[Question #8805] Details around HPV/HSV/Syphilis
 |
39 months ago
|
Greetings,
If I may, I'd like to get some clarity on the viruses primarily spread via infected-skin (lesions) to non-infected skin - that is, HPV, HSV, and Syphilis. It appears that HPV and HSV are common (maybe not so much Syphilis) and thus considered with friction during sex - vaginal or anal, even if this is more of a logical than evidential notion.
My question: Why would friction above the condom during sex cause the spread of these common viruses and not hand-to-genital masturbation when it is a vigorous activity? Can there not be direct contact of infected skin on the hand/fingers with breached skin on the genitals? Cross-referencing hand-to-genital exposure and friction during sex with these common viruses, I am challenged with understanding the difference. On the contrary, I really don't see how either activity can permit rubbing of sufficient infected material deep enough into tissues. Does it logically have to do with the infection sites and one not being on a hand (with the rare exception of HPV)?
I am aware that the busiest STD clinics do not present patients with non-traditional exposures testing positive for STIs. Further, that the logical notion of STI transmission from friction is in correlation with the actual sex component.
Last thoughts: Is it HSV1 that is just common and not HSV2?
Respectfully,
Michael
 |
H. Hunter Handsfield, MD
39 months ago
|
Welcome to the forum. I'm happy to address this, but there are no data and mostly I can just speculate.
---
Transmission of most infections, STI or otherwise, is a complex interplay of several factors. Friction indeed does seem to be significant for the three main skin-to-skin STIs (herpes, syphilis, HPV), in which the causes probably need to be massaged into exposed tissues. But others include the number of organisms, duration of the contact leading to transmission, immune system response (not necessarily meaning immunity from prior exposures), and poorly understood biological factors also might be involved. To my knowledge, for these particular STIs there has been no research on this -- we're left with educated guesswork to explain the rarity of hand-genital transmission. My guess is that it comes down largely to the number of viruses likely to be carried over from one's own infected site on his or her hands to a partner's genital tissues.
We get questions about both HSV1 and HSV2 and hand-genital exposure. I doubt here is any difference between them in the low likelihood of hand-genital transmission.
In absence of firm data, that's about the best I can do -- admittedly, mostly just logical assumptions. But let me know if anything isn't clear.
HHH, MD
------
|
39 months ago
|
Thank you Dr. Handsfield. That was all clear to me and provides the clarity I needed.
Warm wishes,
Michael
|
39 months ago
|
In retrospect, if I can followup in two parts to the initial question and response...
1. Im thinking that the friction in skin-to-skin contact just aids in the transmission of STIs when there is actual sex, vaginal or anal - if there is an infected skin lesion (damaged skin) that directly comes into contact with uninfected breached skin - but the friction on its own seemingly doesnt cause transmission by itself assuming there wouldnt be enough organism exposure without the unprotected sex act fostered by longer duration and perhaps more skin-skin contact. For practical purposes, is that a correct assumption? If not, what about the actual sex act gives risk to skin-skin contact?
2. If the above is a safe assumption, can I say the same for infected blood - circulating around the body and exposed via a skin lesion or cut in the skin - that I did for just transmission by an infected skin lesion? Lastly, is infected blood as virally concentrated as infected tissue in damaged skin?
Thanks,
Michael
|
39 months ago
|
Then again, it would be the act of sex aiding the transmission of skin-to-skin STIs not the other way around as just mentioned.
|
H. Hunter Handsfield, MD
39 months ago
|
1) There has been little research, to my knowledge, on the details of transmission of these infections. Most of what I have said is just common sense extrapolation from a) the most common locations of initial infection and b) animal studies, in which simple contact of the organisms with skin or even mucosal (moist) surfaces usually is insufficient for infection to take hold. But I suspect you're right: factors other than transmission (e.g. organism load, i.e. the dose of organisms at the time of exposure) undoubtedly is also very important.
2)The concentration of organisms typically is far, far lower in blood than in infected tissues and secretions. I really don't think you need be worried about blood exposure, short of injection drug use, massive exposure, and so on. I've never heard of anyone catching syphilis or herpes by blood exposure, apart from rare cases of syphilis transmission by blood transfusion, and that's exceedingly rare. And never for herpes. And HPV doesn't circulate in blood.
That completes the two follow-up exchanges include with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
--- |
H. Hunter Handsfield, MD
38 months ago
|
Hello again. I realized I had miscounted -- you have one more follow-up comment coming, so I have re-opened this thread. Sorry!
I'll also add to my response no. 1 yesterday: Yes, probably there are circumstances (probably involving especially large exposure load) in which transmission could occur in absence of friction or massage, especially when mucosal (moist) surfaces are exposed.
---In case of any further clarifications, please post no later than 4 weeks after the original question.
|
38 months ago
|
Hi,
The circumstances in which transmission could probably occur - in the absence of friction or massage - would likely be genital rubbing presumably since the genitals can near direct contact with mucosal surfaces, correct? Of course, as you mentioned, probably when or if there is especially large exposure load. I would say this (clothless) genital apposition often does not promote large exposure, especially because of the duration as well. Hence, infected patients do not present STI with only genital apposition without actual sex.
Thank you Dr. Handsfield.
Respectfully,
Michael
|
H. Hunter Handsfield, MD
38 months ago
|
Well, "genital rubbing" implies the friction we have been talking about. Genital apposition certainly can involve substantial rubbing and friction, and it is not 100% safe in regard to the skin to skin infections (herpes, HPV, syphilis). But it's very low risk, whatever the biological reasons.
That winds down this thread (again). Best wishes and stay safe.
---