Shared Rolled Up Post-It for Snorting Cocaine

[InsideMyHead]

Hi Doctors,
I know this question has been answered time and time again, but I can’t seem to find any responses past 2009, and so I’m wondering if anything has changed since.

About two months ago I shared a rolled up post-it note with a friend to snort cocaine (3 times in one night using the same post-it). While I do not know his HIV or Hep-C statuses, he is a homosexual male who leads a very promiscuous lifestyle and has admitted making risky decisions in the past. Upon examining the rolled up post-it the following day, I did not notice any blood on it. However, due to the cold weather, I did have a small cut in my nose which may have come into contact with the post-it. In this specific instance, do the risks for contracting HIV or Hep C remain slim? Or does this potential cut in my nose place me at a higher risk than those who have posed a similar question? I never sniff cocaine and am so worried that this one stupid decision has put me at serious risk.

Also, 7 weeks after this event, I had a genital herpes (type 1) outbreak - my first in approximately 2 years. Could this possibly be attributed to ARS? In other words, could a brief dip in one’s immune system during seroconversion trigger a genital herpes outbreak?

If you could please provide me with some insight it would be very much appreciated!

Thank you for your help!

[Edward W Hook, MD]

Your isolated sore throat is not suggestive of the ARS.Please, no more what if questions.  Nothing more to say.  EWH

[InsideMyHead]

Also, the sore throat would have lasted longer than just a couple of days, correct?

[InsideMyHead]

Thanks again Dr. Hook. I really appreciate all of your help!

[Edward W Hook, MD]

Of course. While sore throats are quite common as part of the ARS, nasal stuffiness, runny nose, or congestion are not. I remain confident that when you test, your test will be negative.   EWH

[InsideMyHead]

Hi again Dr. Hook,
I just had one more question which I forgot to mention a few weeks ago. Several days before my herpes outbreak (approx. 6 weeks after possible exposure) I also experienced fatigue, sore throat and a runny nose for about 4-5 days. While I was always under the impression that nasal congestion was not a typical ARS symptom, I am getting conflicting information on the internet that says otherwise. Can you please tell me whether these symptoms are consistent with ARS? I plan to get tested at the 3 month mark, but would really appreciate your reassurance in the meantime!
Thanks again.

[InsideMyHead]

Ok thanks so much for your reassurance Dr. Hook. I will let you know how everything goes.

[Edward W Hook, MD]

There are so few cases of HIV transmitted this way that they are the subject of medical andecdotes call case reports.  Thus there is no denominator to help define the frequency.  

Theoretically hepatitis B or I suppose C could also be transmitted this way but again this does not happen commonly enough to allow me to provide a frequency of the event(s).  EWH

[InsideMyHead]

Thanks so much Dr. Hook, that definitely puts my mind at ease! Can I just ask approximately how many occurrences resulted in infection of HIV? Does the low risk still apply for Hepatitis as well? While I will certainly undergo testing to help clear my conscience, would you have considered it necessary for such an occurrence? Again, thanks for all your help on this, you don't know how much it truly helps!!

[Edward W Hook, MD]

Welcome to the Forum.  I'll be happy to answer your questions.  The answers have not changed but are a bit more nuanced.  There are a VERY small number of cases in which sharing devices to snort cocaine appear to have led to transmission of infection.  Typically in those cases the snorting instruments (paper, dollar bills, etc.) were obviously contaminated by blood from the infected persons.  Thus, in answering your questions, please remember:

1. Despite the fact that your friend has what you characterize as a risky lifestyle, the statistical chances are that he does not have HIV.

2.  Even if he has HIV, the chances of becoming infected in the circumstance you describe are very low and the cut on/in your nose does not change this.

3.  Your recent genital HSV outbreak is not likely to be a manifestation of recent HIV.  Genital herpes is not a described indicator of ARS.

So, what to do.  First, don't worry. Second, if you are concerned and this event is on your mind, then go on an get a test. At this time the results will be highly reliable.  When you get the negative result that I am confident that you will, please understand that you did not get HIV and put this event behind you.  EWH