Risk of STD/worry

[kellyh91]

Dear Doctor, first of all thank you very much for contributing to this forum.  It is an excellent source of information.
I would like to ask the following - I have been reading the STD - International Experts Forum and some of their answers seem to confuse what I have read on this forum so grateful if you could clarify and help me not worry about this...(or let me know if I should get tested)...

I have visited several CSWs/escorts over the last 7/8 years and have carried out the following activities with them: (i) protected fellatio; (ii) deep kissing with lots of tongue contact/exchange of saliva; (iii) mutual licking of nipples; (iv) she using her bare hands and masturbating me (occasionally I am sure some of her own vaginal fluids and saliva will be on her hands and transferred to my penis); (v) me using my hands to feel her vagina (including insertion of finger occasionally); (vi) general skin to skin contact without penetration.

I was under the impression that all of the above was "safe" sex but having read the other forum, one of the doctors suggested (iv) is possibly not safe and they would recommend testing in that scenario.  I am confused.  Could you please let me know if all of the above is safe practice?  I am now in a serious relationship and hoping to try for a baby with my partner, so would really not want to pass anything to her/put her at risk.  Thank you so much for your advice Doctor.

[Edward W Hook, MD]

Good question.  Some STIs are more easily transmitted than others so, at least statistically there is a slightly higher risk for classical STIs such as chlamydia than for HIV.  Further, yearly chlamydia testing is recommended for every U.S. woman under the age of 26, irrespective of exposure history. Thus, as a matter of good sexual health practice, routine testing (we call this screening if there are no symptoms, it becomes "diagnosis" if there are symptoms) testing is reasonable but thereshould be no rush.  In over 70 years of combined STI focused practice, neither of us on this Forum have ever seen a case of chalmydia, gonorrhea, or trich (the most common STIs)  transmitted through the activities you describe.  I really would not be worried.  EWH

[kellyh91]

Thanks so much Doctor, your answer was comprehensive and well explained.
Can I just ask a follow up question - you focus on HIV transmission but I assume your assessment of "no-risk" applies to all STDs and not just HIV?  Also, based on the activities I have listed above, would testing be your recommendation or do you think testing under those circumstances are not necessary?
Thanks again Doctor, I really appreciate the advice.

[Edward W Hook, MD]

Welcome to the Forum.  In general, despite that fact that, unlike Dr. Handsfield and despite the fact that we do not work side by side with them as Dr. Handsfield and I did for many years, the answers on the International Forums and these Forums are remarkably similar. That does not mean that our styles of expression don't differ a bit but the messages are the same.  Despite this, we are used to having clients worry about minor differences in wording and word choice.  Further, please understand that when it comes to estimating risks for any specific situation. our statements must, of necessity be ESTIMATES.  For a variety of mathematical reasons far too complex to go into here, all one can do with data from well conducted scientific studies is estimate probabilities.  By definition, any estimate, cannot ever be 100% certain because of the incredibly low possibility that someone will get HIV through a previously undescribed mechanism tomorrow.  On the other hand, when Dr. Handsfield, I or our colleagues on the International Forums say that something is virtually zero, very close to no risk, or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.  

All of the activities you list are not in any way associated with HIV transmission and have not been demonstrated to place persons who engage in them at risk,  Specifically:
(i) protected fellatio – NO RISK - ;
(ii) deep kissing with lots of tongue contact/exchange of saliva- NO RISK;
(iii) mutual licking of nipples -NO RISK;
(iv) she using her bare hands and masturbating me (occasionally I am sure some of her own vaginal fluids and saliva will be on her hands and transferred to my penis)  -NO RISK :
(v) me using my hands to feel her vagina (including insertion of finger occasionally) -NO RISK ;
(vi) general skin to skin contact without penetration - NO RISK.

Some may argue that there is a theoretical risk of some of these activities (including iv) however the fact is that transmission in these ways has never been scientifically proven despite that they have occurred millions, if not billions of times.  

I hope these comments are helpful.  Please do not worry and continue your commitment to safe sex.  You do not mention testing but if you are concerned, there is no reason not to validate what I have said above with an HIV antibody test.  I am confident it would be negative.  EWH