exposure in hot tub?

[danny012]

Hello Dr.
thanks in advance for answering my question about a drunken encounter that i had.

i am male, i met a girl who is in her mid-20s (i dont know her HIV status), we ended up in the hot tub, we did not have any intercourse.  However, please can you help asess my HIV exposure which i cant get out of my mind:

1) i fingered her in the hot tub under water (later when i got home i noticed a small cut on my finger with skin slightly coming off. I dont remember when the cut took place.(before or during the exposure), it was fairly small. however what concerns me if the cut took place right before the exposure, what would the risk be? i also had a precious cut that had a scab over it on the same finger

2) i had my underwear on in the hot tub, but when we were getting close i think i ended up touching her vagina (she had her clothes off) with my erect penis, it did not go inside her though (this was underwater as well). if she was infected with HIV would the transmission be possible this way? or would the water dilute the virus?

3) we got out of the hot tub and i fingered her again with the finger that had a cut on it until she squirted. i have read that while vaginal fluids do not contain large amounts of virus , but cervical secretions do ...would squirt fluids contain hiv and would that be a risk to my cut on the finger.

4) she later gave me a handjob with a hand that she was touching herself, is this a risk?

based on the above situations, do you think i require testing for HIV.
many thanks for your answer

[H. Hunter Handsfield, M.D.]

I'm not going to get into a debate with your doctor, but it is difficult for me to believe he knows of cases transmitted by a cut and neither Dr. Hook nor I nor all our colleagues are unaware.  I stand by my comments and advice above.

p24 is a component of HIV.  Its presence in the blood is a test for the virus itself.

That's all for this thread.

[danny012]

After some anxiety i decided to go test 6 weeks after exposure. After hearing my possible exposure, the doctor said that there is absolutely a risk of HIV transmission via fingering with a cut and that there have been cases of transmission. He rhetorically said, "how do you think people become infected". He did p24 antigen test as well as the normal antibody test. there is definitely a  lot of conflicting information on this and i am honestly confused.

Just curious, how can you guys be so sure that "fingering with a cut" is no
risk....

Also can you please advise what exactly does P24 antigen test measure and when it is most affective?

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.

I don't know where you heard that "dipping" -- brief/superficial penile-vaginal (or penile anal) penetration -- is high risk.  There are no data on it, but surely it is a lot lower risk for HIV than more complete vaginal sex.  And even for that, i.e. typical unpotected sex for several minutes, the average HIV transmission risk, if the female partner has HIV, is once for every 2,000 events.  That's why a) many spouses of HIV infected people remain free of HIV for many years and b) almost all heterosexual HIV infections occur in the regular partners of infected people.  One-off exposures almost never result in HIV transmission.  Why?  HIV is pretty hard to transmit; it takes lots of virus that has to get into a place where there is prolonged contact with susceptible cells.  Superficial and brief exposures don't make the grade.

There are no specific statistics I can site about rates of HIV in the average sexually active women.  1 in 1,000 (tops) is a consensus, but it varies widely.  If you consider minority women in eastern urban inner cities, it might be 1 in 100; in white women in the midwest or west, it would be far less than 1 in 1000.  Even among commercial sex workers, in teh US probably fewer than 1 in 1,000 are infected in most geographic areas.  For more detail, you could explore the CDC website; start with www.cdc.gov/aids then search there for epidemiology and surveillance data.  However, you'll find most of the information concerns overt HIV/AIDS; you'll be hard pressed to find specific data of the sort I just quoted.

[danny012]

thank you doctor for your response.

this indeed is reassuring. could you please explain why a fleeting contact with woman's vagina is considered no risk (i think this is called frottage)  while dipping (or brief insertion of penis head) into vagina is considered a risk. in the end the penis is in touch with the same fluids under both situations, no?

also are there statistics available to see what is the likelyhood of any woman in US is HIV+?

thanks again for your help in clarifying

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Sometimes all the information to accurately answer a question is in the title itself.  Responding to "exposure in a hot tub?", without reading anything else:  If you had unprotected vaginal or anal sex in the hot tub, there might be risk of HIV.  Anything other than that would be no risk.

Now I have read the rest of the question. Like many people anxious about HIV, you make unscientific assumptions about transmission of the virus.  It requires unprotected sex, i.e. a penis without a condom inside another person's vagina, rectum, or (rarely) mouth.  HIV is never transmitted by fingering, kissing, or other non-penetrating contact.  Further, if you are in the US or other industrialized country, it is statistically unlikely your hot tub partner had HIV anyway.  To your specific questions:

1) There was no risk from fingering, whether in the hot tub or anywhere else.

2) HIV is not transmitted by brief, fleeting contact with a woman's vaginal area, even if she has HIV.

3) Cuts on the finger do not significantly increase the risk.

4) HIV cannot be transmitted by hand-genital contact.

Assuming this is your only potential risk for HIV, you definitely do not need testing.  Well, not from a risk standpoint -- but if you remain nervous despite my reassurance, you are of course free to be tested if the negative result will help.  In the meantime, don't worry about it.

Regards--  HHH, MD