HIV Exposure from Bleeding Open Cut Fingering

[yikes21]

Hi Doc,

I'm trying to determine my risk of getting HIV after a recent vacation.

I was in a strip club in Negril, Jamaica and, stupidly, was blacked out drunk when I got there. I otherwise would have no worries about HIV infection except that, at one point during the night, I picked a piece of glass off of my shoe and it cut me fairly deeply. I had a pretty thick stream of blood going in the club and had to go get a napkin to stop it up.

To get an idea of the depth of the cut, it might have been able to use, at most, a single stitch at the time and it has been four days and it seems that the top most layer of my skin is all that is left to heal (i.e. I wouldn't expect to knock it open again right now). Also, the next day after the cut, I knocked it shuffling through my pockets and that caused it to begin bleeding profusely again so I would imagine that, if I did finger her that night, it would have split open again.

I had the same girl entertaining me the entire night. I definitely did not have intercourse or oral sex with her but, at most, I MAY have fingered her (I say MAY because I was blacked out drunk and do not remember which is why I'm investigating this). And, as you know, Jamaica has fairly rampant HIV/AIDS... I could only imagine the statistic for strip club workers.

Would this have possibly exposed me to HIV?

What tests at what times would provide reassurance of this? Also, do you think you could provide a simple breakdown of the 3 types of tests (antibody/ELISA, p24 antigen, and DNA PCR/RNA PCR) and the times to test and accuracies of them? You touched on it in this thread just a little:
http://www.medhelp.org/posts/show/764623
"according to most experts around 50% are positive by 2 weeks, 90% by 4 weeks, 95+% by 6 weeks, 99% by 8 weeks, and three months is the longest it ever takes"
"All this is for the standard HIV antibody tests."

THANKS!

[Edward W Hook, MD]

Let's start with the bottom line.  No one has ever gotten HIV from masturbation of a sex partner, no matter whether or not they had cuts on their hands, skin rashes, open sores, bad cuticles or whatever (we have had questions regarding each of these).  Then, considering that you were so drunk that you do not remember what happened, odds are that nothing did.  I again say this from the experience of working through similar problems with multiple clients.

While rates of HIV may be relatively high in Negril odds are still that your dancer friend did not have HIV.  Remember, in the Caribbean, the highest rates of HIV among high risk groups is 10%.  Thus odds are strong that she did not have HIV, even if you did manage to stick your finger into her vagina.

Having told you that you are no risk, let's now analyze when you might expect if you were the first person, EVER, on record to get HIV from exposure of their finger to genital secretions through masturbation of a partner.  The standard figures for becoming HIV antibody positive are, as you mention: 50% positive by 2weeks, 85-90% positive by 4 weeks, 95% positive by 6 weeks and 98-99% by 8 weeks.  These figures, particularly when considering the more recently available antibody tests are conservative.  I know of no HIV expert who has not seen all of their patients who seroconverted do so within 6 weeks.

My advice, do not worry.  If you must get tested, do so once, somewhere around 4 weeks following exposure.  If your tests is negative then, you can be sure you did not get HIV.  Hope this is helpful.  EWH

[Edward W Hook, MD]

Stop trying to overthink this.  "What if" questions are just not prodictive.  Of course vaginal secretions carry the virus in infected persons but the slin of the fingers and the nature of finger-genital contact is such that HIV transmission does not occur.  Vaginal secretions are the source of infection in sexual transmission of HIV from infected females to uninfected males..

The data you summarize for test accuracy are about right and reflect the data we regualrly provide on this site. None of them however are going to lead to an HIV diagnosis for you as you are not at risk from the expsoure you describe.  

No further questions please.  EWH

[yikes21]

Doctor Hook,

Very helpful. Thank you.

So, do vaginal secretions carry any meaningful, infectious viral load, at all? You said no one has been infected from vaginal secretions and fingers. It seems to be a relatively benign bodily fluid like saliva, then.

Extending this a bit further, would contacting vaginal secretions on a mucous gland (skin that is highly susceptible to microscopic cuts and, therefore, multiple points of infection) be a high risk activity? (ie is it the menstrual blood from unprotected vaginal intercourse with a woman with HIV that *really* causes most HIV infection)

Finally, if you do not mind as I know I have gotten my $20 worth of your time already, do you think you could post a table of the effectiveness windows for each test? antibody/ELISA, antigen/p24, DNA PCR/RNA PCR?

So far all I know is:

antibody/ELISA - 50% by 2 weeks, 85-90% by 4 weeks, 95% by 6 weeks, and 98-99% by 8 weeks

antigen/p24 - ?% by 3-4 weeks

DNA PCR/RNA PCR - though not used for diagnostic purposes, 99% by 2 weeks? (not sure of this one)

...and I thought one of these tests do not provide meaningful results AFTER a certain number of days?

THANK YOU!