[Question #9563] Frottage with slight penetration with csw
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31 months ago
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Dear Doctors,
Happy new year.
I am 40 yr old male living in Hong Kong.
On 3 Jan 2023 i visited a high end massage parlour (charging USD320 for 90 min massage and sex) and engaged in unprotected oral (giving and receiving) with a csw followed by condom protected sex. Condom sex is a must at this establishment.
On 5 Jan 2023 i visited another massage parlour (charging usd250 for 60 min massage and sex). I engaged in unprotected oral (giving and receiving) and intense frottage. She was on top rubbing her very wet vagina on my bare penis shaft and head for 2-3 minutes. I would use the head of my penis to rub her clit. From this forum, i understand these acts to be very low risk in nature and zero for hiv.
HOWEVER At one point during frottage, she pivoted and the head of my penis slid into her vagina. We both immediately separated in shock. We both acknowledged that penetration occurred but it was shallow - only my penis head went in and was immediately taken out by her standing up - 1 second max. Exposure.
We finished with condom protected sex without washing off my penis which was covered with her fluids. Condom was intact.
She is nice lady in her 30s from China. She said she goes for annual pap smears but never done a blood hiv test. She also notes that she always has sex with condoms but this isnt the first time where she had one of her clients “accidentally” slip inside her for a brief moment. She insists on using condoms with me. Shes also allows most of her clients to ejaculate in her mouth after a blow job but always spits the cum out.
On 10 Jan 2023 - i had a 38.8c fever, violent vomiting (once) and minor diarrhea with muscle and joint pains. No rash. I recovered within 24 hours and i am eating fine now with no body pains.
Based on the above, grateful for your assessment of my risk for sti and hiv especially the 5 Jan encounter -
did it amount to penetration?
Did i just go though ARS with the vomiting and diarrhea/body ache/fever?
Should i go for a 4th gen hiv comb
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Edward W. Hook M.D.
31 months ago
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Welcome to our Forum and thanks for your questions. I'll be glad to comment. Irrespective, this was a very low risk exposure. You cannot be sure that the partners you described did not have HIV if they have not tested although it is unlikely. There are several considerations here:
1. There is no known risk of acquiring HIV from receipt of oral sex.
2. Cunnilingus, which you performed on several of your partners is very low risk for acquisition of HIV but very, very rare cases have been described. How common this is unknown because the risk is so very low (certainly less than the lower than 1 in 10,000 chance sometimes cited by the CDC).
3. It sounds like each of your partners may have performed oral sex on others on multiple occasions. The risk for acquisition of HIV from performing oral sex on untreated, HIV infected partners is rare but well described. Again, current estimated are that this occurs less than once in every 10,000 sex acts.
3. Transient, shallow penetration- Penetration is penetration and while the brevity of your exposure, as well as the precautions your partner takes in her job make her relatively low, but not no risk.
4. Your symptoms- The GI symptoms you describe, vomiting in particular is not an accepted part of the ARS. More likely that your transient illness was due to something else.
Bottom line and synthesis. You are taking appropriate precautions to reduce your risk for STIs, including HIV but your partners are not no risk. I doubt that your symptoms were due to HIV and doubt that you were exposed. If you wish, out of an abundance of caution, you could have a 4th generation test for HIV at this time. If it is negative, your recent illness was definitely not HIV. Personally I would not be concerned and probably would not bother to test but, of course, testing is a personal decision. I hope this analysis of your situation is helpful. EWH
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31 months ago
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Dear Dr Hook
Many thanks for your analysis.
It all makes sense. I have a couple of follow up questions on the following topics
Brief shallow penetration - from reading other replies on this forum i understand that even if full unprotected penile vaginal penetration occurred and she was hiv positive, the chances of me getting infected is 1/2500. Would the fact that my penetration was shallow and brief lower my chances of getting infected? If so would there be a ball park estimate that you can give?
i want to further clarify that i just recovered from covid on 29 Dec 2022 (negative RAT for 2 consecutive days). Would my recent covid make me more likely to catch hiv even from a brief shallow penetration?
ARS - in your many years of experience, have you ever seen a case where ARS symptoms appear for 24 hours and vanish? I only had a fever for half a day and vomited once with diarrhea to follow but everything went back to normal within 24 hours. I read that ARS fever is persistent and typically lasts for at least a week along with other symptoms like body ache and sore throat (the latter which i did not have).
Given that I’m fully recovered from the GI illness and fever for over 2 days now, would the 4th gen hiv test still be helpful and be able to confirm whether my GI ordeal and fever was due to ARS?
Im really worried about the shallow penetration incident and the illness i got afterwards. Putting the two together has made me very anxious and i cannot sleep.
Many thanks for your time. You’re literally the only person i can talk to about this ordeal and I’m grateful for your support.
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Edward W. Hook M.D.
31 months ago
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Straight to your follow up questions:
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Logically briefer duration or limited penetration would be associated with lower risk but there are no scientific data on this. Remember, these are ESTMATES if AVERAGE risk.
There are no data and no reason to think that recent COVID-19 would change risk in any way.
Correct, the symptoms of the ARS typically last several days. Your symptoms really did not suggest the ARS.
If your symptoms were due to the ARS, a 4th generation HIV test would be positive, then and now.
Try not to worry. As I’ve tried to indicate, this was a relatively low risk encounter. EWH
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30 months ago
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Dear Dr Hook
Thank you for your reply. After much waiting and anxiety I went to the clinic for a HIV 4th gen test and syphillis test . I hope for the best.
My last follow up question is around gonorrhea and chlamydia. I’m concerned that given my practices of giving oral sex to multiple female partners (cunnilingus) , I may have caught gonorrhea and chlamydia in my mouth. I also read online that a recent study in Australia in 2019 found that it is possible for a person with oral gonorrhea to pass it on orally to others via kissing.
I’m very worried now as I have given oral sex to multiple female partners and sometimes I get a sore through every now and then.
It was just Chinese new years a week ago and my mother gave me a big kiss on the lips(family tradition over Chinese new years).
Now I’m worried that I may have gonorrhea and may have passed it to her.
I would be grateful for your comment on:
my risk of catching oral gonorrhea and chlamydia through performing oral sex on multiple sex partners (some csw);
chances that I would pass it to my family members through kissing (some saliva may be present) and sharing chopsticks exposed to my saliva; and
Does oral gonorrhea and chlamydia resolve on its own without treatment?
Whether I should get a throat swab test now.
Many thanks
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Edward W. Hook M.D.
30 months ago
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Thanks for your follow-up. The research by the Australian group you cite is controversial. The kissing they have focused on is so-called "open mouth kissing" in which there is saliva exchange. Oral STIs, particularly gonorrhea and only very rarely chlamydia certainly do occur, but they are less common than ano-genital infections. Among unprotected oral exposures, cunnilingus is probably lowest risk (fellatio is higher still). When you combine the fact that most persons (including CSWs) do not have STIs, that most exposures to infected partners do not result in transmission of infection, and that oral infections appear to often resolve on their own without therapy, the likelihood that you acquired oral gonorrhea (or chlamydia) is quite low and the likelihood that you transmitted to others through kissing is lower still, approaching zero.
FYI, most oral infections are asymptomatic.
The decision to test is up to you. It is unlikely that you are infected in the throat with gonorrhea (or chlamydia) but if you wish to address any lingering anxiety/concern that you might have, then a throat swab (specifically for gonorrhea and chlamydia- routine bacterial throat swabs would not detect the STIs), then the swabs are easily performed and provide accurate information. In addition, going forward, as you have unprotested exposures of any sort to new or multiple partners, it is advisable to occasionally (yearly or at six months intervals, depending on your numbers of exposures and level of concern) to have screening in which testing for STIs is performed, even in the absence of symptoms. This is good sexual health practice.
This will complete this thread. I hope my responses have been helpful. Please don't worry- your likelihood of infection at all is quite low. EWH
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