Grinding on Buttocks/Anal area

[afasdufha116]

Dear Doctors,

I am a heterosexual male, but I’m worried about an exposure to my rectum/anus (not my genitals). 10 days ago, a masseuse sat on my buttocks and was grinding her wet vagina (without underwear) against my buttocks while massaging me. I'm afraid her vaginal secretions might have dripped down into my anus. No penetration or any other form of risky contact happened.

3 days go, I went to see an STD specialist and I requested to have a rectal swab for STDs (mainly Gonorrhea ,Chlamydia, Syphlis). He said that no testing was required; there was no risk for HIV or STD from the incident. In fact, he found the whole idea of risk quite unbelievable. He just mentioned that the only small risk would be if there were blisters/lesions present during the grinding (for Herpes), and he said to just monitor any blisters in the area within the next few weeks.  Also, because he saw I didn’t seem convinced, he just gave me 2g of Zithromax (8 tablets) which he said would take care of Gono and Chlamydia if I had it. I took it in one shot.

I came to this reputed site for a second opinion.
i) Does this event carry any risk for HIV or any STD? Would you recommend any testing? I’m thinking of doing a HIV Duo test at 28 days and a VDRL
ii) Assuming I had a RECTAL infection from this, would 2g of Zithromax clear Gono and Chlamydia? I saw some postings that said you need Ceftriaxone injection to clear Gono, not Zithromax
iii) If I had a RECTAL infection that’s not cured, is there a chance I could spread it heterosexually (e.g. transfer it to my wife via my genitals/ semen)?
iv) Can I resume unprotected sex with my wife?  If yes, how many days after I took the Zithromax will it be safe?

I tried searching for answers on the site first, but it’s just most of what I find are men whose genitals are exposed to fluids, not so much the anal area. Thanks for your help, this is a great site.

[Edward W Hook, MD]

I assumed that this was the case when I answered your question the first time.  No change in my answer or recommendations. EWH

[afasdufha116]

Hi Dr Hook, thank you for your response. I'm sorry, but one last point and I promise this will be the last. I forgot to be clear in my opening post description that the grinding took place over my butt crack/butt opening, not on the butt cheeks. That's the reason for my worry in the first place, of secretions entering the anal area. Does this change your opinion and assessment? I'm guessing it won't but I just wanted to be sure you had the complete information. Thank you again for your great work.

[Edward W Hook, MD]

"...if a man has a RECTAL STI infection of sorts (e.g. Rectal Gono or Chlamydia), his semen/seminal fluids would not be infectious/contagious to female partners, because semen is produced and discharged in a separate tract, i.e. the urogenitary tract?"
CORRECT.  Gonorrhea and chlamydial infections are local infections spread only by direct contact.  HIV enters the blood and is spread throughout the body. Thus a man initially infected at the rectum can have infectious semen or blood.  EWH

[afasdufha116]

Hi Dr Hook,

Thank you for your fast response. Sorry, I just have one final clarification for my own understanding/reassurance - this is because I don't fully understand the biology or mechanics of anal STI vs genital STI. Regarding Question (iii) above, do I understand correctly that if a man has a RECTAL STI infection of sorts (e.g. Rectal Gono or Chlamydia), his semen/seminal fluids would not be infectious/contagious to female partners, because semen is produced and discharged in a separate tract, i.e. the urogenitary tract? I'm just a little confused with that mechanics, because let's say in the case of HIV and Syphlis, a man who is infected through anal sex would still have contagious semen/ seminal fluids.   But other than that last point, I'd have to say that between the specialist I visited and your re-assuring validation, I think I now have the courage to not test. Thank you so much for your great work here!

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to address your questions.  I agree with the assessment you have received from the STI Specialist you spoke with and would have given you the same advice.  I would not have provided the treatment however because I try my best not to give people antibiotics that are not needed as they can complicate matters and cause side effects.  The event you describe was no risk.  There was no risk for STIs, other than the very, very low chance of herpes already mentioned (less than 1 in 10,000).

With that, I'll address your specific questions:

i) Does this event carry any risk for HIV or any STD? Would you recommend any testing? I’m thinking of doing a HIV Duo test at 28 days and a VDRL
No, as already said, this was an entirely no risk event.  There is no medical need for testing of any sort.    It would be a waste of your time and energy.

ii) Assuming I had a RECTAL infection from this, would 2g of Zithromax clear Gono and Chlamydia? I saw some postings that said you need Ceftriaxone injection to clear Gono, not Zithromax
The 2 gram dose of azithromycin you received is an alternate therapy for gonorrhea with a high degree of efficacy.  You did not need it to start with and certainly do not need ceftriaxone.  

iii) If I had a RECTAL infection that’s not cured, is there a chance I could spread it heterosexually (e.g. transfer it to my wife via my genitals/ semen)?
No, for the same reasons you are not at risk.  Gonorrhea is spread by direct contact.  There is no way you could have gonorrhea in your rectum, much less spread it to someone else unless you had rectal sex with them.

iv) Can I resume unprotected sex with my wife?  If yes, how many days after I took the Zithromax will it be safe?
It was never unsafe to have sex with your wife related to the event you describe and certainly there is no reason to abstain after the medication you took.

I hope these comments are helpful.  EWH