STDs Expert Forum
HIV/HepB risk
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HIV/HepB risk

Dr. Hook and Dr. Hansfield:
Thank you for work on this site.  Your previous posts are really helpful.
Three weeks ago, I visited a massage place with an Asian woman was not born in the U.S.
The masseuse put a condom on her tongue and licked my anus.  She then took the same condom and put it on her finger and inserted it into my anus while she performed oral sex (protected with a condom).  

I’m now terrified that some of the masseuse’s saliva came in contact with or was inserted into my anus and that I could have picked up Hepatitis B or HIV and terrified that I could pass it on to my wife.

So a couple of questions assuming that the masseuse’s saliva came into contact with my anus: 1) Do you think my actions put me at a realistic risk (not the “might get hit by a meteor risk” that Dr. Hook has mentioned in his posts) for HIV and, if you were me, would you get tested?
2) Do I have a realistic risk for Hepatitis B and, if you were me, would you get tested?
3) Is it worse if the masseuse inserted the side of the condom that touched her tongue rather than just got her saliva in me (because I don’t know what she did)?
4) If you were me, would you refrain from sex with your wife until you were tested for fear of spreading a disease?
5) If I need to get tested, what is the minimum amount of time that has to pass for the test to find something.  

I’m currently feeling some symptoms like stomach ache and fatigue, but I know that it could be from catching something else or just from the anxiety I’m experiencing.
I’ve read many of your posts and feel like I'm not really at risk, but need to hear from you on my specific situation.

However I’ve also seen estimates where 1 in 10 Asian-American’s are infected with Chronic Hepatitis B and that Hepatitis B is 50-100 more times infectious than HIV and that HBV is present in saliva.  I’ve also seen Dr. Hook’s post that unprotected oral sex spreads HIV 1-in 10,000 instances.  Based on those numbers, I’m calculating that my risk, if in fact saliva got in my anus is roughly 1-in-1000 to 1-in-2000 that I got HBV from this incident.  
6) Does 1-in-1000 to 1-in-2000 odds sound right to you?
7) Directly after the incident I found info and convinced myself that I was not at risk and within six days of the incident had sex with my wife.   If I had HIV or HBV, would I be infectious within 6 days of the exposure.  This has me panicked.
8) If I was infected is there any chance I could pass it to my kids.  

I’ve never done anything this stupid and selfish before and I hate myself and just want to make sure I don’t hurt or destroy my family (something I should have thought about before).
Thanks in advance for your thoughts.
Tags: HIV HepB
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Welcome to the Forum.  I understand that you are concerned over this possible exposure and that you worry for your family but the fact is that neither you nor your family are at any risk for infection. There are NO cases in which hepatitis B has been transmitted from person to person through transfer of saliva in oral0genital contact.  Oral transmission of hepatitis B is not even mentioned in medical textbooks. I urge you no to worry.  

1) Do you think my actions put me at a realistic risk (not the “might get hit by a meteor risk” that Dr. Hook has mentioned in his posts) for HIV and, if you were me, would you get tested?
I would not worry and see no medical reason for concern.

2) Do I have a realistic risk for Hepatitis B and, if you were me, would you get tested?
Same answer- I see no meaningful risk and would not get tested.

3) Is it worse if the masseuse inserted the side of the condom that touched her tongue rather than just got her saliva in me (because I don’t know what she did)?
No, still no risk.

4) If you were me, would you refrain from sex with your wife until you were tested for fear of spreading a disease?
No, I would not let this event lead me to abstain from sex.

5) If I need to get tested, what is the minimum amount of time that has to pass for the test to find something.  
All persons who acquired HIV, if this were a realistic possibility (which I do not consider to be the case) would have a positive antibody test by 8 weeks following exposure. For hepatitis B, the CDC states that 3 months is the proper interval for testing.  I suspect the CDC's estimate is quite conservative but, unlike the case for HIV, do not have data to refute their estimate.

6) Does 1-in-1000 to 1-in-2000 odds sound right to you?
I think this estimate is far too high.

7) Directly after the incident I found info and convinced myself that I was not at risk and within six days of the incident had sex with my wife.   If I had HIV or HBV, would I be infectious within 6 days of the exposure.  This has me panicked.
Most unlikely, this is one of those "what if" questions that is a bit over the top.  Please do not worry.

8) If I was infected is there any chance I could pass it to my kids.  
No, not in the context of normal activities, including kissing, hugging, sharing eating utensils, etc.

Please do not worry- this was not a risky encounter. EWH


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Dr. Hook:
Thank you so much for your prompt reply.  I cannot express how much it means to me.  You and Dr. Handsfield are providing an amazing service by making your expertise so accessible in this forum.  By the way, I tried to click yes to the "Was this answer helpful" box but my big fingers hit more of the no and now I cannot change it.  Just wanted to be clear that this was incredibly helpful.  Thanks again.
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I'm pleased my comments were helpful. Take care.  EWH
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Dr. Hook:

I'm sorry to trouble you again with this, but I'm back to being panicked.  I have been sick with something over the last few days that comes and goes, makes me occasionally fatigued, and with some occasional respiratory symptoms, but no full on head or chest cold like symptoms. I think I feel something on my right side ribs as well, but I also touch there and can feel sensative spots outside my ribs in the muscle so I think it is that (and i know i am probably looking for pain there due to my paranoia).  I have not had a fever, my stool and urine are normal color.  My wife has also had the respiratory symptoms that come and go and tonight she is feeling a bit funny in her digestive track.  Reading your sight has been extremely reassuring that I am not at risk, but these symptoms have me very scared for her.  I know you have better things to do, but a word from you that I am being paranoid would be helpful.  Does it sound like I just have a cold or something?  I am so scared I have hep b and have infected my wife that I am ready to cry.
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It's been 8 weeks since my incident.  I've had sex with my wife about 4 times.  Is it possible that I'm infected but that she is not even after sex a couple of times?
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I have nothing more to say. You continue worry about a no risk encounter.  EWH
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Thanks for you response the other day.  It helped to calm some frayed nerves.  However, since I have had prolonged flu like symptoms for a few weeks including an unusual fatigue I have not had before with the flu, I did go and get tested just to have that piece of mind you always refer to (to insure I was not the first person to get hep b this way and be unlucky enough to get it despite odds similar to being struck by meteorite).  The test was about 8 and a half weeks after my incident and the results came back negative for hep b, just as you would have expected.

I have one last question, If you will allow me, but since I did the test at eight weeks instead of the prescribed three months, I am wondering the following, there is no way that, on the hypothetical scenario that I had been infected that I would have enough virus in my blood to have symptoms but stil have it be undetectable in a blood test, right?  

I know this is a ridiculous hypothetical question, and I know you have on two occasions told me I am worrying needlessly.  It's just that I'm actually sick with something that gives me flu like symptoms that I have had for longer than I normally get the flu and it is making it hard for me to put this to bed.

Anyway, I should fully trust my negative test and know my symptoms are from something else, right?

Thanks for your patience with me on his.  Your responses and reading your previous posts have been more help than I can even express.

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Please trust your test results.  The situation your are hypothesizing is simply not realistic.  If you cannot move forward from your no risk exposure, I would urge you to work through this with a counselor.  To still be worrying at this time is unjustified and working through this with a professional is appropriate.  EWH
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Dr. Hook:

Thanks again for your patience with me. I will put the hep b behind me as I take your comment above to indicate that my test at eight weeks would be adequate time and if I was experiencing symptoms, the virus would certainly be detectable.  

Is there anything else in your mind related to my incident that could be causing me sore throat head pressure, and fatigue.  I have had this for like two weeks which is longer than I have ever had a cold or flu.  Have you seen anxiety cause this before.  I figured if it was anxiety it would have stopped after my test results, but it hasn't.  I just feel bad for longer than I have before and it's why I continue to be concerned.  

Hope you have a great New Years and thanks again for all you do.  I promise to leave you alone now and truly sorry to keep bothering you.
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Last answer.  

Your sore throat is not related to the events you describe above.  As to what it might be, I cannot say.  You should discuss it with your own doctor if it really concerns you.  I suspect it will go away with time.

Further questions will be deleted without comment.  EWH
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