LOW or NO Risk Exposure?

[concerned20072007]

20 days ago I deeply fingered the vagina of a massage therapist (who was visiting from China).  Afterwards, I realized my finger had been pricked accidentally with a safety pin earlier in the day (a pin-sized wound).   I noted that my wound was not bleeding but did appear to be slightly infected (oozed small amounts of pus when I pushed on the wound that did not seem to contain any blood).  15 days after exposure I became fatigued, with bad headaches and a sore throat.  The sore throat is relieved some when I cough up the green-colored phlegm congestion.  2 days ago I visited a doctor and started antibiotics hoping my symptoms were due to bacterial infection.   Sore throat is better but cough, sneezing, running nose, fatigue and headaches remain.  I have not noted any fever.  3 days ago (17 days after exposure), I tested for HIV Antibody and DNA (PCR).   Antibody test came back negative.  I have yet to receive DNA (PCR) results.  I am a married male avoiding sex with my wife since the potential exposure.  Continued abstinence or the desire to have only protected sex will be difficult so I am seeking some advice before I am able to conclusively test negative with the antibody test at 6 weeks.  

1.  I assume my exposure was low risk for HIV but do you think it is ZERO risk?   Are you aware of even ONE instance of HIV through hand-to-genital masturbation due to a cut or abrasion on the finger?

2. I understand a negative HIV Antibody test is conclusive at 42 days.  How safe should I feel with a negative test at 17 days?   How safe should I feel if I were to test negative on the antibody test at 31 days?    Does a negative antibody test 15 days after symptoms conclusively indicate symptoms were NOT related to any HIV infection?

3. How reliable would a negative PCR DNA test result be 17 days after exposure?   are their risks of false positives with PCR DNA testing?

[H. Hunter Handsfield, M.D.]

Directly to your questions:

1) Depends on how you define "zero".  If it's too low to measure and nobody has ever acquired HIV through the sort of exposure you describe, and since few massage therapists are HIV infected, for practical purposes the risk is zero.  But of course nobody can guarantee that you could not get infected through the wound on your finger, if your massage partner had HIV.  But your risk is higher for dying in the next 24 hours from an accident or sudden illness.

2) It was a waste of money and energy to be HIV tested at all on account of this non-exposure event.  The time since onset of symptoms is less useful in predicting test results than the time since exposure, so the negative antibody test doesn't mean much.  A negative antibody test at 1 months will be highly reliable, however.

3) The PCR was a mistake as well, for exactly the reason you state.  There is a far higher chance of a false positive result than the possibility you caught HIV.  It probably will be negative, but think what you'll go through if it's falsely positive, as you sort out the confusion with additional testing!

I won't have any further comments.  There is no information you can provide that could possibly change my opinion or advice.

HHH, MD

[concerned20072007]

Thank you for your work and your candor.   I gather you don't see much value to PCR / DNA HIV testing as a method of testing for infection.  I had hoped that I could take some solace in a negative PCR result at 17 days.  

Can I assume from your comments that you think I should disregard any positive from the 17 day PCR / DNA test as a false positive and that the very most I should do is take the antibody test again a month after exposure if I feel I need an absolute peace of mind?   Obviously I fear HIV but I moreso fear infecting my wife.

Again, I thank you and I won't bother you further.

[H. Hunter Handsfield, M.D.]

Most likely the PCR will be negative.  If it is positive, just don't panic, but follow your provider's advice about how to proceed from there.  In the meantime, mellow out.  There simply is no signficant risk to you or your wife.

[concerned20072007]

The PCR DNA test was negative too.   Only additional thought I have is wondering how much comfort I should take in a negative 17 day PCR DNA test for HIV.   But I know I have probably already worn out my welcome with you given the huge variance between my concern and your belief that I am at risk.   Thank you for your support and this website.

[concerned20072007]

By the way, I meant how much comfort should anyone take in the 17 day negative PCR DNA test for HIV despite the risk level of their exposure.  I know you think I should take total comfort since you don't think I was ever at risk in the first place.