Aa
Concerned Traveler
Hi Dr.
Went to Manila with a friend and met two sex workers in a place that supposedly tests them for STD’s weekly. They went home with us and went to the friend’s room first.
Him: given oral, masturbated by them using lube, inserted fingers in vagina. Then my room: masturbated me using lube, I manipulated each girl’s clitoris < 1min. I did not insert fingers into vagina. I pick at my nails but no cuts, open sores or torn cuticles. Washed hands after.
2 days post event, friend develops moderate fever for 48 hrs. 5 days post event, I develop mild fever (99 - 100) for 48 hrs and has not yet broken, headache, mild aching in lower back and a bit of diarrhea. no enlarged lymph nodes, rashes, etc. Flu shot 2 weeks ago.
Questions:
1) I believe I can absolutely rule out masturbation since I can’t infect myself and they had no visible cuts – do you agree?
2) Re: clitoris –likelihood I could have contracted HIV from this? Also saw dermatologist (cheap healthcare in third world countries) who pointed out very small indentions in the skin below and surrounding cuticles and noted “they were possible transmission hazards”. Said these were healed injuries from picking at my fingers. Thoughts on this?
3) Let’s pretend we were exposed – friend’s fever at 2 days and my symptoms onset at 5. I believe this would be too early to be caused by HIV – do you agree?
4) PCR test done at 6 days exposure, not yet received results – what is the validity of a 6 day result if any.
5) If # 4 is invalid, what tests should we request, if any?
6) We also had herpes tests (HSV PCR) - have not received results – Reliable at 6 days?
7) On other STD’s, with both were given Zithromax and have tested negative for syphilis based on VRDL… anything else to address?
8) I'm a very happily married man who got drunk and did something very stupid… My wife will expect unprotected sex when I return after two weeks away. Should I sleep with her or tell her so I can pursue additional testing?
Went to Manila with a friend and met two sex workers in a place that supposedly tests them for STD’s weekly. They went home with us and went to the friend’s room first.
Him: given oral, masturbated by them using lube, inserted fingers in vagina. Then my room: masturbated me using lube, I manipulated each girl’s clitoris < 1min. I did not insert fingers into vagina. I pick at my nails but no cuts, open sores or torn cuticles. Washed hands after.
2 days post event, friend develops moderate fever for 48 hrs. 5 days post event, I develop mild fever (99 - 100) for 48 hrs and has not yet broken, headache, mild aching in lower back and a bit of diarrhea. no enlarged lymph nodes, rashes, etc. Flu shot 2 weeks ago.
Questions:
1) I believe I can absolutely rule out masturbation since I can’t infect myself and they had no visible cuts – do you agree?
2) Re: clitoris –likelihood I could have contracted HIV from this? Also saw dermatologist (cheap healthcare in third world countries) who pointed out very small indentions in the skin below and surrounding cuticles and noted “they were possible transmission hazards”. Said these were healed injuries from picking at my fingers. Thoughts on this?
3) Let’s pretend we were exposed – friend’s fever at 2 days and my symptoms onset at 5. I believe this would be too early to be caused by HIV – do you agree?
4) PCR test done at 6 days exposure, not yet received results – what is the validity of a 6 day result if any.
5) If # 4 is invalid, what tests should we request, if any?
6) We also had herpes tests (HSV PCR) - have not received results – Reliable at 6 days?
7) On other STD’s, with both were given Zithromax and have tested negative for syphilis based on VRDL… anything else to address?
8) I'm a very happily married man who got drunk and did something very stupid… My wife will expect unprotected sex when I return after two weeks away. Should I sleep with her or tell her so I can pursue additional testing?
MEDICAL PROFESSIONAL
I'm sorry, the case IS closed; that's the moderator's decision, not yours. You're just going to have to accept the reassurance. You didn't catch HIV and it is ridiculous for you to be having CD4/CD8 testing. And please do not start a new thread with the same questions; it would be deleted without reply (and without refund of the posting fee).
Sorry, not closed... need some additional info please!
Lab in india messed up blood draw for DNA tests - they had to re-sample. The report says:
Result Status - Preliminary
HIV Monitor - Result Pending
HIV Viral Load - Result Pending
What we were able to get is the lymphocyte enumeration. All was normal except:
Him - High absolute CD3+ / CD4+ (53) and high CD4 / CD8 ratio (2.92)
Me - Low CD3+ (706)
Does this tell us anything at all?
Thanks!
Lab in india messed up blood draw for DNA tests - they had to re-sample. The report says:
Result Status - Preliminary
HIV Monitor - Result Pending
HIV Viral Load - Result Pending
What we were able to get is the lymphocyte enumeration. All was normal except:
Him - High absolute CD3+ / CD4+ (53) and high CD4 / CD8 ratio (2.92)
Me - Low CD3+ (706)
Does this tell us anything at all?
Thanks!
Case closed. Thanks again!
MEDICAL PROFESSIONAL
"Based on this clarification, does your expert option concur with my layperson observation of zero risk for transmission from finger to genital contact?"
Yes, but for a simpler reason. You're over-thinking the situation. Nobody has ever been known to catch HIV by fingering. As far as I'm concerned, the biological reason doesn't matter very much.
Yes, but for a simpler reason. You're over-thinking the situation. Nobody has ever been known to catch HIV by fingering. As far as I'm concerned, the biological reason doesn't matter very much.
Hi Dr.
Thanks for the reassurance! I almost wholly feel the same, meaning that the experience was entirely safe. The one lingering issue is that of my fingers (not penis) manipulating her clitoris. My previous statements I fear were confusing so if you could indulge me just once more, I will try to clarify.
I manipulated each clitoris with the middle finger on each hand for < 1min. Neither finger had any visible cuts or sores. The dermatologist’s comments were that my fingers, specifically surrounding the fingernail and cuticle, due to having been "picked at", had microscopic indentions / breaches in the outer most layer of skin that could theoretically have allowed for transmission.
I feel that transmission was impossible, despite the dermatologist's comments as:
1) The clitoris typically would not be covered in vaginal secretions
2) Even if it were, they would have been exposed to air by separation of the labia and thus the virus would have been diminished / eliminated
3) Though the outer most layer of skin might have had microscopic breaches, the underlying layer still would have prevented vaginal fluid contact with my bloodstream - thus, no transmission
Based on this clarification, does your expert option concur with my layperson observation of zero risk for transmission from finger to genital contact?
Again, many thanks for your reassurances. As you rightly point out, this is a life experience that has taught me a great deal and your expert views have made the situation much more bearable.
Best
Thanks for the reassurance! I almost wholly feel the same, meaning that the experience was entirely safe. The one lingering issue is that of my fingers (not penis) manipulating her clitoris. My previous statements I fear were confusing so if you could indulge me just once more, I will try to clarify.
I manipulated each clitoris with the middle finger on each hand for < 1min. Neither finger had any visible cuts or sores. The dermatologist’s comments were that my fingers, specifically surrounding the fingernail and cuticle, due to having been "picked at", had microscopic indentions / breaches in the outer most layer of skin that could theoretically have allowed for transmission.
I feel that transmission was impossible, despite the dermatologist's comments as:
1) The clitoris typically would not be covered in vaginal secretions
2) Even if it were, they would have been exposed to air by separation of the labia and thus the virus would have been diminished / eliminated
3) Though the outer most layer of skin might have had microscopic breaches, the underlying layer still would have prevented vaginal fluid contact with my bloodstream - thus, no transmission
Based on this clarification, does your expert option concur with my layperson observation of zero risk for transmission from finger to genital contact?
Again, many thanks for your reassurances. As you rightly point out, this is a life experience that has taught me a great deal and your expert views have made the situation much more bearable.
Best
MEDICAL PROFESSIONAL
1) This doesn't change anything. You're the one who raised the issue of whether the penile skin problems could increase risk. I simply replied in order to disagree with your dermatologist.
2) Too speculative. The symptoms were for sure not cause by HIV, and I won't play a speculative game that has no basis in reality.
You had an entirely safe sexual exposure: believe it! My advice is that you return home, not get tested, continue relations with your wife, and chalk up the whole event to experience. But whatever you do, I won't respond to "what if" or "did you really mean" sorts of questions. Please accept the reassurance at face value without second guessing.
2) Too speculative. The symptoms were for sure not cause by HIV, and I won't play a speculative game that has no basis in reality.
You had an entirely safe sexual exposure: believe it! My advice is that you return home, not get tested, continue relations with your wife, and chalk up the whole event to experience. But whatever you do, I won't respond to "what if" or "did you really mean" sorts of questions. Please accept the reassurance at face value without second guessing.
Thanks Doc - Very helpful indeed, although disappointing about the tests being too early. A couple of short follow-up questions if I may:
1) in your response to my question (2), you mention anomalies of my penis. Just wanted to clarify that at no time did my penis touch her vagina or clitoris. Rather, it was my hands that were proported to have anomalies which also touched her clitoris. Does this change your perspective? I believe this is a zero risk transaction unless an open, bleeding cut came into contact with vaginal secretions which is unlikely because 1) I had no such cut and 2) even if I did the secretions would have had to have come from the clitoris (not her vaginal cavity) and therefore have been exposed outside the body to air. Is my logic sound?
2) On question (3), you note that my symptoms could not be caused by HIV in only 5 days post-exposure. If by some freak reason they were being caused by a recent HIV exposure, would it be safe to assume I was also therefore producing significant levels of antibodies and that one of the current tests would catch this at only 6 days? If so, would it be PCR, p24, etc.?
Thanks again
1) in your response to my question (2), you mention anomalies of my penis. Just wanted to clarify that at no time did my penis touch her vagina or clitoris. Rather, it was my hands that were proported to have anomalies which also touched her clitoris. Does this change your perspective? I believe this is a zero risk transaction unless an open, bleeding cut came into contact with vaginal secretions which is unlikely because 1) I had no such cut and 2) even if I did the secretions would have had to have come from the clitoris (not her vaginal cavity) and therefore have been exposed outside the body to air. Is my logic sound?
2) On question (3), you note that my symptoms could not be caused by HIV in only 5 days post-exposure. If by some freak reason they were being caused by a recent HIV exposure, would it be safe to assume I was also therefore producing significant levels of antibodies and that one of the current tests would catch this at only 6 days? If so, would it be PCR, p24, etc.?
Thanks again
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
HIV is sexually transmitted only by unprotected vaginal or anal sex, i.e. a penis without a condom inserted inside another person's vagina or rectum. There is debate about transmission by oral sex, with some experts believing it never happens and others acknowledging extremely low risk. For sure oral to penile transmission is very, very rare if it happens at all. Kissing is zero risk and so are fingering and other kinds of hand-genital contact, even when genital fluid or saliva is the lubricant.
As for your symptoms, 2 days is much too soon for symptoms of a new HIV infection. Sounds like you caught some other kind of infection, but not HIV. And I will also point out that, statistically speaking, it is unlikely your partner(s) had HIV. My understanding is that HIV infection is currently quite uncommon in Phillippine sex worker (probably under 1% infected) -- and from what you were told, it is fair to assume your partners had recently tested negative.
To the specific questions:
1) I believe I can absolutely rule out masturbation since I can’t infect myself and they had no visible cuts – do you agree? YES.
2) Re: clitoris –likelihood I could have contracted HIV from this? NO. I DO NOT AGREE THE MINOR SKIN ANOMALIES OF YOUR PENIS COULD INCREASE THE RISK OF HIV EVEN IF YOU WERE EXPOSED.
3) Let’s pretend we were exposed – friend’s fever at 2 days and my symptoms onset at 5. I believe this would be too early to be caused by HIV – do you agree? YES; SEE ABOVE. EVEN 5 DAYS IS TOO SOON. MOSTLY IT'S 10-20 DAYS.
4) PCR test done at 6 days exposure, not yet received results – what is the validity of a 6 day result if any. 6 DAYS IS TOO SOON. IT OFTEN TAKES 7-10 DAYS UNTIL PCR BECOMES POSITIVE.
5) What tests? BASED ON THIS EXPOSURE, I WOULD NOT RECOMMEND ANY HIV TESTING AT ALL, CERTAINLY NOT PCR. IF YOU WANT TO BE TESTED ANYWAY, FOR REASSURANCE PURPOSES, HAVE AN HIV ANTIBODY TEST AT 6-8 WEEKS, OR A DUO TEST (BOTH ANTIBODY AND P24 ANTIGEN) AT 4 WEEKS.
6) HERPES TESTING WAS ALSO A WASTE OF MONEY AT 6 DAYS; I RECOMMEND AGAINST ANY HSV TESTING BASED ON SUCH AN EXPOSURE.
7) I ALSO WOULD NOT HAVE TREATED YOU WITH AZITHROMYCIN. BUT NO HARM WILL BE DONE, AND IT WILL PROTECT YOU FOR SURE AGAINST CHLAMYDIA AND PROVIDE REASONABLY GOOD PROTECTION AGAINST GONORRHEA AND SYPHILIS.
8) Should I sleep with [my wife] or tell her so I can pursue additional testing? I CANNOT GUARANTEE YOU WERE NOT INFECTED. BUT THE CHANCE OF HIV OR ANY OTHER STD IS VERY, VERY LOW. IF I WERE IN YOUR SITUATION, I WOULD NOT BE TESTED AND I WOULD CONTINUE UNPROTECTED SEX WITH MY WIFE. BUT IF YOU CAN'T TAKE EVEN THE TRIVIAL RISK, THEN YOU'LL NEED TO AVOID SEX WITH HER FOR 6 WEEKS AND WAIT FOR TEST RESULTS. WHETHER OR NOT YOU TELL HER THE REASON, HOWEVER, IS YOUR DECISION, NOT MINE
I hope this helps. Best wishes-- HHH, MD
HIV is sexually transmitted only by unprotected vaginal or anal sex, i.e. a penis without a condom inserted inside another person's vagina or rectum. There is debate about transmission by oral sex, with some experts believing it never happens and others acknowledging extremely low risk. For sure oral to penile transmission is very, very rare if it happens at all. Kissing is zero risk and so are fingering and other kinds of hand-genital contact, even when genital fluid or saliva is the lubricant.
As for your symptoms, 2 days is much too soon for symptoms of a new HIV infection. Sounds like you caught some other kind of infection, but not HIV. And I will also point out that, statistically speaking, it is unlikely your partner(s) had HIV. My understanding is that HIV infection is currently quite uncommon in Phillippine sex worker (probably under 1% infected) -- and from what you were told, it is fair to assume your partners had recently tested negative.
To the specific questions:
1) I believe I can absolutely rule out masturbation since I can’t infect myself and they had no visible cuts – do you agree? YES.
2) Re: clitoris –likelihood I could have contracted HIV from this? NO. I DO NOT AGREE THE MINOR SKIN ANOMALIES OF YOUR PENIS COULD INCREASE THE RISK OF HIV EVEN IF YOU WERE EXPOSED.
3) Let’s pretend we were exposed – friend’s fever at 2 days and my symptoms onset at 5. I believe this would be too early to be caused by HIV – do you agree? YES; SEE ABOVE. EVEN 5 DAYS IS TOO SOON. MOSTLY IT'S 10-20 DAYS.
4) PCR test done at 6 days exposure, not yet received results – what is the validity of a 6 day result if any. 6 DAYS IS TOO SOON. IT OFTEN TAKES 7-10 DAYS UNTIL PCR BECOMES POSITIVE.
5) What tests? BASED ON THIS EXPOSURE, I WOULD NOT RECOMMEND ANY HIV TESTING AT ALL, CERTAINLY NOT PCR. IF YOU WANT TO BE TESTED ANYWAY, FOR REASSURANCE PURPOSES, HAVE AN HIV ANTIBODY TEST AT 6-8 WEEKS, OR A DUO TEST (BOTH ANTIBODY AND P24 ANTIGEN) AT 4 WEEKS.
6) HERPES TESTING WAS ALSO A WASTE OF MONEY AT 6 DAYS; I RECOMMEND AGAINST ANY HSV TESTING BASED ON SUCH AN EXPOSURE.
7) I ALSO WOULD NOT HAVE TREATED YOU WITH AZITHROMYCIN. BUT NO HARM WILL BE DONE, AND IT WILL PROTECT YOU FOR SURE AGAINST CHLAMYDIA AND PROVIDE REASONABLY GOOD PROTECTION AGAINST GONORRHEA AND SYPHILIS.
8) Should I sleep with [my wife] or tell her so I can pursue additional testing? I CANNOT GUARANTEE YOU WERE NOT INFECTED. BUT THE CHANCE OF HIV OR ANY OTHER STD IS VERY, VERY LOW. IF I WERE IN YOUR SITUATION, I WOULD NOT BE TESTED AND I WOULD CONTINUE UNPROTECTED SEX WITH MY WIFE. BUT IF YOU CAN'T TAKE EVEN THE TRIVIAL RISK, THEN YOU'LL NEED TO AVOID SEX WITH HER FOR 6 WEEKS AND WAIT FOR TEST RESULTS. WHETHER OR NOT YOU TELL HER THE REASON, HOWEVER, IS YOUR DECISION, NOT MINE
I hope this helps. Best wishes-- HHH, MD
Thanks in advance for your insight on this... I'm truly racking my brain and need some objective, expert opinion to plan my next steps.
Many thanks
Many thanks
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