[Question #6913] Protected oral and masturbation with vibrator

11 months ago
Respected Dr., 

last Monday I went to a Thai massage. The woman has many clients a day and is been doing her job for 15 years.  She easily gives her clients a handjob and blowjob and for sure is available for vaginal and anal intercourse. I think she is very high risk.

I put a condom on my penis BEFORE anything got started. Then I used a vibrator on her vagina for 15 minutes but hardly touched her vagina with my fingers; if at all it was minimal. Then she gave me a blowjob with the condom on till I came. The condom remained intact, i.e. it didn't break wide open. I took the condom off my penis and immediately washed my hands thoroughly and then my penis and left. Since then I feel guilty as I am married and worry now constantly.

My questions:

a) How would you rate my risk for HIV? I know that insertive unprotected oral is calculated at 1:10,000. So WITH a condom AND not even knowing she is HIV-positive it must be one in many many millions or even truly zero? Can you give a number to this?

b) Same for other STD`s (am vaccinated against HBV)

c) Is a condom failure really only possible like that 1.) the condom breaks obviously wide open or 2.) the condom is misused, like not put on properly BEFORE?

I contacted her again and texted if she tests regularly for HIV. She was very evasive and just said that she was always fine and that she doesn't worry. The place is only licensed for regular massages. That all made me very suspicious. 

d) So should I test for anything? My main fear is HIV.

e) Can I have sex with my wife?

I think I am so paranoid because she seems to be such a high risk person with so many partners and no testing.

Thanks for your answers!
Friedrich
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Welcome to the forum. Thanks for your confidence in our services. Directly to your questions:

Contrary to what you might assume, given your sex worker partner's history, the chance she has HIV is probably under 1%.

a) There has never been a proved (or to my knowledge, even suspected) case of HIV transmitted by hand-genital contact: zero risk. For unprotected oral sex, the risk for the penile partner is even lower, 1 in 20,000. (Its estiamate at 1 in 10K for penis to oral.) One in 20K is equivalent to receiving oral by infected partners once daily for 55 years before transmission might be likely -- and here too, there has never been a scientifically documented case. With a condom, for sure the risk is truly zero.

b) Also zero risk for all toher STDs, both from hand-genital contact and condom protected oral sex.

c) Your statements about condom use are correct. And anyway, even without a condom, you would not have been at significant risk for any infection from the events described.

d,e) I would not recommend any testing after such an exposure, and if I were in your shoes I would continue unrptected sex with my wife with no worries about infecting her with anything.

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

HHH, MD
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11 months ago
Respected Dr. Handsfield,

just one follow up and I hope to be able to let it go then.

IF!! an oral exposure may ever lead to HIV then the transmitting "fluid" would need to be blood, right? How much blood would be necessary for this? Understanding, that traces of blood are not sufficient to  cause infection (and that saliva kills HIV), I guess she would have to have her full mouth full with blood, like right back from the dentist, right?

I hope your answer will help me to let go of my irrational fears.

Kind regards
Friedrich
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
No, blood is not the only body fluid that carries HIV or transmits infection. Semen and vaginal fluids account for most sexual transmission of HIV. So does breast milk of nursing mothers. The important fact is that no cases are known to have been transmitted by hand-genital contact and only very rare ones by oral sex (and none mouth to penis) -- even though billions of those events probably involved small amounts of exposure to blood or other infected fluids. Even with unprotected vaginal sex, HIV i stransmitted on average less than one time in a thousand. It take slots of virus for transmission to occur -- far more than is possible with hand-genital or most cases of ora=genital exposure.

I hope this information is helpful.
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11 months ago
Dear Dr. Handsfield,

 this will be according your regulations my last follow up. I cannot let go of the worry that somehow the oral incident has put me at risk.

My question:

Can a condom failure really happen unnoticed?

Thanks for a last answer and all the best for you!
Friedrich
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Some condom failures are not noticed. Not all men feel condoms break during intercourse, and only discover the broken condom after withdrawal. If he doesn't look closely and the room is dark, it may not be noticed. However, it is obvious that with oral sex, it would be much more difficult for breakage to occur without seeing it. If the condom was intact after the oral event was complete, then obviously is did not fail.

I'm sorry you remain so concerned after my reasoned, science-based advice. You understand that your fears are irrational. Even though testing isn't necessary, you are free to be tested anyway if the negative results will help you move on without worry.

That concludes this thread. Thanks for your thanks; I do hope the discussion has been helfpul.
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