an assessment please

[auskie912]

Hello Doctor,
Could you please assess these two situations in terms of HIV or STD risk? I apologize for the explicit descriptions but I didn't want to miss anything out while getting an assessment from you.
1) While filing papers, my finger was cut by a loosened staple that was a little rusty. The files were years old. Normally I would not care much, but the setting could be of significance. I was working at a children's orthopaedic hospital and I'm afraid the wound could have come into contact with some bodily fluids somehow?
2) I had protected oral, changed condoms and then had protected vaginal sex at a massage parlor. I asked the girl if she had STDs, she said no and she says she's even more worried than me so she is very careful and uses a condom everytime for vaginal sex (don't know about oral). She said the last time she got tested for STDs was two months ago, and business has been pretty bad. I'm pretty paranoid because I have an in-grown hair type thing on my left testicle that has been there for around half a year now and was afraid it could come into contact with vaginal fluids though my doctor said not to worry about it. She also licked it beforehand so it came into contact with her saliva, though I did tell her to stop immediately. Lastly, before she put on the condom for oral, she could have accidentally touched her tongue/mouth on the forehead of my penis by mistake because she was licking my testes and thigh area. Could the condom have 'trapped' that saliva and caused risk during subsequent oral/vaginal intercourse?I had a huge scare from an encounter half a year ago and was tested negative for HIV after 13.5 weeks of the incident, and I don't want to experience that horror again. I thought I'd learn after such a scare, but I couldn't control myself.
3) How long do I have to wait until I'm in the 'clear' if there are no symptoms?

[Edward W Hook, MD]

Your post is laden with anxiety about HIV which is inappropriate, not matter where you work or whom your sex partners are.  You have nothing whatsoever to worry about.  Let's take the situations one by one.

1.  No risk whatsoever.  HIV is not passed by inanimate objects in the workplace other than hollow needles and surgical instruments.  Every day thousands of people working in hospitals, clinics and other health care settings experience paper cuts, scrapes, etc in the work environment and no one has ever gotten HIV than way.  The virus dies quickly outside the body, even if there had been such a contamination.  I repeat no risk whatsoever.

2.  Condoms work and protected intercourse is safe, even if your partner was infected and it is unlikely on a purely statistical basis that she was.  Incidental "trapping" of a tiny bit of her saliva within a condom is not a risk for HIV, again, if she was infected which is unlikely.  You have nothing to worry about and do not need testing for the exposures you describe.

I do worry however that your anxiety is harming you.  Having told me that you had a scare in the past, combined with the two concerns you express today suggest that you are inappropriately concerned about your risk for HIV.  If this statement resonates with you at all, I would suggest talking about it with a mental health professional/counselor (out of concern for you.)  EWH

[Edward W Hook, MD]

This thread has already ended.  There are no more answers forthcoming.  EWH

[auskie912]

Greetings Dr. Hook,

My post nasal drip resolved but it seems to come and go. Since you said it's not a part of ARS I suppose it's irrelevant. However, 16 days after intercourse I noticed a red bump (a little swollen) on my neck that looked and felt like a mosquito or insect bite but it was sort of big for one. It didn't itch unless I touched it, though the next day it itched more but reduced in size, but by the third day it stopped itching altogether and now on the 4th day it's much smaller. There were also other mosquito bites near my neck but much smaller in size. I came across a picture of "HIV rash" on the internet and it had some bump though it didn't quite look the same (seemed to be more raised), it did set me off. In fact, that picture was seen on this site on the bottom on the 'google advertisements' so I did not even intend to search it up. I don't know if others share this view, but I am curious as to why medhelp allows these advertisements and even graphical ones on a forum where people are already anxious. I suppose it's to keep the site running, but what about the 'related tags' on the right with terms like 'ARS symptoms' and 'diarrhea' in bold? I think it may be unsettling when one sees it.

I also noticed a strange mouth lesion today which may simply be episodic, though I'm not sure. It's already receding and nearly gone in a day. Am I overreacting and going on a symptoms frenzy? I apologize for trying your patience again but I'm simply in need of some reassurance and calming. Do these new symptoms change your assessment or is it time to end this thread?

[Edward W Hook, MD]

Your concerns are unfounded.  Post nasal drip is not part of ARS, your symptoms have lasted too long to be ARS and your exposures were close to no risk.  You say nothing about seeing a health care provider for evaluation of your symptoms.  this is what should be done, not worrying that you have HIV.  EWH

[auskie912]

An update: I know you said it's worthless to assess risk by symptoms, but It's been two weeks since the incident and I'm still experiencing post nasal drip and it is really causing worry. It's sometimes in the form of sticky mucus behind my nose that is hard for me to expel. At other times it's easier, but I keep producing mucus. Additionally sometimes it gets better and it's like it almost disappears but then later on appears again.

This seems to be my only symptom for now, is this indicative of anything? Can ARS even present this way at all? I don't recall post nasal drip as a symptom of ARS in the first place but I remember you saying there's overlap with other bacterial infections in some post quite awhile ago. I'm quite worried right now and with this post nasal drip that's lasted for two weeks now it's nerve wracking and I can't even seek mental help.

[Edward W Hook, MD]

My comment was in reaction to your question - "Does getting sick from intercourse increase risks or open opportunities for 'coinfection' with other STDs?".  I really did not understand what you meant but guess taht you were suggesting that sex somehow, in and of itself, could make people sick.  I have trouble thinking of sex as a health hazard.  EWH

[auskie912]

Thanks for your followup. I am just a little confused and slightly alrmed by your statement so a quick clarification if possible?

"Getting sick just from intercousre is not described unless you have caught something"?

Do you mean by 'described' that other STDs may cause one to become sick very shortly after intercourse if one were to catch them? However HIV is not one of these anyway correct?

Thanks this will be my last post on this topic. I appreciate it.

[Edward W Hook, MD]

One last time, these are no risk expsoures, thus my answers will be brief.  

1.  Please look at the numerous other posts on this site stating that "ARS symptoms" are a waste of time to focus on and are virtually meaningless.  I cannot explain your runny nose and other symptoms but I can assure you that they are not ARS.  Getting sick just from intercousre is not described unless you have caught something and you have not caught HIV or an STD.

2.  I agree with your doctor.

3.  Nothing to worry about.

EWH

[auskie912]

First off, I would like to say a word of thanks Dr. Hook, you provide an invaluable service. Your statement resonates with me, however in my present location (Hong Kong) I cannot find a mental health counselor that I can afford (unlike the US where I can seek mental health for free) so I suppose I have to deal with my mental issues on my own for the time being.

However, I'd like an answer to some uncertainties if you may.

1) My large concern: immediately the day after I had some post nasal drip/sticky phlegm, but it went away. Then 2.5 days or so after the incident I am currently experiencing a post nasal drip with sticky phlegm, aside from fatigue earlier. I am afraid it may become a sore throat soon. This is what happened in my previous scare as well so it's bringing back haunting memories. Why do I get sick or post nasal drips after intercourse? Last time I even had a sore throat and runny nose though as well shortly after having a post nasal drip. Is this irrelevant to my risk and ARS? Does getting sick from intercourse increase risks or open opportunities for 'coinfection' with other STDs?

2) Additionally as I mentioned, I have an ingrown hair / folliculitis on my left testicle (according to my doctor) that's been there for around 7 months that could have come into contact with vaginal fluids during intercourse, and I am sure that it came into contact with saliva.  Do you agree with my doctor that it is not a method of transmission?

3) Lastly, do I have to worry about herpes? I heard that it can be spread even by skin to skin contact. She was not having an outbreak as far as I know.

Thank you Dr. Hook for your continued patience and kindness. I understand it can be frustrating responding to such anxiety ridden posts but I would like to have you know how great of a help it is for me and I do appreciate it.

[auskie912]

also i'd like to add that the girl is from china, although this occurred in hong kong. additionally the next day, now, i feel quite fatigued and some post nasal drip. i don't normally feel this tired even after exercising and i'm tired even after taking a nap. last time half a year ago i had a sore throat and runny nose after intercourse. does feeling 'sick' a day after sex or even hours afterwards indicate anything or increase risks of std transmission?