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Non-Sexual Exposure to HIV?
Dear Doctor(s):
I am a gay man who recently went on a date with a guy who told me he is HIV+ and undetectable. We kissed, cuddled, and held hands throughout the night. There was no sexual intercourse of any kind. My concern is that my hands are often extremely dry, irritated, and a bit raw. They are often in such bad shape that the skin cracks causing an open cut or wound to appear. On the night of our date my hands had these open cracks. They are pretty deep looking and you can see red and a clearish type color inside the actual wound. They appear mostly around my knuckles, so you might be familiar with what I am trying to describe. Since we were holding hands and cuddling is it possible I was exposed through these open wounds. If he had some sort of cut or something and it got into my open cut would I be infected? How about his sweat getting in there? I've heard some say HIV transmission must take place inside the body, but these are open cuts, so I am guessing I was in a risky situation. I remember his hand did pass over them and I touched his skin, so there was some exposure. Was I at risk? Do I need testing? Thanks, for your help.
I am a gay man who recently went on a date with a guy who told me he is HIV+ and undetectable. We kissed, cuddled, and held hands throughout the night. There was no sexual intercourse of any kind. My concern is that my hands are often extremely dry, irritated, and a bit raw. They are often in such bad shape that the skin cracks causing an open cut or wound to appear. On the night of our date my hands had these open cracks. They are pretty deep looking and you can see red and a clearish type color inside the actual wound. They appear mostly around my knuckles, so you might be familiar with what I am trying to describe. Since we were holding hands and cuddling is it possible I was exposed through these open wounds. If he had some sort of cut or something and it got into my open cut would I be infected? How about his sweat getting in there? I've heard some say HIV transmission must take place inside the body, but these are open cuts, so I am guessing I was in a risky situation. I remember his hand did pass over them and I touched his skin, so there was some exposure. Was I at risk? Do I need testing? Thanks, for your help.
MEDICAL PROFESSIONAL
These are excellent and wise followup questions. In addition to my responses, I would strongly encourage you to go with your new partner the next time he has a follow-up appointment with the doctor or clinic managing his HIV infection. In addition to my comments below, ask these same questions of his doctor or a case manageer or counselor in the clinic -- and follow that advice.
You said he has an undetectable viral load. Can you confirm that he is taking antiretrovirual therapy (ART) to control his HIV infection? If so, then the chance you will ever catch HIV from him is very low, probably sero or close to it -- even if you were tohave unprotected anal sex. (I'm not necessarily recommending that -- just an example of the low risk in general.) It will be important to continue to monitor his viral load and modify his treatment if it rises. Even with major blood exposure -- if he were to have an injury with lots of bleeding and you helped out -- there would be low risk of transmission. And there certianly will be little if any risk through day to day contact, regradless of cuts on your hands or his.
As for MRSA or other skin bacteria, don't worry about it. If he has such an infection, then you will be intimately exposed -- the bacteria will be all over his body (not just on cuts and wounds) and throughout the house. The chance it will harm you is low.
As I suggested, also discuss all this with your partner's doctor or clinic -- you will find their advice similarly reassuring. All things considered, you're going to be at low risk of HIV.
You said he has an undetectable viral load. Can you confirm that he is taking antiretrovirual therapy (ART) to control his HIV infection? If so, then the chance you will ever catch HIV from him is very low, probably sero or close to it -- even if you were tohave unprotected anal sex. (I'm not necessarily recommending that -- just an example of the low risk in general.) It will be important to continue to monitor his viral load and modify his treatment if it rises. Even with major blood exposure -- if he were to have an injury with lots of bleeding and you helped out -- there would be low risk of transmission. And there certianly will be little if any risk through day to day contact, regradless of cuts on your hands or his.
As for MRSA or other skin bacteria, don't worry about it. If he has such an infection, then you will be intimately exposed -- the bacteria will be all over his body (not just on cuts and wounds) and throughout the house. The chance it will harm you is low.
As I suggested, also discuss all this with your partner's doctor or clinic -- you will find their advice similarly reassuring. All things considered, you're going to be at low risk of HIV.
Doctor Handsfield,
I sincerely appreciate your detailed response. It was very helpful in easing my anxiety. If it is possible I'd like to ask a few more questions. We've both decided to move forward in our relationship and I just want to clear a few things up. First, we've made the decisions to not have anal sex yet. Should we decide in the future it will be protected. Are there any other steps I need to take to ensure I remain negative? Casual contact, kissing, unprotected oral (both ways), sleeping in the same bed, showering, etc...I am assuming are all safe? Next, I noticed while we were holding hands the other night that he had a small blister/scab looking wound on his arm. It brushed up against me and felt like a crusty bump. It was deep red in the center with a scabby white outer edge. I asked him about it and he said it was something he gets, like MRSA or Staph. I know MRSA and Staph are spread with skin to skin contact and as I mentioned I have the cracked areas in my hands. Should I be concerned with contracting this type of infection or HIV from this sore? The only preventive measure I took was washing my hands when I got home, but I didn't go crazy cleaning my car or any surface I touched (like steering wheel, cell phone, etc...). I know you're a busy man, so I will not ask anymore questions. Thanks, again.
I sincerely appreciate your detailed response. It was very helpful in easing my anxiety. If it is possible I'd like to ask a few more questions. We've both decided to move forward in our relationship and I just want to clear a few things up. First, we've made the decisions to not have anal sex yet. Should we decide in the future it will be protected. Are there any other steps I need to take to ensure I remain negative? Casual contact, kissing, unprotected oral (both ways), sleeping in the same bed, showering, etc...I am assuming are all safe? Next, I noticed while we were holding hands the other night that he had a small blister/scab looking wound on his arm. It brushed up against me and felt like a crusty bump. It was deep red in the center with a scabby white outer edge. I asked him about it and he said it was something he gets, like MRSA or Staph. I know MRSA and Staph are spread with skin to skin contact and as I mentioned I have the cracked areas in my hands. Should I be concerned with contracting this type of infection or HIV from this sore? The only preventive measure I took was washing my hands when I got home, but I didn't go crazy cleaning my car or any surface I touched (like steering wheel, cell phone, etc...). I know you're a busy man, so I will not ask anymore questions. Thanks, again.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
There are two main reasons you need not be worried. First, people with undectable HIV viral loads do not transmit the virus. Even if you had had unprotected anal sex with this partner, I would advise you not to worry and not even to be tested for HIV.
Second, even if we assume your partner was untruthful about his HIV viral load, or if it had risen since he was last tested -- and even if he had a very high viral load -- there was no risk from the sort of exposure you describe. Nobody has ever been known to be infected by fingering, hand-genital contact, or other body contact without penile penetration. And of course people have such exposures all the time in the presence of cuts and nicks of the fingers -- there must have billions of such exposures to HIV infected people around the world across the decades, yet still no known transmissions of the virus.
In general, experts advise persons at potential risk for HIV (such as non-monogamous gay men) to not get tested after individual exposures unless they are particularly high risk, such as unprotected anal sex with an untreated HIV positive partner. Instead, we advise regular testing from time to time, like once a year. If you have not been tested for HIV in the past year, this might be a good time, since it's on your mind. But for sure not because of this particular exposure.
I hope this has helped ease your mind. Best wishes-- HHH, MD
There are two main reasons you need not be worried. First, people with undectable HIV viral loads do not transmit the virus. Even if you had had unprotected anal sex with this partner, I would advise you not to worry and not even to be tested for HIV.
Second, even if we assume your partner was untruthful about his HIV viral load, or if it had risen since he was last tested -- and even if he had a very high viral load -- there was no risk from the sort of exposure you describe. Nobody has ever been known to be infected by fingering, hand-genital contact, or other body contact without penile penetration. And of course people have such exposures all the time in the presence of cuts and nicks of the fingers -- there must have billions of such exposures to HIV infected people around the world across the decades, yet still no known transmissions of the virus.
In general, experts advise persons at potential risk for HIV (such as non-monogamous gay men) to not get tested after individual exposures unless they are particularly high risk, such as unprotected anal sex with an untreated HIV positive partner. Instead, we advise regular testing from time to time, like once a year. If you have not been tested for HIV in the past year, this might be a good time, since it's on your mind. But for sure not because of this particular exposure.
I hope this has helped ease your mind. Best wishes-- HHH, MD
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