[Question #9784] Protected sex with massage therapist

29 months ago

Hi Doctor,

To give some background, I have excessively dry skin and a slight allergy to penicillin medication which makes me have diarrhoea. I had done a clean shave of my torso and following poor judgement went to a massage parlour which by standards was seedy, a Filipino therapist of unknown HIV status (who mentioned she was clean) gave me a full body massage and foam bath and a protected session of insertive vaginal sex and I fingered her. I also sucked her nipples briefly.

Three days later that I had a rash developing around my thighs which made me panic and this was later chalked up to be a bad case of folliculitis, two days after, I started developing a sore throat, a bit of a fever (37.8C) and eye discharge. There were no boils or bumps or discharge from the penis.

I went to the doctor a week in to deal and came clean with what happened. He made me take a syphilis test (Rapid Plasma Reagen); this was a week post exposure which came non-reactive. He also prescribed Doxylag, Flagyl and Betamet for the skin and I recovered within four days. The urine test showed nothing. I asked the doctor if a HIV test was still needed, and he reassured me that there wasn’t any need since this looked like a bacterial infection at best.

I made the mistake by reading the internet, I didn’t test for HIV and that's because of the rules surrounding it that positive people get deported, and the anxiety kicked in. When it got bad, my body temperature went up, had diarrhoea and I assume because of stress I developed a few boils on my back and there’s tingling in my skin.

Should I still get tested for HIV? Or is this anxiety playing on my mind?

H. Hunter Handsfield, MD

29 months ago

Welcome to the forum. Thanks for your question and for your confidence in our services.

You seem to have an inflated view of HIV risks. The events described carried no significant risk of HIV infection. It is statistically unlikely your massage therapist has HIV, but even if she does, HIV cannot be transmitted by massage or fingering, and condoms are highly effective against transmission by vaginal sex. (Even with no condom at all, if a woman has HIV, the risk to her male partner is one chance in 2,500.) And body shaving before skin-to-skin contact does not increase HIV risk. In addition, skin rash or other symptoms of acute retroviral syndrome (ARS, i.e. initial HIV infection) cannot start sooner than 7-8 days after exposure, and usually it's 10-14 days -- so onset of rash at 3 days cannot be due to HIV; and your description doesn't suggest an ARS rash anyway. Your sore throat also began too soon. Finally, you were at no risk for any other STDs either.

We try not to be critical of the medical care users report they have had. However, I believe your doctor overreacted; probalby he isn't an HIV/STD specialist and may not understand what constitutes risk for HIV and other STDs. I would not have prescribed doxycycline (Doxylag) or metronidazole (Flagyl) either. The betamethasone (Betamet) might have been appropriate for your rash, but would have no effect on rash due to ARS -- which suggests your doctor knew the rash was not related to HIV. Where I agree with your doctor is in not recommending an HIV test; I see no need for it. But in addition, the syphilis blood test made no sense, at least not in regard to your recent exposure: the skin rash of secondary syphilis cannot begin sooner than several weeks after exposure. If your doctor genuinely suspected syphilis, he probably understood it would have to be from a different exposure at least several weeks ago.

In summary, I see no need for HIV testing. (If it were necessary, you would have to do it regardless of the deportation policies where you are [UAR? Dubai?] -- if someone has HIV, s/he has to know it and needs to immediately return home for treatment anyway, regardless of deportation rules.) But since there is no chance you caught HIV and none of your symptoms suggest ARS, you really needn't be worried about it.

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

HHH, MD

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29 months ago

Thanks for your very quick reply Doctor, you're right about the location of the incident and that's what caused the anxiety.

It's been 30 days since the exposure and I haven't noticed anything besides the anxiety so I just wanted to add in my case in this instance specifically to see if there's anything I needed to do or look out for.

I know I have two follow up questions for this one but I'll only need one. since I've gone through the website on many of the other cases you've had in the past and I figure the recommendation will almost be identical on me pursuing life as normal.

Seeing that there's nothing, your answers have helped reassure me and bring my anxiety to ease.

Doctor. Thanks once again and thank you for providing this service. I'm committed more than ever to safer sex.

H. Hunter Handsfield, MD

29 months ago

"...anything I needed to do or look out for"? No, nothing. Now knowing that a month has passed since your erotic massage, I will point out that if you remain nervous about it, you can have a nearly conclusive test for HIV at this time, and a truly conclusive one when 6 weeks have passed, i.e. about 2 weeks from now. I'm not recommending you be tested -- just acknowledging that some anxious persons are more reassured by negative test results than by professional opinion, no matter how expert. (We don't take it personally!) If you feel you would like that additional reassurance, don't worry about the deportation business. There is no chance of a positive test result.

And thanks for reviewing other discussions with issues like your own. It sounds like you correctly understand. I'm glad to know you have been reassured, and that you're perhaps even more committed now to safe sex!

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28 months ago

Hi again Doctor,

I thought I sent a response to close the thread. But as a final follow up, and this is me responding a week later that so far I've had no major symptoms and I've been on the forums a lot because of heightened anxiety as you've mentioned to others I now tend to observe changed in skin. So just for my reassurance and keeping my sanity in check , here's what I observed. Let me know if these are symptoms or just my heightened sense of noticing every minor thing.

I have had skin drying in spots on my right hand ( not sure if this is because of copius use of hand sanitizer, weather or something else and a very tiny sore on my lower lip that I'm hoping happened because I bit it in my sleep.

I had a sore throat for another three days, this would be 35 days post event that subsided and I recovered after taking amoxicillin but I still spit out phlegm but it's not painful.

Once again, as a final thank you for being an amazing resource in a platform filled with misinformation, I've been on the forums a lot just to make sure I've got my bases covered and this entire experience although traumatic, has been educational.

Best wishes.

28 months ago

When I say platform filled with misinformation I meant the general internet. Sorry , wasn't referring to this website.

H. Hunter Handsfield, MD

28 months ago

I knew what you meant! These skin changes, your other symptoms, and their timing are not consistent with ARS as the cause.

I still hope you go ahead with testing to confirm you do not have HIV. Most likely you'll continue with at least some background worry about it until you know for sure. You won't regret testing when you finally do it.

Thanks for the thanks and your kind words about the forum. Stay safe.

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