risk of transmission

Hi Drs!

2 encounters with CSWs

1st -4 wks ago- she fingered her vagina, then immediately massaged the tip of my penis.  

2nd -3 wks ago- I fingered her for 5 mins, quickly used hand sanitizer.  I inspected fingers & noticed rough looking hangnail, and a pinpoint looking break in the skin.  2 hrs later, i noticed coagulated blood where the hangnail once was.  This sent me into a panic.

I'm not AS concerned about the first episode - i know HIV dies quickly once exposed to air - however, the fluid exchange was rapid, and was massaged onto my urethra.  The 2nd episode makes me really nervous.  i can't help but wonder if there was an open wound while i was fingering her.  

now i have fatigue, malaise, sore throat, and mild fever (mid 99's) 3-4 weeks out.  I know symptoms are bad indicators, but still!

1.  what are the odds of infection for these 2 encounters?  Would you say i have a better chance of being abducted by aliens and then having a meteor fall on the spaceship?  I realize i'm resorting to hyperbole, but i want to know if my chances are truly infinitesimal.  is the risk zero?

2.  If my finger wound was in fact fresh and bleeding during fingering, could a torn hangnail be a wound that would provide a route for HIV infection?  i often see you both allude to the "depth" of a cut when assessing this type of risk - is a fresh hangnail wound deep enough (assuming it's actively bleeding)?  

3.  If your answer to #2 is no, why?  Biologically, what is the difference between sticking a finger with a fresh wound (like bleeding hangnail) in a vagina vs an exposed penis?  Aren't both equally opportune routes of invasion?  Or are there no target cells (which HIV needs to infect) near a freshcut as opposed to the urethra?  Why does the depth of the cut make a difference?

4.  is it possible for ARS to show with a sore throat/fatigue/malaise WITHOUT a high fever or rash?  How high typically is an ARS fever?  

Thanks so much!!

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help. the risk of HIV from both of the encounters is ZERO.  No doubt about it. HIV is not spread through masturbation, even when a partners’ secretions are "massaged" into the penis/urethra and even if there is a hangnail present. Still zero risk. There has never, not ever been a case of HIV transmission transmitted through masturbation of any sort.  

I'll now answer your specific questions, mostly repeating what I've just said above:

1.  We agree. You are more likely to be killed by a speeding glacier while reading this than to get HIV from the encounters you describe.

2.  Depth and "freshness" are irrelevant- still zero, as I said.

3.  A biologically complex answer would be required, far beyond the scope of this Forum.  If you choose to believe me, so be it.  There are NO such cases of transmission documented in the medical literature.  

4.  Classical ARS is a flu-like illness with high fevers.  Some people however get HIV without any symptoms whatsoever.  thus it is logical that anything in between could happen as well. that however in no way changes the fact that your risk from the exposure you describe is zero.  EWH

[squigglyone]

Thank you so much for the unequivocal reassurance!  I truly do appreciate it.  

I just want to ask one last question (i know, you figured that was coming.. =)).  Above, you say that my risk of infection would be "zero" even if i had a bleeding hangnail on my finger at the moment I stuck my finger into the CSW (assuming she was positive).  And, i DO believe you re #3.  

However, in a prior post, you have stated: "If she was infected AND you had cut yourself JUST before you used your finger (i.e. open, recent wound) there is a chance . . ."  
http://www.medhelp.org/posts/HIV-Prevention/Fingering-with-cut-on-finger/show/463928

Can you please explain why my situation (risk) is different that this prior poster?  

Thanks again!  and thanks for responding so quickly to my first post.  

[Edward W Hook, MD]

Some days I chose different words than others.  I get tired of writing the same thing day after day after day when, as you are aware, i get asked the same questions repeatedly.  No appreciatble risk for either of you.  EWH

[squigglyone]

Thanks doc!  I apologize if my follow up question upset you in any way.  I know you're asked the same thing over and over.  

I'll keep an eye out for that speeding glacier.  In the meantime, I will truly rest easier having read your comments.  Thanks for everything you do here.    

[squigglyone]

Hi Doc,

So, I am still driving myself nuts, and cannot wait for the 6 week mark, let alone the 3 month mark.  28 days is approaching soon -

can i get the DUO test and will it be 100% conclusive at that time?  Also, the last thing i'll need is a false positive - are the DUO tests prone to such false positives like the PCRs?

Again, I must be blowing this out of proportion - i know.... but please indulge me - you truly believe the risks I've described (actively bleeding hangnail in vagina) is ZERO - no if's and's or but's or about it?  

many many thanks!

[Edward W Hook, MD]

DUO tests are less prone to false postives than PCR tests.  At 28 days, either a DUO test of a combination of a PCR and a standard antibody test can provide reliable evidence of the presence or absence of HIV.  Personally, I think tesitng is a waste of time and money for you.  You are not at risk. EWH

[iikor]

What if in such situation vaginal fluids (maybe with traces of blood) enter the cut and result in HEP C coinfection? Will the 28 days test still be valid? Or will hep c delay the validity of the tests.

[Edward W Hook, MD]

Last answer.  You need to accept that this was a no risk exposure.  Hepatitis C would not change this. there will be no further answers.  EWH