Transmission through pre-cum to cut on hand

[newyorker5]

Hello, doctors.  I've searched other threads here and elsewhere, and have not been able to find anything comparable to my circumstances.  I am a gay man in my 30s, and have practiced safe sex my entire adult life, have been in a monogamous relationship for over 10 yrs, and have generally prided myself in making responsible decisions to avoid HIV infection.  Unfortunately, a recent situation I found myself in has me extremely anxious, and I'm hoping you can help me determine my risk of infection.    About 2 weeks ago (December 20), I was getting a massage at a reputable, up-scale massage parlor here in NYC; one thing led to another and the masseur ended up giving me a "happy ending" to the massage that entailed my holding his penis.  The thing that worries me is, he was erect and had a lot of pre-*** on his penis -- and what's worse, I realized much later that I had a tiny cut on one finger of the hand I'd used to touch his penis, and there's no doubt there was contact.  I've had this situation going over and over again in my head, and aside from the guilt of essentially cheating on my boyfriend, I'm really scared that I might have become infected.  10 days after the incident, I developed the flu (still have it), which includes the fever, night sweats, body aches, and sore throat, plus the standard sinus and chest congestion and copious amounts of mucous, even though I received my flu shot a couple months ago.  So my questions for you are: (1) what is the probability of transmission in this instance, (2) what would the likelihood be that I would get this combination of flu symptoms 10 days later, esp since I got the flu shot, and (3) how long should I wait before getting tested with 100% reliability?  Just to reduce the anxiety I'm experiencing, I've comtemplated contacting the masseur to ask him whether he's infected, but realize this would be a little ludicrous.  In any case, any information you can provide would be greatly appreciated. Many thanks.

[H. Hunter Handsfield, M.D.]

Hand-genital contact doesn't transmit HIV, period.  You must have seen comments along these lines if you have read the forum as thoroughly as you imply.  In theory, a cut on the hand might hake a difference, but even then it isn't a measurable risk.  If you think about it, innumerable people have small skin defects on the hands--minor nicks and cuts, etc--and yet hand-genital infection never transmits HIV.  You were not at risk at all from the events you describe.

The forum has also pointed out that symptoms never reliably indicate new HIV infections.  You caught a cold, nothing more.  Your symptoms really don't sound like ARS anyway.  I suppose it could have been influenza, but any number of viruses could be responsible.  The flu shot is irrelevant:  even for influenza itself, it takes more than 10 days for maximum protection to develop, and even then the flu vaccines are only 70% effective anyway.

To the direct questions:

1) Zero for all practical purposes.

2) The chance you caught a respiratory virus is infinitely greater than the chance your symptoms were due to HIV.  Just think about it.  Say 12 million people get a new respiratory virus like yours every year.  That's a million a month, or 333,000 every 10 days.  Among those 333,000 persons, every single one participated in all life's routine activities in the preceding 10 days, and tens of thousands had sex with new partners.  And that's unprotected vaginal or anal sex.  I haven't a clue whether these particular numbers are accurate, but you get the idea.  The "coincidence" of a respiratory virus 10 days after your massage parlor events is higher by far than the chance your symptoms are due to HIV.

3) I don't recommend HIV testing at all after such an exposure.  But if you are like most questioners on this forum, my reassurance will not be sufficient and you'll need a negative test result for psycological reassurance.  If so, get tested 6-8 weeks after the event.

In the meantime, truly don't worry about it.  There really wasn't any risk to speak of.

Happy new year--  HHH, MD

[newyorker5]

Hi Doctor, and thanks so much for the speedy and very helpful reply.  In fact, yes, after combing various threads I had seen similar scenarios addressed -- but none of these exactly matched the confluence of circumstances (i.e., clear fluid-cut contact in gay establishment, flu symptoms despite flu shot, etc.) to make me feel better.  When you're mind is racing in this way, only a direct answer to your own specific circumstances will do.  In this regard, thanks very much for your reply, and a happy New Year to you too.