50 year old heterosexual male , unicircumised, uk.

Last full STD screen 2018- all clear

Since then in a permanent relationship.

I was involved in  following incidents across the years 2018-203 , all in Chinese/Thai massage parlours

1. Hand job( masseue touching  my genitals and masturbating me ) - 3-4 episodes

2. Nude massage and frottage 2-3 times, some of this involved contact of my genitals with breasts and labia but no penetration

3. Fingering - masseue lady put her finger into my anus- once

4. I never request or solicit oral sex/anal sex or vaginal sex from any massue or CSW

4. However more recently . on feb 3- I visited a chinese massage parlour. Agreed on a body to body massage followed by masturbation- The lady ( chinese , probably 20s) jumped on top of me for the nude massage . I had a feeling that although she intended a vigorous massage,  for a brief period , maybe 20 seconds my penis might have slipped into her vagina as the feeling was a bit different. I immediately stopped her and proceeded with a normal massage and hand relief.

Since then:

No symptoms

In the off-chance of chlamydia- I completed a week of Doxycycline 

Separately- I had a small boil with cellulitis on my hand for which I received C-Amoxiclav for 5 day (unconnected)

Any risk at all  for any STI from the above episodes? Any testing needed?

Presuming no risk/ very low risk , I am  now resuming  sexual activity with my regular partner

You describe a zero risk sexual lifestyle. With perhaps extraordinarily rare exceptions, STDs are not transmitted by hand-genital contact, fingering, massage, or frottage (body rubbing, including genital apposition without penetration. Hence your own assessment, as I understand it, is correct:  the only exposure that carried potential risk is the possible brief vaginal penetration. And given how brief that was, there was little STD risk from that event as well.

Had you asked ahead of time, I would have advised against the doxycycline, but it probably did no harm. However, the dose you took was effective only against chlamydia and also would have prevented syphilis if exposed. It isn't reliable against gonorrhea, but that was covered by amoxicillin/clavulanate. I see no need for testing for anything, unless you want the assurance of a negative HIV test. There was virtually no chance of it, however; if somehow I were in your situation, I would not be tested for anything and would be continuing unprotected sex with my wife without worry.

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

HHH, MD

1. Chlamydia is common. Uk data says 300 per 100000 prevalence in women. .Even if there was a risk with brief contact Doxycycline would have treated Chlamydia - correct? So no point in testing. Correct?

2. Gonorrhea: rarer than Chlamydia uk data says 40 per 100000 prevalence in women. Brief contact+ absence of symptoms makes it even more unlikely. I didnt know Co amoxiclav was sufficient. Here in NHs they give Azithromycin. Are they equally effective

3. Syphilis:  prevalence 0.3  per 100000. Very rare in women. Mostly seen in MSM in UK. Brief contact makes transmission unlikely.  Correct?I didnt know Doxycycline prevented syphilis. Is it used a post exposure prophylaxis for Syphilis

4. HIV: relatively rare in heterosexual women i  UK. Prevalence  for whole population reportedly 2  per 1000.( includes msm, drug users., those born outside uk etc who are at higher risk). Heterosexual women at lower risk.Assuming massues/csw are higher risk maybe 1 per 100? ( likely lower).Cdc estimate for transmission 1 in 2500. So net risk for vaginal intercourse to completion would be probably 1 in 250000? Very brief contact like this minimal risk- difficult to quantify but even if risk reduces by  half it would be 1 in 500000= as good as 0.Correct?

5. What about mycoplasma/ herpes/ hpv? Not worth worrying over?

I hope I am not overthinking this:)

If any testing was undertaken for reassurance- when/ what tests?

Many thanks once again

2. There are no actual data on amox/clav versus gonorrhea, but it is active against most strains of gonorrhea bacteria in lab testing and would eradicate many or most infections. The combination of doxy plus amox/clav would be close to 100% effective.

3. Yes, doxy for a week is 100% protective if exposed to syphilis. Once syphilis is established, doxy for 2 weeks is the standard treatment and is 100% effective in people who cannot take penicillin (allergy etc). One week probably would work but has not been studied.

4. I agree with your assumptions and calculations, except the first:  in UK probably under one in a thousand such women has HIV.

5. Mycoplasma genitalium is a risk but testing of asymptomatic persons isn't recommended. All other mycoplasmas and related organisms are normal in the genital tract and not documented to cause any health problems. Herpes far too low a risk for testing in absence of symptoms, partly because the tests don't perform sufficiently well: negative results do not exclude infection, and positive results often are false. HPV is universal -- 90% of all sexually active people are infected at one time or another, often several times; any new exposure doesn't materially elevate risk. Vaccination is key to preventing serious outcomes, but you're too old:  you've probably already had most of the HPV types covered by the vaccine.

I don't think I've ever had a patient with any STD after the exposures you describe.

-Last incident was on a Friday evening. I started Doxycycline on Wednesday morning. So not straight after- not sure if it makes any difference

not sure if the above makes any difference to overall risk assessment.

So- 

Strictly speaking no tests needed from a medical/ scientific viewpoiht.? But for reassurance if tests to be done. Which tests/ when?

If you insist on testing for reassurance -- which is completely unnecessary -- I would say only a urine gonorrhea/chlamydia test and a blood test in a few weeks for HIV. No point in syphilis testing. (Amox/clav also is 100% effective in preventing or aborting an early case of syphilis.) And the chlamydia test cannot possibly show anything -- but it's automatic when testing for gonorrhea.

No lab test is 100% perfect. Negative result will be no more reliable in showing your are uninfected than the scientific principles I've already stated. Why waste your money? Testing in this situation just makes no sense at all. 

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.