HCV-menstrual blood

Dear Dr., I had an exposure 10 days ago where I started to finger a massage lady in a massage parlour. She had her slip on and I fingered near (or at) her vagina from the side of her slip (did not enter vagina). She stopped me and said that she has her menstruation and has a lot of blood. Probably I got a little of her blood on my fingers. I checked my fingers very thoroughly and could not find any cuts or abrasions. I am vaccinated against HAV and HBV and I understand HIV is not a risk. But I have read that HCV is a lot more transmissable than HIV once blood is involved. I called a hotline here in Germany and he said "the risk is not zero". I am overwhelmed with guilt and anxiety and have the following questions:

1) Is there any chance (even remote) I could have contracted HCV? If yes, could you give me a number?
2) Should I test for HCV?
3) Is menstrual blood even infectious? (Some sites say it is necrotic blood and therefore not infectious)
4) Can I really safely drop this whole thing?

I am really confused because I realized that HCV is so amazingly widespread. So drug use, blood transfusions and health care transmissions cant explain the 1% prevalence.
I once went through the diagnostic window with a HIV scare. I feel I cannot manage that again with a HCV scare. PLease help.

Best,
Pat
PS: Your work is fantastic - thank you so much!

[H. Hunter Handsfield, M.D.]

First, I disagree with your comment that "HCV is so amazingly widespread. So drug use, blood transfusions and health care transmissions cant explain the 1% prevalence."  One percent is pretty low, and in any case that's the national average.  The prevalence is far lower in most of the population.  Most experts agree that those transmission methods can easily account for the overall frequency of HCV.

The potential for sexual transmission of HCV is somewhat controversial, but it is clear that heterosexual transmission is rare if it occurs at all.  And that requires vaginal or anal sex.  (The only proved sexual transmission risk is among men who have sex with men who also participate in potentially traumatic rectal sexual practices, e.g., fisting.)  In theory, other kinds of blood exposures could transmit it, but probably not oral exposure to blood -- only if the blood were injected (which is why most HCV in industrialized countries results from shared injection equipment in injection drug users).

So the direct answer to your questions are:

1) The risks is zero or close to it -- certainly too low to be worrying about it.

2) No, you should not be tested on account of this event.

3) I assume menstrual blood is infectious, but the odds your partner had HCV are low -- and see above about oral exposure.

4) Yes, you can and should "safely drop this thing".

Thanks for the thanks about the forum.  But this is your third question about a non-risk event with respect to STD.  Please educate yourself on the real risks of STD/HIV transmission and try to avoid using the forum a crutch.  Life is full of real risks -- but when it comes to sex, you are overly concerned about trivial ones.

Regards--  HHH, MD

[Pat677]

Dear Dr., I meant to add that I read and understood about the 0 chance to transmit HIV by fingering, regardless of blood, cuts, abrasions.... Is that similar with HCV? My understanding is that a tenfold chance (HCV compared to HIV) of a non-risk event is still zero, right?

Sorry, freaking out...

[H. Hunter Handsfield, M.D.]

Anything multiplied by zero is still zero.

"Sorry, freaking out":  Consider professional counseling.  I doubt you're going to ever get beyond your irrational fears (of STD in general) without professional care.

That will be all for this thread.

[Pat677]

Thx, will consider counseling. Just 1 follow-up: you said "see above about ORAL exposure". I did not have oral, just fingering and am afraid of blood on skin of fingers. Does that reduce risk to true zero?

Promise to not post again.

Best,
Pat

[H. Hunter Handsfield, M.D.]

Sorry, I misunderstood.  Probably even lower risk than for oral exposure.

I know that logical analysis can be difficult when one is emtionally caught up in fear of transmisison.  But still think it through logically.  Although there could be a theoretical risk of tranmission of HCV if there were recent, fresh cuts on the fingers, to my knowledge such transmission has never been documented or suspected.  The regular sex partners of infected people have regular unprotected intercourse for many years (including sex during menstruation) have no higher chance of having HIV than people without such histories.  Given that, what can be the risk from a single exposure like you describe?  Is it "true zero"?  I don't know.  But it's low enough to be considred zero.  And remember that the odds are strong your partner doesn't have HCV anyway.

Definitely no more on this thread.  Please do follow through on your plans to seek professional attention for the apparent psychological issues.