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HIV + Hep C and cocaine straws

Hi Doctor,

I wasn´t sure whether to put this under the HIV or STD forum.. I hope this is ok..

A few days ago I did a couple of lines of cocaine at a party with some people with dubious histories.  It´s not something I ever usually do, but I didn´t think too much of it at the time.  I´m wondering however if I might have put myself at risk of HIV or hepatitis C transmission by sharing the same banknote?

As far as I can see, there doesnt seem to be much risk of HIV because the virus doesnt tranmit very easily under such circumstances.. is this correct?  There is a lot more debate on the internet around Hep C.  A lot of sites claim that sharing a note or straw is a definite risk.  However, NHS guidelines in the UK say there isnt enough evidence to suggest a practical risk, and they don´t recommended testing if nasal inhalation is the only activity performed.  It seems like the CDC might agree with this as well?  This was easy information to find but it has left me rather confused.. do you think I could be at any risk from HIV or Hep C and would you recommend testing for either?

Thank you very much for your help
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300980 tn?1194929400
MEDICAL PROFESSIONAL
I've read the other thread that you mention.  Several points of clarification:

1.  Our answers are are specific to the questions asked. The reason I say this is because not all mucosal surfaces are the same. The question you referred to asked Dr. Handsfield about eye exposure, yours asked about nasal exposure. the nature of the mucous membrances involved is not the same.
2.  Some mucosal surfaces are designed specifically to absorb liquids, other are not.  For instance, your entire gastrointestinal tract is a mucosal surfaces.  Different parts of it have different absorbtive capacities.
3.  Absorbtion of things such as virus is very different from absorbtion of chemicals and water- this is because of the the relative molecular size of these things- water is a small molecule, HIV is many molecules, asembed together to be a viral particle - many. many times larger than a water (or cocaine) molecule.  

Finally, please note that in both responses (mine and Dr. Handsfield's) we each note that transmission of HIV is a rare event.  I hope this both clarifies your concern and answers your question - you sitll have nothing to worry about.  EWH
Helpful - 2
300980 tn?1194929400
MEDICAL PROFESSIONAL
We can deal with these questions on this site.  Short answer- there is little to worry about and I would not recommend testing for either hepatitis C or HIV.

Longer explanation.  For both HIV or hepatitis C to be transmitted by sharing a straw (or rolled up bank note) for cocaine ingestion would require someone before you to contaminate the straw in a major way with visible blood and then for the straw to be stuck into your nose so vigorously that it lead to introduction of the contaminated blood into your circulation.  It would require an infected straw partner, a substantial (visible) amount of blood on the straw and for you to jam it though your mucosal surface, drawing blood.  While theoretically possible, this simply has never been definitively reported and if it was, would be extraordinarily rare.  Your risk is so low that I would not recommend concern or testing for either infection.

Final comment.  Both the strength and the weakness of the internet is the large amount of information, right and wrong, that can be found on it.  When looking for information of this sort, go with known sources whenever possible, as you infer you have done.,  Hope this helps.  EWH  
Helpful - 2
Avatar universal
Thanks very much for the clarification.. I understand that although absorbtion can occur, it is not efficient enough to warrant concern under these particular circumstances - hence the need to go so far as to draw blood.

Thanks for answering my questions in such depth and for providing such informative advice.
Helpful - 1
Avatar universal
http://www.thebody.com/Forums/AIDS/SafeSex/Archive/TransmissionSexual/Q9039.html
Helpful - 0
Avatar universal
That's a similar question that I had from yesterday (A Worried Mom) I understood intact (those without tears or ulcerations) mucous membranes to be able to transmit the virus across the membrane.

Helpful - 0
Avatar universal

Sorry to bother you doctor but I was just wondering if you could clarify one point for me.  Your detailed explanation is very clearly illustrated so I know I have nothing to worry about.. but I just want to enquire about the nature of the mucosal surface.

My nose at this time was entirely normal and intact because I only did a couple of lines.  I´m just wondering if the mucosal surface is ´porous´ to liquids such as blood or not?  Generally speaking, I was under the impression that a mucosal surface absorbs liquids.. such as infected blood.

Your answer states that one would have to jam through the mucosal surface to draw blood, so presumable your implying that the musocal surface is actually a good barrier to infections such as hiv and hep c when it is intact?

Thanks to your first post I know this is a no risk exposure for all the reasons mentioned, of which this is a tiny issue.. so I won´t bother you with any further questions! Thanks for your time
Helpful - 0
Avatar universal
Thank you very much indeed doctor, its great to receive such authoritative advice
Helpful - 0

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