Dr.'s advise please

Dr., Let me start out by apologizing for asking a seemingly repetitive question.... I have been seeing so much conflicting information and am beginning to get a bit confused. I want the expert's opinion in the matter.

29 year old healthy hetero, long term relationship going on 10 years with same woman, two children.

On Feb 7, 2008 at about 900 pm, I met a 43 year old bar fly in a large California city. Slutty woman, both intoxicated, open mouth kissed (made out) and penetrative fingering with lots of vaginal fluid took place. She had pants on so fingering wasn't all that deep. I later checked my hand/finger while washing in the bathroom and did not see anything alarming (although I was intoxicated). Later I checked my fingers again and believe to have noted very dry and chapped nail beds and peeling cuticles. The next day (about 20 hours post event) I noted what resembled a deep red spot which appeared to be under the skin and not open (maybe eczema?) on one of my middle fingers between the nail and first knuckle. At this point I cannot even recall if this was on the same hand or finger which was used, likely due to a severe hangover.

At 9 weeks I went to the local health health department and gave blood. They reassured me that this was indeed very low risk. Due to having to wait two weeks for the results of the blood test, I went to the health department's mobile van at 9.5 weeks and had an oral swab test done, which was negative. I do not know what brand or generation the swab test was.

Questions...

(1) How accurate are the oral swab tests at 9.5 weeks?

(2) Does it change anything if the mouth was dry due to stress and heat, such as if there was not a suitable amount of saliva on the swab?

(3) Is it possible to have a negative oral swab at 9.5 weeks but the blood drawn at 9 weeks to come back other than negative?

(4) In the worst case scenarios, without having significant cuts, gashes, ect on the fingers, how risky was this behavior?

[H. Hunter Handsfield, M.D.]

Indeed the identical questions have been asked innumerable times on this forum.  My responses to your questions are the same, and therefore are very brief, since you know the answers.

1) A negative oral test at 9+ weeks is at least 99% reliable.  With that result and the nature of the exposure, you can be 100% certain you don't have HIV.

2) No.

3) No.

4) Zero.  There might be a theoretical risk if the cuts were fresh, but in the 30 years of the worldwide AIDS epidemic and millions of infected people, nobody is known to have caught HIV by fingering.  You aren't going to be the first.

Regards-- HHH, MD

[1anonymous29]

Thank you Dr. Is testing at the three month mark warranted here? Should I test out to six months as was actually recommended by the HIV counselor who administered the oral test?

[H. Hunter Handsfield, M.D.]

No testing at all was warranted after this exposure.  There is no need for any additional testing. Your HIV counselor was being overly conservative; with modern tests, nobody has delayed positive results as long as 6 months and it's rare after 4 weeks.

[1anonymous29]

Thanks so much Doc!!! You have truly put my mind at ease....

[1anonymous29]

Dr.,
I have read in other places on the web that the natural lube of the vagina (the non cervical fluid) is not infectious for HIV, much like saliva. They claim that the cervical fluid is what contains the infectious amounts of the virus and is contained much deeper in the vagina. Do you know of this to be fact or fiction. If it is true it would put into perspective the "no risk from fingering" idea.....  

[H. Hunter Handsfield, M.D.]

The debate you describe isn't helpful, probably meaningless.  HIV certainly is present in cervical secretions of infected women, but to my knowledge non-cervical genital secretions have not been studied.  So the answer to your question is unknown.  But probably it doesn't matter, because cervical secretions undoubtedly are always resent in vaginal secretions.  This has nothing to do with why fingering carries no risk of HIV transmission.  

[1anonymous29]

Thank you Sir!!!