In human sexual behavior Foreplay is a set of intimate psychological and physical acts between two or more people to increase arousal. Foreplay may precedes intercourse and may not. Some would be described as following:
Touching:
You may get STD by skin to skin contact with your partner. some example would be
Molluscum Contagiosum, HPV, Herpes, syphilis. scabies
Example:
Molluscum contagiosum are papular eruption usually around genital and by direct skin to skin contact.
Syphilis by contact to spirochetes bacteria
Herpes by contact to herpes viral shedding
Genital warts by HPV viral shedding
etc
Manual Stimulation "Hand job"
This is a common practice and patient usually received this by sex worker. This would involved partner provided hand stimulation for sexual arousal.
Risk will be as following:
1)Sex worker/ Partner use her saliva (body fluid) for masturbation
2) If sex worker has contaminated hand , sometimes from infected discharge of previous customer by performing the same act
3)Sex worker use contaminated oil or lubricant or lotion
Remember size of bacteria, parasites and virus responsible for STD are so small that it is impossible to see them Use protection at all time to minimize your risk
Who is Physical Sex worker ?
This would be the person who collect money to offer physical sexual pleasure ( could be legal or illegal, overseas or in the US ). If patient having encounter with a person sexually and exchange money then this would be possibly a risky partner. As prostitution is not legal in certain area then sex worker would misrepresent their identity and profession in order to find customer.
The common scenario is that you get involve with a person who has different profession and not official sex worker, however, you end having some type of sexual encounter with her/ him and you pay tip or certain financial compensation ( We are not discussing legal aspect of that, this is just pure clinical picture to teach you the risk taking behavior). At this point it does not matter what that person claim as a profession, that particular person is "Sex Worker"
Example 1: You met a girl in bar and she mention to you that she is a waitress or bank teller, or a hair stylist, however, you end up receiving oral sex from her and then she ask you to give her some money afterward. At that point, she would be consider as sex worker as far as STD concern. It does not mater what she had claimed as her profession.
Example 2: You are getting a massage and you receive hand job and you pay tip. She or He would be a sex worker.
Sex with physical sex worker is consider as high risk
Genital to genital contact: This is a common sexual behavior among people specially younger generation prior of becoming fully sexually active. By putting erected penile in close contact of female genitalia. Sometimes clothing involved and sometimes not. If there is no underwear involved the chance of getting sexually transmitted disease will be higher. Bacterial infection such as gonorrhea are so small and contagious that by getting exposed to minimal discharge and secretion would put you at risk of infection. During foreplay both partner get stimulated and would have some secretion, The secretion would moist the area and facilitate the transmission of infection by exposure to infected body fluid. Having barrier such as underwear may help to decrease the exposure, but unless you have barrier made of latex ( wearing condom) you will encounter fair amount of risk.
Penile to Anal Foreplay:
This type of foreplay is very risky.
If patient has STD or not you will have risk to get bacterial infection which exist in the area from fecal mater such as E-coli.
Many people have certain stages of hemmorrhoid and some with bleeding so the area would be exchange station for Viruses or bacterial, such as Gonorrhea, HIV, Hepatitis C , Syphilis....
If anal sex is part of your sexual intercourse, always use condom and lubricant and leave that for the last part of the sex. In other words, it is not recommended that you perform anal sex then you have vaginal penetration. You will introduce Anal bacteria to the vagina.
We know anal sex is considered as high risk for HIV transmission because of 2 main reason
1) HIV is very active in lymphoid tissue and we have them in rectal area.
2) Lining of anus is thin and dry and micro tear and bleeding is very common.
Ejaculation in foreplay:
Getting exposure to semen is risky. It is a body fluid and may contain infectious organism.
If semen gets in contact with anal or oral it could infect you with STD.
Fingering:
It is a manual stimulation of a female's sex organs or female/male anus.
Std risk will be divided in 2 main branches
1) If there is a fissure or cut on skin:
It is easier to contract bloodborne diseases, HIV, Hepatitis C, Hepatitis B, etc
2) Intact Skin:
chances of bloodborne STD will be lower than above
However there is risk of some other STD such as Herpes
Now if contaminated hand with bacteria such as haemophilus Ducreyi, Gonorrhea, Chlamydia... then it could infect and contaminate other part of the body.
Mutual Masturbation: If you exchange hand, for example, you touch your partner then you touch your own genital then you are at risk of infection.
If you accidentally got in contact with body fluid then quickly wash your hand with antibacterial soap and water to decrease chance of transmission.
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