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Known HIV positive blood on inserting finger
I am a very healthy female who always practices safe sex with std free partners.
One wk ago, after months of abstinence, I met with male friend known HIV positive with undetectable viral load (last test 1 wk before encounter) & very adherent to therapy.
After washing his hands, he fingered my vagina for at least 15 minutes.I was quite lubricated and had no pain although he rubbed 2 fingers quite hard and deep.
Then we had penile-vaginal intercourse with condom on.
After intercourse, we noticed blood tinged spots/smears on sheets. There were also blood tinged secretions on my genitalia all way down to my anal area, his scrotum and outer surface of condom. Definitely no blood on inner surface of condom; semen was normal color; and condom did not break or leak (we checked for that).
The only thing we did not check are his fingers.
Next a.m., he assured me on the phone he had no cuts but did not inspect himself physically. To add to my worry, he takes warfarin, but INR at time of incident was only 1.2-1.5. In +, the towel he dried his hands on before fingering me, had a tiny amount of discoloration that might have been diluted blood.
Exactly 3 days later, I inspected his fingers myself and did not notice any healing cuts or scars, but I know these marks can quite often go unoticed despite careful examination especially if they are around nails and under cuticles.
He assured me again that he knows his body very well, and since he has lived with HIV for 20 yrs, he is very careful at not exposing others to any risk. Also, he had 2 long term relationships with serodiscordant female partners without any problems, & this is first time he is faces w/ such incident.
My questions are:
1- What is likelihood blood came from him?
2- Should I have started PEP?
3- What is likelihood of seroconversion (in nb.) if I did not takePEP?
4- What is likelihood of seroconversion (in nb.) if I took PEP?
Please help as I am on verge of losing my mind. TX.
One wk ago, after months of abstinence, I met with male friend known HIV positive with undetectable viral load (last test 1 wk before encounter) & very adherent to therapy.
After washing his hands, he fingered my vagina for at least 15 minutes.I was quite lubricated and had no pain although he rubbed 2 fingers quite hard and deep.
Then we had penile-vaginal intercourse with condom on.
After intercourse, we noticed blood tinged spots/smears on sheets. There were also blood tinged secretions on my genitalia all way down to my anal area, his scrotum and outer surface of condom. Definitely no blood on inner surface of condom; semen was normal color; and condom did not break or leak (we checked for that).
The only thing we did not check are his fingers.
Next a.m., he assured me on the phone he had no cuts but did not inspect himself physically. To add to my worry, he takes warfarin, but INR at time of incident was only 1.2-1.5. In +, the towel he dried his hands on before fingering me, had a tiny amount of discoloration that might have been diluted blood.
Exactly 3 days later, I inspected his fingers myself and did not notice any healing cuts or scars, but I know these marks can quite often go unoticed despite careful examination especially if they are around nails and under cuticles.
He assured me again that he knows his body very well, and since he has lived with HIV for 20 yrs, he is very careful at not exposing others to any risk. Also, he had 2 long term relationships with serodiscordant female partners without any problems, & this is first time he is faces w/ such incident.
My questions are:
1- What is likelihood blood came from him?
2- Should I have started PEP?
3- What is likelihood of seroconversion (in nb.) if I did not takePEP?
4- What is likelihood of seroconversion (in nb.) if I took PEP?
Please help as I am on verge of losing my mind. TX.
MEDICAL PROFESSIONAL
With no sexual exposure for almost 6 months, it is unlikely that chlamydia or other STD explains the bleeding. But all unexplained vaginal bleeding should always be professionally checked. A standard urinalysis or culture does not check for chlamydia or gonorrhea; these tests need be requested by name.
Regardless that your friend's pubic area bump "looked like a wart", it probably was not. Warts do not persist unchanged for many years.
1) A wart, by definition, is a growth caused by HPV. There is no such thing as a wart not caused by HPV.
2) There are no data on HPV transmission risk for a single sexual encounter. But HPV is rarely transmitted by hand-genital contact, so it's not an issue. Anyway, as a non-virgin, presumably with at least a few sex partners in your life, you can assume you have been infected with HPV by now -- and for all you know, could be carrying an HPV strain right now. All sexually active people get HPV at one time or another, most of us probably more than once. Happily, most infections never cause symptoms and clear up over time. It's not something to lose sleep about.
Regardless that your friend's pubic area bump "looked like a wart", it probably was not. Warts do not persist unchanged for many years.
1) A wart, by definition, is a growth caused by HPV. There is no such thing as a wart not caused by HPV.
2) There are no data on HPV transmission risk for a single sexual encounter. But HPV is rarely transmitted by hand-genital contact, so it's not an issue. Anyway, as a non-virgin, presumably with at least a few sex partners in your life, you can assume you have been infected with HPV by now -- and for all you know, could be carrying an HPV strain right now. All sexually active people get HPV at one time or another, most of us probably more than once. Happily, most infections never cause symptoms and clear up over time. It's not something to lose sleep about.
Thank you so much for your your thorough answers and for putting my fears about HIV to rest.
Yes, I did read you summary on the study you mentioned but could not comment on it in the above posting as I would have exceeded the 2000 character limit.
Prior to this encounter, I have always had steady partners who tested negative for HIV and hepatitis B and C, & did not suffer from gonorrhea; however, I never went to the extent of asking for a chlamydia or syphilis test.
My last PAP smear in May 2011 was normal. I had very mild UTI-like symptoms in June but there was no growth in the urine and the symptoms subsided spontaneously. I do not know though if testing for chlamydia in the urine has to be specifically requested or if regular urine cultures check for it.
Of note, I have been abstinent since April until now.
This being said, I am going to see my gyne ASAP and get tested for chlamydia in both urine and vagina as of tomorrow. I will definitely keep you posted of the outcomes.
However, I have one more -and last- worry now. After my initial posting, I started reading about HPV and remembered that this same friend had what looked like a single wart on his pubic area, above his penis. I asked him about it and he said he has had it for many years and never had it checked.
1- Are all genital warts HPV? None of the internet sources had a proper answer if any at all.
2- If my partner has HPV what is my risk of getting infected after one sexual encounter?
Thanks and thanks again.
Yes, I did read you summary on the study you mentioned but could not comment on it in the above posting as I would have exceeded the 2000 character limit.
Prior to this encounter, I have always had steady partners who tested negative for HIV and hepatitis B and C, & did not suffer from gonorrhea; however, I never went to the extent of asking for a chlamydia or syphilis test.
My last PAP smear in May 2011 was normal. I had very mild UTI-like symptoms in June but there was no growth in the urine and the symptoms subsided spontaneously. I do not know though if testing for chlamydia in the urine has to be specifically requested or if regular urine cultures check for it.
Of note, I have been abstinent since April until now.
This being said, I am going to see my gyne ASAP and get tested for chlamydia in both urine and vagina as of tomorrow. I will definitely keep you posted of the outcomes.
However, I have one more -and last- worry now. After my initial posting, I started reading about HPV and remembered that this same friend had what looked like a single wart on his pubic area, above his penis. I asked him about it and he said he has had it for many years and never had it checked.
1- Are all genital warts HPV? None of the internet sources had a proper answer if any at all.
2- If my partner has HPV what is my risk of getting infected after one sexual encounter?
Thanks and thanks again.
MEDICAL PROFESSIONAL
Glad to be of help. Take care.
Thank you for your outstanding professionalism and competence. Your responses are by far the most comprehensive, factual and convincing.
Thanks again for investing in this invaluable forum.
Thanks again for investing in this invaluable forum.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
The bottom line is that you are at no measurable risk for HIV from the events described. The reasons are several. First, it is very unlikely the blood was his. In the vast majority of instances in which blood appears after vaginal sexual contact, the woman's cervix or vagina is the source. As you will appreciate, it is difficult to check internally by self examination. And absence of any bleeding source on his fingers also suggests the blood wasn't his.
Second, fingering has never been known to transmit HIV and you aren't likely to be the first case.
Third, with your partner on anti-HIV treatment and undetectable viral load, there is little if any risk of transmission even if you had had a "real" exposure, such as unprotected vaginal sex. In case you haven't read it, please see the blog that Dr. Hook and I wrote about this; you can find it on the right side of this forum's home page: "Anti-HIV Treatment Markedly Reduces Sexual Transmission". That neither of your friend's long-term female partners was infected corroborates the absence of risk to you.
So the replies to your specific questions are:
1) The blood probably was yours. If you have not been professionall evaluated, please do that now. STDs like chlamydia, gonorrhea, or other causes of cervicitis are common causes of sexually-provoked vaginal bleeding. Please see your regular reproductive health provider soon, or your local health department STD clinic or a Planned Parenthood clinic.
2) No, PEP is not warranted in this situation.
3, 4) Virtually zero in both situations. You don't even need HIV testing, unless you feel you need the negative result in order to convince yourself that I'm right.
I hope this helps. Please return with a follow-up comment and let me know the outcome after you have had a gyn/STD evaluation. In the meantime, don't worry about this.
Regards-- HHH, MD
The bottom line is that you are at no measurable risk for HIV from the events described. The reasons are several. First, it is very unlikely the blood was his. In the vast majority of instances in which blood appears after vaginal sexual contact, the woman's cervix or vagina is the source. As you will appreciate, it is difficult to check internally by self examination. And absence of any bleeding source on his fingers also suggests the blood wasn't his.
Second, fingering has never been known to transmit HIV and you aren't likely to be the first case.
Third, with your partner on anti-HIV treatment and undetectable viral load, there is little if any risk of transmission even if you had had a "real" exposure, such as unprotected vaginal sex. In case you haven't read it, please see the blog that Dr. Hook and I wrote about this; you can find it on the right side of this forum's home page: "Anti-HIV Treatment Markedly Reduces Sexual Transmission". That neither of your friend's long-term female partners was infected corroborates the absence of risk to you.
So the replies to your specific questions are:
1) The blood probably was yours. If you have not been professionall evaluated, please do that now. STDs like chlamydia, gonorrhea, or other causes of cervicitis are common causes of sexually-provoked vaginal bleeding. Please see your regular reproductive health provider soon, or your local health department STD clinic or a Planned Parenthood clinic.
2) No, PEP is not warranted in this situation.
3, 4) Virtually zero in both situations. You don't even need HIV testing, unless you feel you need the negative result in order to convince yourself that I'm right.
I hope this helps. Please return with a follow-up comment and let me know the outcome after you have had a gyn/STD evaluation. In the meantime, don't worry about this.
Regards-- HHH, MD
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