Concern about exposure from Frottage

[HaveQuestions]

On June 12, 2015 I went to an Asian Massage place in Manhattan. She placed her finger in my anus and rubbed vigorously for several minutes and later sat on me while we were both unclothed and rubbed back and forth for several minutes. There was no penetration, but she did rub up and down my penis and possibly over my scrotum, there was some baby oil for lubrication. I looked at her briefly afterward and saw no visible lesions, but didn’t look inside her labia. Since then I haven’t had any noticeable lesions but am concerned about HSV-2. At 35 days I had a full 8-test panel done at Lab Corp and all came back negative except HSV-1 (>5.00), which I knew I had. I get a single oral lesion a few times a year. Medhelp’s Drs. HHH and Hook indicate that frottage like this is practically speaking risk-free, but your handbook says that outercourse can transmit herpes. I did take valtrex perhaps 4-6 times during the 35 day period. I haven’t had intercourse with my wife since the event and don’t plan to (she is aware of the event) until I am certain I wasn’t infected with anything. I’m also terrified that I’ll somehow transmit something to my young grandchildren.

Question: What is my risk of contracting HSV-2 from this event and do you recommend further testing (and when do you recommend it)?

[Terri Warren]

I do not think this experience is very risky. I wouldn’t say it is risk free, but low risk. When there is genital to genital contact with rubbing, virus can be transmitted, but it is also useful, for transmission to happen, to have longer contract and perhaps deeper contact. How long was the genital rubbing? But again, in my opinion, as you describe the incident, you are not out of the woods. Since the labia is the main site of shedding in women, contact with her labia in the way you describe, presents some risk. You may wish to hold off antiviral therapy though as it can impact test results. taking it 4-6 times won’t, but more might.

So if you were my patient, I would certainly recommend that you test again when 3-4 months have passed since the incident to be the most safe. If your HSV 2 test was negative at 35 days, that’s great and says the odds are in your favor that you did not contract herpes.

If by some chance you did, your grandchildren are NOT at risk as long as you just wash your hands after touching your genitals – and just normal washing with soap and water, not extended washing.

Terri

• This reply was modified 6 years, 11 months ago by Terri Warren.

[HaveQuestions]

Thanks, Terri. Of course, it would have been great if you had said the exposure was risk free, but it certainly seems logical that rubbing like this could transmit the virus.

I would say that the rubbing lasted no longer than a couple of minutes. I really don’t think she went back and forth more than 10-20 times, and she was moving steadily but not vigorously. I remember it was pretty slippery with baby oil, but don’t know if that makes a difference.

One question – is there any value in testing at 8 weeks and then again at 12 weeks? How good are the statistics that show how long it takes people to build antibodies? I understand that 16 weeks is the gold standard, but it would be good to have some reassurance along the way.

Second issue – with my grandchildren, I have to admit I’m even afraid to pick them up. Even with no visible sores, I’m afraid that somehow I will transmit it to them from kissing, touching their faces or hands, or if I hold their hands and they put their hands in their mouth (you know how kids are). I’m afraid to let them touch my legs since herpes has the “boxer shorts effect”. I realize intellectually this is over-reacting, but I would be so devastated if somehow my beautiful grandchildren were harmed by a stupid mistake I made.

One other thing – the Syphillis test came back negative at 35 days. Is there any need to repeat that test at 6 weeks or longer?

Finally – I assume you agree that it would be best to wait on intercourse with my wife until the 3-4 months? I’m certainly willing to do that. I’ve already hurt her so much with my mistakes, I won’t inflict a disease on her. Would you mind letting me know what sort of interaction with her is safe during this period? I admit I’m even afraid to kiss her on the lips.

I have had some redness on the underside of the penis just below the head since Thursday. It seems better, and I haven’t seen any lesions. Hopefully just irritation – some pain and discomfort. I have an appointment with a urologist on Monday to ask him about that and get other advice.

Speaking of which – last question – what medical specialities would you say have the greatest expertise in this area? Would you say dermatologists are the best professionals to meet with in the absence of doctors who specialize in STDs? I’m just wanting to have a face-to-face consultation with someone who can give me as much accurate information as possible. Or, have you found that even in that specialty, there is a good deal of misinformation on the STD topic, especially herpes?

Thank you again for your help. I really appreciate your guidance and counsel.

[HaveQuestions]

Terri – a quick additional question. I must admit I’m curious. The earlier mentioned physicians seemed quite positive in their advice over the past few years that frottage is a no risk activity. They would say things like, “no penetration, no risk”, or “haven’t ever seen a case of std from frottage in nearly 40 years” and “there’s a theoretical risk but no practical risk”. They would then advise against any testing and tell the folks to continue with their normal activities with no worry. I’m honestly just trying to get peace of mind on this as frankly, it’s been driving me crazy (and my wife would agree), since the event.

To your knowledge, has there ever been a verified case of frottage/genital rubbing (especially similar to mine) where herpes (or any std) was transmitted? I certainly plan to continue testing no matter what your response, I guess I’m really just trying to clarify the risk at this point.

Thank you again for this forum, it is a life saver.

[Terri Warren]

I think you are safe to have interaction of any kind with your grandchildren, while you are waiting to see if you have an STD.
And also I think if you had no oral contact with the massage person that you are safe to kiss your wife.
The issue of frottage is not a clear one and I think one that is hard to sort out. If we believe that the labia of women is the main site of viral shedding (not the vagina) then how can rubbing up against it not have any risk of transmission? You are looking for me to say it is no risk but I’m not going to say that because first of all, I never say never to an STD acquisition that involves direct genital to genital contact and second, I just don’t believe that there is no risk.
In terms of medical specialists for herpes: I have seen dermatologist, ID docs, generalists and OB doctors all give amazingly wrong advice about genital herpes.

The only statistic we have that might be helpful for you at this point is that by 6 weeks from the encounter, 70% of people who are going to be positive ARE positive. If you test negative then, it is a very good sign.

Again, I don’t think the encounter that you had is high risk but it is, in my opinion, definitely not zero risk. But I am only one clinician with one opinion. You can likely find other opinions from other clinicians.

The syphilis test can become positive between 9-90 days after an infecting encounter.

Terri

[HaveQuestions]

Thanks, Terri. That makes sense. I did kiss the masseuse a couple of time on the lips. Just light pecks. I have already kissed my wife several times and she has shared food with my grandson. Does that mean they are now at risk?

Also, she kissed my back and upper legs in a few places, am I at risk of infection in those locations now?

I will get tested again tomorrow. I’m going crazy thinking I have brought this horrible disease into my beautiful family.

[Terri Warren]

They are NOT at risk, no. The intact skin of the back and upper legs are too thick to allow virus in – this is not a risk.

I have absolutely no reason to believe that you have brought herpes (which is certainly not as horrible as many things) into your family. If you have herpes, which I seriously seriously doubt that you do, it is not contagious in ways you would interact with your family, except sex with your wife. You have jumped from “yes, there is a small risk of acquiring herpes in this situation” to “I’ve acquired herpes in this situation” You have jumped from 5% to 100% in a single leap. Your thinking on this is slightly out of control. I believe that you need to try to think more calmly and rationally.

This is the final post on this subscription. If you have more questions, please feel free to renew.

Terri

• This reply was modified 6 years, 11 months ago by Terri Warren.

[HaveQuestions]

Thank you, Terri. I did renew for more questions. This is helpful. On the question of kissing, a light kiss with the massage person on the lips is not a risk?

[Terri Warren]

No, I am not at all concerned that a light kiss with the masseuse would give you genital herpes.

Terri

[HaveQuestions]

Thanks, Terri. I did another hsv-2 and syphyllis test at 6 weeks and two days thru std-testing.com labcorp. Both came back negative. I’m starting to get a little more relieved but obviously am still a bit on edge.

I plan to get another test next week at just about 8 weeks. Can you tell me what is the percentage of previous hsv-1 test subjects who are hsv-2 positive who test positive at that point?

Also, my kissing question sounds a bit silly in hindsight, but again, the medhelp doctors seem to say zero risk from kissing in particular social kissing, while it appears your advice on the forums may be a little more conservative. Frankly, after your response, my paranoid brain went to, well, maybe it was a medium kiss, not a light one. At any rate, it was certainly not a heavy romantic kiss. Worst case on the heavy side of a social kiss. Closed lips, no more that a second or maybe two, maybe a bit firm, but brief. Like a smack from a grandma, perhaps. Two kisses on separate occasions. In the light of day I see it hard to believe that if a couple of kisses like that led to transmission, then wouldn’t oral hsv-2 would be as prevalent as hsv-1? I still find it hard to kiss my wife, even on the cheek, I’m afraid. Just need some professional encouragement, I guess.

I’m afraid I’m still doing the ‘crotch watch’ as Dr. Hook puts it. I’m sensing discomfort and some minor pain down there somewhat regularly, especially right on the tip. The very tip is a bit red, but no visible lesions that are obvious. Every time I feel something, I worry, of course.

I do have a question about autoinoculation. I’m changing bath towels and wash cloths every day to prevent spread to other parts if my body in case I am infected and haven’t developed antibodies. Also, I’m using paper towels to dry my hands after washing as well as hand sanitizer. Is this overkill, or appropriate sanitary measures?

I’m also worried that I may scratch myself down below at night while sleeping and then transfer the bug to my face or eyes inadvertently. Is this a true risk?

So in summary, 6 weeks negative – how relieved should i be given the risk level for my exposure, curious about 8 week percentages, kissing still weighing on my mind, towel sanitation, autoinoculation/spreading and the ever present crotch watch. Your thoughts?

Thanks again, Terri. The lifeline you provide is priceless.

• This reply was modified 6 years, 11 months ago by HaveQuestions.

[Terri Warren]

We don’t have 8 week percentage, only 6 weeks which I already gave you.
A closed mouth quick kiss is extremely unlikely to transmit herpes. Autoinoculation with no lesions also seems extremely unlikely. Changing towels every day is likely not necessary but isn’t going to hurt anything.

Terri

[HaveQuestions]

Hi Terri. Good to talk with you today. Thank you for sharing your expertise on this subject with me. It was very helpful and illuminating. Quick question, if someone did want to do daily swab testing to see if they were shedding, how long would that need to go on to determine if they might be positive for hsv2? Or would it really not accelerate the time for determination over the blood tests but simply tell them that on that say on this one day or 7 days or 30 days or 60 days, etc., that they aren’t shedding virus? So, for example, if someone doesn’t shed for 30 days, is that an indication of a negative result or simply mean that shedding wasn’t detected in that location at that moment for those days?

[Terri Warren]

Even if someone didn’t shed for 30 days of swabbing, it would not tell us that they were not infected with herpes, no. I know that this is so difficult for you, the waiting and not knowing for sure, but I would suggest that you consider using this time to mend fences with your wife, build on your relationship and communication, think about what’s going on that you found yourself in this positive and try to sort out what needs this is meeting for you and how you can manage these needs in a way that does not put you at such stress. I know this is just eating you up inside.

This is your last post on this subscription. If you need more information feel free to renew.

Terri

[Terri Warren]

We are finished here with questions. I see that you have also posted on the ASHA forum for Dr. Hook. I’m not interested in getting into a controversial discussion with my colleagues – we don’t always agree on everything but to put us in this position is not something I will do – ever. Did you not notice that I also post there and answer the herpes questions? You have chosen to raise this issue with Dr Hook which is absolutely fine but we are done here and we will have no more phone conversations. I think your severe anxiety is causing you to make questionable decisions. I hope you will seek professional help to get through this difficult time.

Terri

[HaveQuestions]

Terri, please forgive me. I acted thoughtlessly and selfishly. I promise to follow only your direction going forward. I will apologize to Dr. Hook if you want me to.

[HaveQuestions]

After you told me you kindly talked with Dr. Wald on my behalf, I found an interview from 2013 where you said sometimes outbreaks occur on the foot. I remembered then that two weeks ago I woke up and saw what looked like three lesions on the side of my foot. I thought they may have been bug bites, but they sure looked like lesions. Today, two weeks later, it has mostly healed, but the area is still a bit concave. I’m not sure, but I have reconciled to the fact that if it is hsv2, I will need to live with it. I’ve even come to realize that I would rather live a transparent life with hsv2 than the hidden life I was living before.

I am starting counseling – I had my first session yesterday and I am now in a weekly recovery group, and my wife has been amazingly understanding and supportive and our relationship is better in many ways than ever.

I know I need your direction, Terri. Our local doctors don’t have nearly your expertise.

Please, can you find a way to forgive my thoughtless, hurtful actions? I promise to behave in a respectful, honest manner with you and won’t get any other counsel without your direction and permission.

[Terri Warren]

The outbreak was on the heel, which is in the area of innervation of the sacral ganglia.
You don’t need my forgiveness. I honestly have nothing else to offer you.
Dr. Hook has reassured you and I hope you can accept this reassurance and move on.

Terri

[HaveQuestions]

Thank you, Terri. He said there was still a possibility however small, of infection. Which is the same thing you said. May I ask, if I do come up positive, would you be willing to work with me? I plan to follow the testing and behavior regimen you outlined to me.

[HaveQuestions]

Also, I didn’t give either of you all the information you needed. I didn’t recognize a likely outbreak when I saw it, even though it looked like one. It was just in a very unusual place. I still should have mentioned it. So, I didn’t get it tested in a timely fashion which could have provided an answer to at least the question of having been infected. I’m just way out of my depth here. You have been a truthful, wise counselor and clinician and have helped me more than I can imagine. You saved my wife from me becoming complacent and possibly not carrying on with testing, which now i am certainly going to do and frankly given the likely lesion, I am preparing to receive a positive test result. You cared enough to tell me the hard truth even when you knew it was a hard truth to deliver. You have epitomized the true healer while I gave been just about the worst patient ever.

Please know that I finally realize that and that my respect and admiration for you couldn’t be higher.

[HaveQuestions]

Per your direction, I have called my primary care physician to see if he can order an HSV2 test where we will get the index value. I called std-testing.com yesterday and they said that both LabCorp and Quest will only provide them the <0.9 value when the test is negative. The representative said that they have asked both labs in the past if they would provide a more detailed index value for negative tests and were told that they could not. Once I have the index value, I will report back. We’ll of course be hoping for a low value.

[HaveQuestions]

I received back the hsv2 results from Friday. They were from Quest and showed negative at less than 0.9. While encouraging, of course, it would have been great to get a detailed index value. I know your own lab provides these, but am having difficulty finding someone around here who knows where to go to get the more detailed numbers, for a baseline, if nothing else.

Do you know of a lab I could request more detailed index values from? Is there a registry, or something like that?

I saw my dermatologist on Saturday. He swabbed the area near my ankle, which is still healing after two weeks. He only had an Elisa kit, I believe he said, but I asked him to do a PCR if at all possible. Hopefully we’ll get the results this week but even if negative, I’m not sure it will resolve the issue. Hard to believe it was just bug bites if it has taken this long to heal. It sure looked like lesions a few weeks ago but I didn’t realize then they could be in that location. I wish I had taken a photo.

Please believe me, ma’am, I am trying to get past this, but for the sake of my wonderful, innocent wife and family, I really need to be sure. With your help, I know now that if I am positive, I can learn how to live with this and someday soon even be happy again, but I like to know one way or the other, of course.

[Terri Warren]

I’m glad you are getting negative results so far, that is good news for you. If you are taking Valtrex, the antibody test may be unreliable.

Terri

• This reply was modified 6 years, 10 months ago by Terri Warren.

[HaveQuestions]

I haven’t taken any valtrex in several weeks, but do believe the several I took over a few weeks early on delayed typical blood test results. I got blood drawn for another blood test today at labcorp for hsv2 and syphillis. I know it is too early to be definitive, but since I can’t find a lab that gives detailed index values this is what I’m left with. Based on seeing what almost certainly had to be three red herpes blisters in a row below the ankle on the outside of my left foot on July 14 or so 30 days after the exposure, I’m steeling myself for an eventual positive result. It is still a red area that hasnt completely healed. Although my wife has been amazing about this, I don’t know how she’ll react to a positive blood test. Thank you for your expert support. You have really been a godsend.

[Terri Warren]

You have paid for 9 questions and have posted 14. Before I can respond, you will need to pay for 6 more questions (two more rounds(

Terri

[HaveQuestions]

Thanks, Terri. Sorry about that, I paid for 3 more rounds.

I had another lab test for HSV-2 and Syphilis from Labcorp done on Thursday, results posted negative on Friday. This would be just about 8 weeks from exposure. Still wish I could find a way to get blood test done that would do more than just say “Less than 0.9”.

Also saw the dermatologist on Friday morning. He looked at my ankle and said something like, “well if it is herpes, it is an unusual presentation, but I’m always willing to learn.” He saw some small blisters on the edge and took some fluid for a PCR, I believe I’ll get the results on Wednesday or so. He also took a punch biopsy to look for eczema or some sort of fungus. Last week, he had done a culture on the ankle/foot area and PCR swabs on genitals, mouth and anus. All came back negative, but I’m not sure how much that tells me, other than no shedding at that time. Still encouraging news, of course.

I’m trying to be optimistic, but a few weeks ago those three red blisters in a row sure seemed like herpes blisters in my memory. I’m mentally preparing to hear that the PCR comes back positive.

Had a little scare yesterday, my grandson took a drink from a straw I had drank from earlier. I doubt that I have anything oral other than hsv-1 which I’ve had, but it still freaked me out a bit until I saw some posts of yours that cup sharing and straws are not realistic transmissions risks. Nonetheless, I’m going to be more careful about that. I haven’t had any visible lesions on either lips or genitals that I could see since the exposure (or the “boxer shorts area” since I’ve been looking there), but am still trying to be very cautious.

[Terri Warren]

I honestly think you are worrying needlessly at this point. A negative (regardless of value shown) is very good news indeed at 8 week post encounter.
I have never seen a herpes outbreak on the ankle without also seeing lots of genital lesions and that was only once.
Remember that if you are taking antiviral medicine it can influence your antibody test.

Terri

[HaveQuestions]

Hello, Terri. I went ahead and tested again for HSV2 through Labcorp at 12 weeks and 16 weeks post-encounter and both came back negative. I’ve also not seen any symptoms, of course. I’m taking it as certain that I wasn’t infected. Thank you for your help these past few months. They were difficult but you definitely made it easier for me to get through them.

Also – the spot on my ankle came back as a fungus, which we are treating for. It is pretty much gone now.

Thank you!

[Terri Warren]

I’m so happy that you can now relax about this issue. Whew! You want through a lot with that, didn’t you? Happy to be here with and for you.

Terri

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