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Transmission Questions
Dr. H. Sorry for originally posting this as a reply to another post. I did not realize there was a fee.
Many of the posts that I have read seem to have at their root a lack of understanding of how easy it is to transmit various STDs. I count myself among those who, until reading posts on this site, felt that it was much easier to catch STDs than it apparently is. My questions are:
1. Why are deep kissing, mutual masturbation and similar activities so low risk? For example, a man touches a woman's genitals and then touches his own. Why is that more safe than having unprotected sex? Is it that the various viruses cannot live long enough on your hand to be a risk of transmission? Or there another reason? I guess I am looking for the why behind the low risk.
2. What STD's, if any, are an exception to the explanation to Question 1. In other words, which STDs carry a higher risk of transmission without actual penetration and why?
3. Is a male receiving unprotected oral sex from a woman at any higher risk for STDs than he would be deep kissing the same woman? It seems to me that the only real risk is that she could transmit HSV1 oral to genital. If so, how high is that risk if she does not have any evidence of cold sores?
4. Same question as #3 except that the male is giving unprotected oral sex to a woman. What is the risk of an STD for that male?
Thanks in advance for your reply. As I am sure you have heard before, I wish my doctors gave answers as clear and to the point as yours.
Many of the posts that I have read seem to have at their root a lack of understanding of how easy it is to transmit various STDs. I count myself among those who, until reading posts on this site, felt that it was much easier to catch STDs than it apparently is. My questions are:
1. Why are deep kissing, mutual masturbation and similar activities so low risk? For example, a man touches a woman's genitals and then touches his own. Why is that more safe than having unprotected sex? Is it that the various viruses cannot live long enough on your hand to be a risk of transmission? Or there another reason? I guess I am looking for the why behind the low risk.
2. What STD's, if any, are an exception to the explanation to Question 1. In other words, which STDs carry a higher risk of transmission without actual penetration and why?
3. Is a male receiving unprotected oral sex from a woman at any higher risk for STDs than he would be deep kissing the same woman? It seems to me that the only real risk is that she could transmit HSV1 oral to genital. If so, how high is that risk if she does not have any evidence of cold sores?
4. Same question as #3 except that the male is giving unprotected oral sex to a woman. What is the risk of an STD for that male?
Thanks in advance for your reply. As I am sure you have heard before, I wish my doctors gave answers as clear and to the point as yours.
Thanks for your reply; it was well worth the small fee. You can count me out of the ranks of the worried well.
MEDICAL PROFESSIONAL
Directly to your questions:
1, 2) Books have been written about why one virus or bacteria has a particular route of transmission. It has to do with how the organism and its human host evolved together. Almost by definition, if something is sexually transmitted, it means the organism evolved a strategy that required the direct exchange of wet secretions applied to a particular site, such as between the opening of the cervix and the lining of the urethra (e.g., chlamydia and gonorrhea). Further, almost no infection is transmitted by "just one" organism; it take a certain number of bugs for infection to "take". That number varies from one infection to the next. The number of gonorrhea or chlamydia organisms that can get from a person's urethra to another person's cervix (or other susceptible site) is such that indirect mechanisms, as by hand-genital contact, don't work. Similar considerations apply to all STDs, but not equally. For example, although genital-hand-genital transmission probably accounts for a few genital HPV infections and rare herpes, I doubt gonorrhea or chlamydia ever have been transmitted that way.
3,4) Also related to the above questions and answers, organisms have different abilities to infect or persist at certain anatomic sites. Most STDs are less well adapted to the mouth and throat than to genital or rectal tissues. As a result, kissing is never known to transmit STDs, for practical purposes; oral sex can do so, but less efficiently than vaginal or anal sex. And the basic anatomy of sex, combined with the comments above about the number of organisms it takes to cause infection, plays an important role. If you think about it, it's a lot more difficult to get a lot of oral secretions into a guy's urethra than the reverse, especially if there is intra-oral ejaculation. And cunnilingus is an inefficient transmission route in either direction.
These principles also answer your follow-up comment/question below.
Bottom line: There are few absolutes in biology and medicine, including STD tranasmission risks. That is, there are exceptions to the rule--some exceptions are so rare they can truly be considered impossible, but others are more likely. It's always a matter of the odds. For exposures that carry less risk than the chance of dying by lightning (which literally applies to some scenarios that come up on the STD and HIV Prevention forums), why worry?
Regards-- HHH, MD
1, 2) Books have been written about why one virus or bacteria has a particular route of transmission. It has to do with how the organism and its human host evolved together. Almost by definition, if something is sexually transmitted, it means the organism evolved a strategy that required the direct exchange of wet secretions applied to a particular site, such as between the opening of the cervix and the lining of the urethra (e.g., chlamydia and gonorrhea). Further, almost no infection is transmitted by "just one" organism; it take a certain number of bugs for infection to "take". That number varies from one infection to the next. The number of gonorrhea or chlamydia organisms that can get from a person's urethra to another person's cervix (or other susceptible site) is such that indirect mechanisms, as by hand-genital contact, don't work. Similar considerations apply to all STDs, but not equally. For example, although genital-hand-genital transmission probably accounts for a few genital HPV infections and rare herpes, I doubt gonorrhea or chlamydia ever have been transmitted that way.
3,4) Also related to the above questions and answers, organisms have different abilities to infect or persist at certain anatomic sites. Most STDs are less well adapted to the mouth and throat than to genital or rectal tissues. As a result, kissing is never known to transmit STDs, for practical purposes; oral sex can do so, but less efficiently than vaginal or anal sex. And the basic anatomy of sex, combined with the comments above about the number of organisms it takes to cause infection, plays an important role. If you think about it, it's a lot more difficult to get a lot of oral secretions into a guy's urethra than the reverse, especially if there is intra-oral ejaculation. And cunnilingus is an inefficient transmission route in either direction.
These principles also answer your follow-up comment/question below.
Bottom line: There are few absolutes in biology and medicine, including STD tranasmission risks. That is, there are exceptions to the rule--some exceptions are so rare they can truly be considered impossible, but others are more likely. It's always a matter of the odds. For exposures that carry less risk than the chance of dying by lightning (which literally applies to some scenarios that come up on the STD and HIV Prevention forums), why worry?
Regards-- HHH, MD
Good questions...also why is giving/recieving oral any different that a handjob with a lot of saliva...cant saliva enter the penis in both instances?
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
