secretion exposure

[quickquestion2011]

I had a sexual encounter with a woman today. It was only mutual masturbation, but she did use a vibrator on herself. Mostly she was holding the handle which doesn't actually penetrate her. But she did touch her vagina  here and there - spreading labia majora and maybe some touching of the labia minor and clitoris but not a lot I really can't say for sure how much secretion she got on her hands, but I know she was not vigorously rubbing her vagina.

But then she asked me to hold the device to masturbate her and she masturbated me with massage oil. I don't think there was a lot of vaginal secretion on her hands, but there was probably some. I didn't actually see any lesions on her vagina. But I am a little concerned in case she does have HSV and had some asymptomatic shedding and because there was not much time in between her touching her vagina and her touching my penis.

Would you recommend getting tested for herpes or anything else due to this event or watch for symptoms in the coming weeks? Or was this a totally safe encounter and should I just forget about it?

[quickquestion2011]

Hi Dr. Handsfield,

Sorry for a follow up question so much later.

Another question that came up for me, with regards to keeping my sexual practices safe until I'm in a long term monogamous relationship. During otherwise safe sexual activity, i.e. mutual masturbation with no intercourse, if a woman rubs her vulva on or sits on one's thigh, particularly the upper thigh, is this a risk for herpes?

[H. Hunter Handsfield, M.D.]

Some STDs (chlamydia, gonorrhea, HIV) require secretions to be deposited inside the body.  Others are transmitted from skin to skin.  Only the latter could be transmitted, in theory, by hand-genital contact.

[quickquestion2011]

Just out of curiosity, even though it is clear that mutual masturbation (even with secretion involvemnt) doesn't transmit STD's - why are herpes and syphilis considered theoretical risks with this act, but say gonorrhea and HIV aren't?

[H. Hunter Handsfield, M.D.]

It's because the main STD bacteria and viruses evolved in a way that requires large exposures of particularly susceptible tissues -- circumstances that generally require insertive sex.  If they were easily transmitted by skin contact, they would be all over people's bodies, far more common than they are, and would not be classified as sexually transmitted.  There rarely is enough exposure through hand-genital contact to permit transmission.  In my 30+ years, I don't think I have ever seen a patient with any STD thought to have been acquired by hand-genital contact.

[quickquestion2011]

I should probably re-phrase my question.

You said in the other post "And another things I should have said above:  if there IS some small risk for STD transmission in this circumstance, it is only for the STDs transmitted from skin to skin, like herpes, HPV, or syphilis -- and even these probably are really zero risk"

If I may ask, why is that? Is it basically because skin to skin stuff is easier to transmit overall.. but in reality it's probably zero because we never actually see it happen with this particular type of sexual activity?

Thank you very much for your input Dr. Handsfield.

[quickquestion2011]

Thank you, Dr. Handsfield.

Sorry if I am splitting hairs.. but when you say in the other thread that HSV or syphilis could possibly be spread this way i.e. genital to hand to genital, this is with the disclaimer that though it's a theoretical possibility, in your extensive career experience as well as in the infectious disease literature, it simply isn't observed?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Replying to the second sentence:  STDs are not transmitted by mutual masturbation.  There are no exceptions -- or at least they are so rare they can be ignored.

Now I have read further.  This is very similar to two other questions earlier today.  See http://www.medhelp.org/posts/STDs/STD-Testing-after-Mutual-Masterbation/show/1538831 and http://www.medhelp.org/posts/STDs/STD-Transmission-through-Mutual-Masturbation-involving-Vaginal-Fluids/show/1538713.  As I replied in thos threads, there simply is no risk from such events.  Please read my replies on both of them.

In response to your specific questions:  No, I do not recommend testing for herpes or anything else; watch for symptoms if you like, but if any appear it won't be from this event; and this indeed was "a totally safe encounter and [you] should just forget about it".

Regards--  HHH, MD