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HPV from Erotic Massage, Could it be Possible?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HPV from Erotic Massage, Could it be Possible?

Three months ago I got an erotic massage that included a hand job and ejaculation; there was NO oral or vaginal insertion. The masseuse was naked and I touched her body including her genital hair and the area surrounding her private part, however, I didn’t get in touch with her vaginal fluid nor did she touch her private part throughout the massage. One week after the encounter, I noticed small pimple on the shaft of my penis (3 mm in diameter). I am version and had not been engaged in any sexual touching except for this case. I went to a dermatologist and he examined the pimple and told me that this is a papilloma virus wart and can easily be removed by freezing. I talked to two other doctors and they told me that there are few factors against the diagnosis of the dermatologist:

1. HPV doesn’t present any symptoms in 1 week. It usually takes from few weeks to 3 months. When I asked the dermatologist who removed the wart about this point, he told me that I could have caught the virus from a public toilet.
2. The shape of the wart is just an elevation under the skin and not the typical genital wart shown in medical web sites.
3. Before I had it removed, the wart got smaller and then bigger in a matter of few days.
4. The only proven way of transmitting HPV is sexual intercourse and direct genital-to-genital contact.
I need medical advice on the following:
1. How likely is it that the dermatologist that diagnosed my wart as HPV is mistaken? Considering the four factors mentioned above and the fact that he didn’t do any test on the wart.
2. I know that there are not typical blood tests for genital HPV, but my doctor told me that there is special test called PCR for HPV DNA, that can detect previous virus exposure but it is offered in few places in Europe. Considering that I am version, doing this test might help me get peace of mind if it turns out to be negative. Can anyone help me with the name of the test and whether or not it is available in Germany?

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Welcome to the forum.  Thanks for your questions.  I have to question the diagnosis of a wart; and whatever it is, I doubt it's an STD or any other infection from the massage.

HIV isn't transmitted from hand to genitals; the massage was no risk.  In addition, genital warts typically appear from 3-9 months after catching the virus with an average around 4-6 months.  A wart definitely can't show up after a week.  Your dermatologist is definitely wrong about the public toilet business, or you misunderstood him.  Your description of the lesion and its variable size in only a few days are very atypical and I suggest you reconfirm the diagnosis with the dermatologist, or seek a second opinion from another dermatologist or an STD expert.  (In Germany, most STD experts are also dermatologists.  But not all dermatologists understand STDs.) Your statement (no. 4) about genital HPV transmission is correct.

To your specific questions:

1)  Normally I would say a dermatologist's diagnosis of warts is highly reliable.  However, given his misunderstanding about transmission, perhaps he isn't very familiar with warts and HPV.  

2) PCR tests detect current HPV infections, not past ones.  However, if your "wart" has been treated and now has cleared up, I don't think testing would be worthwhile at this time.  If you seek a second opinion, perhaps a biopsy would be recommended -- with or without PCR testing, depending on the doc's advice at the time.

A final comment:  I wonder whether your penile lesion might have been molluscum contagiosum.  MC is a minor viral condition that can be confused with wartrs.  It's something to ask the doc if you seek a second opinion from another dermatologist or STD specialist.

Best wishes--  HHH, MD
13 Comments
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Thanks Dr Handsfield for the detailed answer. I have couple of clarifications to make on my original post and couple of follow-up questions to ask, if you don't mind:

1. I agreed to have the wart removed by the first dermatologist. That was probably a mistake as it is would have been easier for me to get a second opinion if the wart was still there.
2. I live in one of the countries in Middle East. I asked about Germany specifically, because the hospitals here usually send advanced tests to be done in Germany. The dermatologist I saw wasn't German but was a local dermatologist.

Moving on to my follow up questions:

1. Most of the information I saw on reliable sources on the web (such as Mayo Clinic website), say that genital HPV is transmitted via sexual intercourse or skin-to-skin contact in the genital area. However, I came across one previous post from you suggesting the possibility of hand to genital transmission of HPV:
http://www.medhelp.org/posts/STDs/HPV-transmission-mode/show/793550
I don't mean to sound skeptical of your opinion because I know of your expertise in this area, but I am just trying to get to some peace of mind on this point. Would you say that the only “confirmed” path of transmission is still sexual intercourse and direct genital-to-genital contact? And hand-to-genital or even genital-to-hand-to-genital is simply not a possibility for transmission?

2. You mentioned two points in your response that might have the answer to ALL of my concerns:

"A wart definitely can't show up after a week.  Your dermatologist is definitely wrong about the public toilet business, or you misunderstood him". If the HPV wart does NOT show up in 1 week, and the virus can NOT be transmitted via using public toilets, etc. The logical conclusion in my case -being a virsion with no sexual touching experience except this massage incident- is that whatever the dermatologist called "wart" and removed by freezing could NOT possibly be HPV. From medical point of view, would you agree with this conclusion?

Thanks again Dr for your insight.

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239123_tn?1267651214
You have taken my remarks in the other thread out of context.  The take-home message there was that HPV may rarely be transmitted by hand-genital contact -- but if so, the emphasis is on "rarely".  The large majority of genital HPV infectiong are acquired by intercourse.

Given the criteria you have stated, the most likely conclusion is that your penile lesion was not a wart.
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As a final remark to this thread and all of my STD/HPV concerns. I am about to get into a marriage relationship and wanted to seek your final advice on my situation. Would you say that I should just forget the whole thing and move on with my life?






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239123_tn?1267651214
Yes.
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Thanks Dr. Your feedback has put hundreds of thoughts in my mind to rest. May GOD bless you....
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239123_tn?1267651214
Be clear that my "yes" response assumes your penile lesion was not a wart.  If it was, then it is possible your penile skin still is infected with HPV which could be transmitted to your partner.  So you still should consider my earlier advice about a second opinion and other options to clarify the diagnosis.  However, there is nothing more that I or any online source can offer; you're going to have to work this out with your doctor(s).
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I appreciate your professionalism and I understand that you can't give me a medical diagnosis online. I already visited another dermatologist who examined me after the lesion is removed and told me that I don't show any signs of HPV. However, he refused to comment on the first dermatologist diagnosis as he didn't see the lesion.

1. If I were to visit a third dermatologist, could a biopsy be done on the area of the skin that was frozen to look for HPV? any other test that can be done at this point.

2. Do you still stand by your previous statement:
" A wart definitely can't show up after a week.  Your dermatologist is definitely wrong about the public toilet business, or you misunderstood him."
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I realized that I started going into circles by re-iterating some of your previous points about the nature of HPV. I will discuss the biopsy option with my doctor and report back the result of I end up doing it.

Thanks.
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239123_tn?1267651214
You've got it right. This thread has gone as far as it can; any more and I would just be repeating myself.
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I visited another dermatologist and his general advice was that I should forget about this lesion and move on with my life. He also told me that what the first dermatologist told me about "the possibility of catching genital HPV from public toilet" is ridiculous. I asked him if there is any test to confirm past HPV exposure, he told that there is blood test but he strongly advise me not to even consider doing any blood test.

I finally reached a conclusion that the lesion I had was misdiagnosed and was nothing to worry about to begin with.

Final questions Dr. Handsfield:

1. Given the description I provided of the message/handjob, was there any risk (and hence need for testing) of catching high-risk HPV, the ones that don't cause warts?

2. What is the blood test that people can do to test for previous exposure, is it anti-body test, or something else? I am asking for informational purpose at this point.

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239123_tn?1267651214
1) As already discussed, HPV is rarely if evern transmitted by hand-genital contact.  Some experts believe a small risk may exist, but I do not.  If there is any risk, there is no reason to suspect it's any different for the different HPV types, whether high or low risk.

2) There is no blood test for HPV except for some that have been used in research. I am unaware of any labs offering it for routine, non-research testing.  And there is no test of any kind for HPV "exposure", only to detect actual infection by DNA testing.  And these tests are not approved for or recommended in males; they are intended strictly to be used in conjunction with Pap smears in women.

Do not seek HPV testing and do your best to ove on with your life.

That's definitely the last comment on this thread.
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Going through all the FACTS shared by Dr. Handsfield, now I realize that I had ZERO risk of catching genital HPV or any other STD from the experience I described. It is a psychological spiral that I have been going through; caused by guilt feeling and the incompetent dermatologist that I visited at first.

I will work on forgetting the whole thing and moving on. If I don’t succeed, I will probably seek some counseling. Thanks Dr. Handsfield for being patient with my repeated questions/concerns. No more questions/comments from my side...
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