HPV/Herpes

Dear Dr. Handsfield,
Over last years I went to thai massages about every 2 weeks. I received massages with happy endings but just handjobs. Seldom (5 exposures over last 4 years) I also received covered blowjobs (with condom) from prostitutes and fingered them (did not touch myself with same hand afterwards). Last covered blowjob was 2 weeks ago, last massage 2 days ago. 2 days ago I discovered a small red pimple (2 mm cross section, could be just a "normal spot") on the shaft of my penis. With fussy further examinations I also discovered 2 tiny (even slightly less than 1 mm!) spots with mormal skin color nearby the pimple. Also I have tiny hard blisters on the sides of some of my fingers only in summer. My doctor told me it is a dishydrotic eczema and not to worry about it.
Here my questions:

1) Could HPV or HSV have been transmitted by the numerous handjobs (hand-genital) or are it absolutely necessarily different types of warts (hands versus genitals)?
2) Is there any chance the blowjobs could have contracted HPV or HSV because the penis perhaps wasn`t fully covered (I do not remember exactly)?
3) Could HPV/warts be contracted to my fingers by fingering (could my blisters on the fingersides in fact be "genital" warts?
4) Do you recommend any testings or examinations?
5) Can I safely have sex with my long time girlfriend?
6) Should I just drop this whole thing?

Thank you in advance and best regards,
Robbie

[H. Hunter Handsfield, M.D.]

First response after the first 2 sentences.  You could not have acquired any STD from the exposures you describe.  No matter what symptoms you have, and whether or not you have genital warts or herpes, you didn't get them from the massage experiences you describe.

Now going on to read the rest...

Your symptoms don't suggest any STD, and a provider has said you don't have an STD.  Thus, you don't have an STD.  No online doc can improve on the diagnosis from direct examinatin.  Most of your questions are irrelevant, since you do not have HPV or herpes.  The direct answers to your questions are:

1,2,3) HPV and HSV are not transmitted by hand-genital contact or through condoms.  Common hand warts (due mostly to HPV type 1) are almost never found on the genitals.  Oral sex doesn't transmit HPV, even without protection.  Your doctor already told you that your hand problem is not due to warts or herpes.  4,5) You don't need testing and can safely have sex with your girlfriend.  6) You definitely should drop the whole thing. You are irrationally overreacting.  But since you clearly can't handle the stress, I suggest you stop going to massage parlors, or at least stop allowing sexual contact while there.

Good luck--  HHH, MD

[Robbie11]

Thanks ever so much doctor. You provide a valuable service to mankind. I understand my worries are an unjustified overreaction - at least I am glad to have supported you with my fee. No I will go back to my work to myself give something back to society.

[Tommy420]

Doc, I don't understand why your answers vary from one question to the other.  In other threads you've said that hand jobs pose no risk for STDs except for possibly HPV.  Here, you're telling someone who has gotten repeated hand jobs at massage parlours that HPV isn't transmitted via handjobs. Why the discrepancy?

Also, I thought HPV can be transmitted via oral sex, although you say unprotected oral sex does not transmit HPV. I'm a bit concerned about the advice you give, especially since you basically told him to go ahead and have sex with his g/f.

Why do sites state that it's possible to catch HPV and Herpes via handjobs?

[monkeyflower]

Well, for one thing he was wearing a condom, and he was receiving oral, not giving.

Otherwise, yes, it's possible to get HPV orally from giving oral to someone with genital HPV. However, think about it. HPV is virtually ubiquitous and almost everyone has oral sex, but how many people have you seen walking around with oral warts? And oral cancer is really rare. It's just not worth worrying about as far as I'm concerned.

As for handjobs, I could be wrong, but I don't think Dr. Handsfield has ever said HPV from a handjob was even remotely likely.

[H. Hunter Handsfield, M.D.]

Don't split hairs in interpreting my replies, which are always tailored to the specific question.  You need to read each one n the context of that thread.  Sometimes I say "zero" when the risk is low enough it can be disregarded; other times I describe the very low chance.  The take home message is intended to be consisent, to either worry or not worry about the exposure.

Whether it's HIV or other STDs, many websites have a "take no chances" (or from a legal perspective, CYA) attitude.  If there is theoretical risk it is listed. I base my advice on known facts, not far out speculation.  In 30+ years in an STD clinic, I have never seen (or even heard by rumor) of a case of HSV acquired by handjob.

Threadjump; no ongoing discussion.

[Dog Monkey]

" Oral sex doesn't transmit HPV, even without protection."

However, I have read a new study that suggests this does transmit the virus –– and causes mouth cancers, (which are steady despite declines in smoking).  So, are you referring to a certain kind of oral sex?  Maybe this page needs updating.

Also, in another article you said that there's open debate on whether to inform your partner about HPV.  Is this sound medical science? or is it a way of rectifying a permissive culture of immorality with the pure logic of epidemiology?  I have a "friend" who's girlfriend (virgin) knew she got HPV from this guy, even though he was asymptomatic and never had warts.  She never forgave him and he, not willing to forgoe sex for the rest of his life, has given it to subsequent partners; at least one of whom now has to get pap smears every 6 months.  To analogize, I guess what I am saying is that if you know you are drunk you might still be able to drive safely, but the odds are against you so it's best to be upfront and tell your friend you are not safe to drive.

P.S.- That friend later found out that another gal he dated, around the same time as the aformentioned transmission, has subsequently died of complications stemming from cervical cancer.  The only thing saving that friend from a life of guilt is the fact that he's not sure who gave it to who.

[H. Hunter Handsfield, M.D.]

Interpret all my responses in the context of the specific question.  My reply in this thread was in respect to acquiring genital HPV from someone's mouth.  If that happens, it isn't known and probably is very rare.  Certainly oral HPV can be acquried by oral sex from a partner's genital infection. Virtually all such infections are asymptomatic, remain that way, and probably go away.  Yes, the frequency of oral and head/neck cancers is rising, and some infections probably are caused by HPV.  But it remains an exceedingly rare kind of cancer.

I have repeatedly said that my advice about informing partners is NOT scientific but personal.  Opinions of the experts are widely varied.  Some agree with you, others do not.  CDC agrees with me that informing partners is not always necessary.  Individual persons' horror stories are a poor basis on which to base generalized health advice.

[Dog Monkey]

Thanks for your prompt response.

I hadn't considered the exact direction of transmission; that is to say from the mouth to the genitalia being rare, while from the genitalia and to the mouth being more possible.  I still point out that the article stressed that the contribution from HPV to oral cancer was considered growing –– as opposed to "exceedingly rare."  In fact, the specific theory advanced by the article was that the number of oral, tongue, pharyngeal and tonsillar(?) cancers caused by HPV may be greatly underreported and understudied.  While such studies (sorry for no cite, I read it on the train) need to be replicated and expounded upon, it's interesting to consider.

With so many messages out there indicating oral sex is o.k. (from a personal and not scientific standpoint) I thought that it is interesting to consider all ramifications (including scientific) for these actions which can lead to disease transmission and proximately caused death, especially when abstinent behaviors don't lead to anything.  I don't go to church much and I am not trying to preach, just pointing out what's logical.  People should not have to die from cancer simply because CDC is worried about offending social norms.  Because laypersons can't distinguish as to whether their HPV may lead to cancer, it seems appropriate that they should be guided by the precautionary principle and inform their partners or otherwise find a safe solution.  I guess I am alarmed that the CDC would not recommend informing partners when considering the potential risks v. rewards (social, scientific, and otherwise).  For example, we know HPV does lead to cancer over time in a significant number of young women.  While incidence of HPV-caused cancer may be rare, it's effects are catastrophic, so the risks are high. This risk can be avoided by old fashioned abstinence or new fangled "informed decision making."  Why on earth would the CDC stand on the sidelines for this one?  I guess that's a rhetorical question.

As for the point that many people have multiple strains of HPV in many parts of their bodies, and that it is not always neccessary to inform your partner, I understand your point.  I gather if we all had to inform everyone of our status we would be alarmed by the number of people with scarlet "HPV" emblazoned on their chest.

It still makes a subject for good debate.  I would like to see a dumb jock and a cervical cancer victim argue this one on the Jerry Springer Show (based on their personal beliefs, of course.)

Thanks!

[H. Hunter Handsfield, M.D.]

It might be a good subject for a debate, but this isn't the place.

Of course a problem can be growing and still be exceedingly rare.