular parter. Not though, I worry what if I contracted this bug and do not know. I was reassured that this type of situation would not lead to and m. gen infection (the word frottage was used by the doctor but I described the act as described above, and was told there wasn’t a risk) However, as I scoured the internet for transmission rates and so on, I cam across a forum with Dr. HHH saying that apposition is different than frottage and it carries some risk. I really apologize for my picking apart at the little details of this. I am just trying to understand my risks. There was no intercourse, just the foreplay I’ve described above. Should I be concerned with this m gen that the media seems to be dubbing a rampant, common superbug.
Thank you
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H. Hunter Handsfield, MD
70 months ago
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Welcome back, but sorry you found it necessary.
Mycoplasma genitalium is not transmitted by frottage or genital apposition. No penentration means no risk for M. genitalium. Apposition may carry small risk for STDs transmitted skin to skin (herpes, HPV), whereas frottage probably does not. In any case, you don't need testing for M genitalium and should not be at all worred about it.
HHH, MD
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70 months ago
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Thanks so much for the reassurance and clarification.
As far as accuracy of tests go, specifically, gonorrhea and chlamydia (urine tests), would you say those tests are accurate? They were not taken within any kind of window period, they were taken 2 months after the incident.
I only ask as I am experiencing a bit of light spotting, (no chance I’m pregnant) between periods, no odors, no real change other than the spotting, (I’ll add irregular periods have been something I’ve struggled with through the years).
When all is said and done, do you agree that the spotting I am experiencing must be from a separate cause and not an STI being my incident was risk free?
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H. Hunter Handsfield, MD
70 months ago
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The gonorrhea/chlamydia tests are highly reliable and show you were not infected at the time you were tested and not the cause of spotting etc. No STD from apposition or frottage could transmit any STD that could cause spotting.---
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70 months ago
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Hi Doctor, hope you’re enjoying the holidays so far.
I wanted to return for my final follow up.
In regard to the chlamydia and gonorrhea test I had done, how likely is the chance of a false negative if I didn’t wait an hour to urinate before the test? I didn’t know this could be an issue until recently, so I wanted to get your opinion, since you specialize in this field.
Secondly, in your experience, have you ever had a patient with a positive chlamydia or gonorrhea result from the type of sexual contact I’ve described above?
And lastly, I read one of your posts from years ago on Medhelp stating stds like chlamydia and gonorrhea need “direct access to susceptible tissues which typically are deep inside” Is this why they are not transmitted through frottage/apposition?
What if the head of the penis comes into direct contact with the vaginal opening, but does NOT penetrate, does that change your assessment in general or for my case in particular?
Thank you so much for answering all of my questions, I’ve followed yours and Dr. Hook’s work for some time and appreciate all of the work you both have done. It’s wonderful to have access to this and helpful to be answered and educated without judgement. Happy Holidays.
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H. Hunter Handsfield, MD
70 months ago
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We are set up for follow-up comments in order to clarify the opening question and our replies to it, not to ask entirely new questions or to otherwise expand the discussion.
Briefly, time since last urinating is a theoretical issue that makes no difference in test reliability. No, neither I nor Dr Hook have ever had such a patient. And yes, you correctly understand the main reason such exposures are risk free — including penis contact with vaginal opening.
Thanks for your very kind words. But you really shouldn’t need this sort of reassurance every time a new concern like this comes to mind. Just remember that STDs are not easily transmitted, and non-insertive sex almost always carries no risk.
Best wishes and stay safe, as you have been!
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