Cocaine & hiv

[Somethinginmymind]

Hi doctor

2 days ago i made a mistake. I'm so concerned an anxious that i might get infected.
I'm also married, this doubles my anxiety.
2 days ago i met a professional sex worker at a party.
I didn't have oral, anal or vaginal sex at all. She licked my testicals and gave me handjob.
I guess i have no risk about these sexual activities.
There was cocaine, we snorted with the same bill 5 times. (15 minutes break after the each snort)
Each time she snorted before me. Her nose didn't bleed (i didn't see her nose bleeding).
But my nose bled after the snorting.
Am i at risk? Since i'm married, i feel guilty and concerned.
Thanks so much for your help doctor

[Edward W Hook, MD]

Sorry this is not a debate. The statement is based on my own experience, discussions with otuher experts and information on the scientific literature.  Questions about "how much blood" or "how long" a person was exposed are simply not productive.
EWH

[Somethinginmymind]

If the blood of the both parties present, why do you say the risk is negligible, doctor? Sorry to bother you that much, but i want understand clearly my risks if her blood got in to my nose ( previously bled) can infct me.
Thank you very much

[Edward W Hook, MD]

Even if "high amounts", whatever that means were present, your risk would be negligible.  I think you are over reacting and advise you to stop worrying and move on. EWH

[Somethinginmymind]

I found that comment in the forum search. According to that comment, high amount of bleeding should occur in both sides to let hiv transmitted. So a little (drop) wouldn't be sufficient. Should i believe that?

I have never heard about or read about any cases of HIV caused by sharing a straw during drug use.  Theoretically, it there was a LOT of blood, and the next person had a very significant wound that was also heavily bleeding....there could be a risk, but you have to realize that the amount of blood that would have to be present to cause a risk would certainly stop a person from using the straw.

[Edward W Hook, MD]

I think your "what ifs" are not helping you and do not provide any informatin that changes my assessment or advice.  This remains a very, very low risk event. You need to relax a bit rather than dwell on something that you can do nothing about at this time. EWH

[Somethinginmymind]

One last thing doctor
If my nose bled afterwards, it means i have active bleeding in my nose and if she had her nose bleeding and i didn"t see, she might have infected me, right?
That's keeping mind busy.

[Edward W Hook, MD]

Your "what if" questions in no way change my assessment of advice. This was a very, very low risk event.  

I see no reason to abstain from unprotected sex with your wife. EWH

[Somethinginmymind]

shall i keep having unprotected sex with my wife?
thank you doctor

[Somethinginmymind]

Thank you so much for the reply doctor.
but what if her nose bled as well. this possibility which i didn't notice is eating me.
i realised my nose bled between the snorts but not hers. if she bled as well, i might have infected if she's hiv positive, right?

thank you doctor

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  The sexual activities you describe are not associated with any risk for HIV or other STIs.  There are several case reports in which sharing a straw or dollar bill have been possibly associated with risk for acquisition of HIV however these instances, are exceedingly rare and in general, poorly documented.  You do not know that the person you shared the bill/cocaine with had HIV and in fact, it is statistically unlikely that she did.  Further, while unlike sexual activity for which there are estimates of the risk of acquiring HIV based on the type and number of sex acts, there are no such estimates for sharing a straw or bill to snort cocaine.  This is at least in part because transmission in this way is so rare.

This I can confidently tell you that the risk for HIV from the sexual contact you mention was zero and that the risk from sharing a five dollar bill to snort cocaine is very, very low but not zero.  If I were you, I would not worry.  I realize that you may choose to test to be absolutely sure that you were not infected in the future but I hope that you will not worry between now and then.  I have never seen a patient who acquired HIV through the drug snorting activities you describe.  EWH