Clothed Handjob

[eagleyes]

Hello Dr. EWH / Dr. HHH

I need some advise on the following situation:

We were partying away at a bachelor’s do in Mumbai, India at a pretty shady bar, with ‘available’ waitresses (possibly CSWs in disguise – high risk).

A couple of waitresses were playing with us and drinking from our soft drink bottles. We were sitting on the ground with seemingly dirty mattresses (that most probably had been used for sex before). I was given a hand job by one of the girls. The girl had just visited the restroom before this.

I was completely clothed (trousers, underwear, shirt and vest) and the girl was clothed too, albeit skimpily. So, basically, she massaged my penis from outside the trousers. I did not kiss her (maybe a hug and a peck on the neck and cheek). She had no direct contact with either my mouth or my penis even with her hands. I tried to check her hands to see if I could see any fluid or blood but I could not as she sort of felt I was being weird and walked away.

I am worried about the following:

1. Any risk of HIV / STD from clothing, even if she had some urine / blood / vaginal fluids on her hands? Even theoretical risk?
2. Any risk from the soiled mattress if it had semen / vaginal fluid from a previous romp immediately before?
3. I had an apthous ulcer on my lip and am worried if a kiss on the neck or cheek could be a risk?
4. Could the fact that the waitresses were drinking from the same bottles as us put me at any risk, especially with my ulcer? Even if they had sores / cuts in their mouths?
5. Any conceivable risk at all from this bachelor party for HIV / other STDs? Would you classify all of the above as ‘casual contact’ / ‘Environmental contact’?


Would a PCR DNA qualitative assay (or an antibody test) be in order for this situation?

[Edward W Hook, MD]

Welcome back to the Forum. In preparing to answer your questions I reviewed some of your 33 earlier posts.     From these it is clear that you are quite anxious and  perhaps feeling guilty when you engage in activities such as these.  With respect to the exposure you describe, I hope that the comments which will follow will help you to stop worrying  - it was zero risk.  Going directly to your questions:

1.  Zero risk.  HIV is not passed through clothing.  Not even a theoretical concern.
2.  No, again zero risk. HIV is not transmitted by contact with soiled mattresses, sheets, etc.  Never.
3.  No, zero risk.  HIV is not transmitted by kissing, even with sores/aphous ulcers.
4.  No, HIV is not transmitted by sharing of glasses or bottles, even in one person (either one) has sores on their lips.
5.  No conceivable risk at all

For you to get a PCR test would be a complete waste of money and time.  

Again, to summarize.  No risk.  No need for testing of any sort.  

Please no follow-up questions.  EWH

[eagleyes]

Hi,

I have a friend who is a doctor and does voluntary work for an Aids and Drug forum here. While discussing HIV transmission with him, he made some points for which i could not get enough references on the internet. Can you please shed some light on this?

1. HIV transmission needs a 'bolus' or a certain amount of virus load to infect someone. He says even if someone was to inject 100 viruses in someone's blood, infection would not be practical and this is why body fluids such as sweat, urine and saliva are not infectious and which is why even unprotected sex has a low chance of infection (not enough bolus to enter through the urethra - in a man's case)

2. Upon entering the human body, the hiv needs to start attaching to the cd4 cells and infecting these cells, thereby 'reverse transcripting' it's RNA into DNA and then multiplying significantly, eventually eliminating the cd4 cell. This process happens within 72 hours of infection. As a corollary, he states a PCR DNA at about 10 odd days should be definitive.

3. The whole point of HIVs survival strategy is to infect CD4 cells, failing which the body's immune system destroys the virus.

I do not mean to drag you into a protracted discussion, but do you broadly agree with these statements? Since you are a microbiologist, you would be the best person to answer.

[Edward W Hook, MD]

A brief answer.

You friend is incorrect with his facts.  Recent data show that when people acquire HIV the infection is started by a single virus in over 70% of infections (about 30% are started by 2 or more).  The amount of virus in oral secretions, etc however is lower than the amount in blood or genital secretions- that is part of the reason infections do not occur through exposures such as yours.

Over the course of years the virus does effect CD4 cells and, over that period, it kills them off, resulting in the failure of immunity which is the hallmark of HIV.

Your friend's thinking about when PCRs do or do not become positive may or may not be true.  the time course of these events simply has not been made for enough persons to give you a definitive statement as to whether a PCR test at 10 days or not gives you a definitive answer.

The bottom line however is that there was NO RISK to the exposure you describe.  No one has ever gotten HIV infected in this way.  You will not be the first.

This ends this thread.  Take care.  EWH