Please let me know my risk..

[ihopeso]

I just called in a CSW in Korea. The oral and vaginal sex were successfully protected by condom. However:

1) We started with a French kissing for 2-3 minutes. I don't think her mouth is bleeding, but as the weather is pretty dry, there seems to be some small ruptures on my lips (no visual blood, but I can taste some blood when I try to suck myself);

2) After the sex, I faced down to let her do a massage for me. She sit on top of my butt without wearing anything. I could feel fluid; it might be her vaginal fluid or just perspiration. To plan for the worst, I assume it is her vaginal fluid leaking on my butt and probably running into my anus. I had some haemorrhoids that are not yet fully recovered.

Dear doctor, do you think I have any risk? To plan for the worst, I assume the CSW is HIV infected though the possibility is 1%, but it's still not 0%. Do you think my risk is ZERO, or very low (but NOT zero). Do I need any testing?

Thank you!

[Edward W Hook, MD]

There are several different levels of evidence that can be used as the basis for scientific knowledge.  The best possible data come from carefully conducted scientific studies randomized controlled clinical trials with large numbers of human volunteers as participants.  These studies are challenging and expensive to do.  Further, for rare events they are logistically difficult to do.  Thus, when these sorts of studies cannot be done we have to use the information obtained from observations.  Such observations have proven to be quite valuable for describing what does and does not happen.  Further when unusual events do occur,health care providers tend to be quite good about sharing their observations in the medical literature.  

If that is not sufficiently comforting enough for you, there is not too much I can do to help.  You can certainly go on to test if you wish.  Lots of persons have done so and none have come to light as infected.  You could be the first but if we were betting, I'd bet a lot that your tests would be negative.

It's up to you.  EWH

[ihopeso]

Thank you for your comment, Doctor.

How medically scientific is the "experience"? There are no instances but do you think it is possibly due to that all the people who were infected by secretions were also contacted by other ways (i.e. vaginal sex or anal sex)?

I'm just not that reassured when you used the word "experience" and "probably"... Can you just speak a bit more? Thanks!  

[Edward W Hook, MD]

The proof of this is in the experience- despite millions of instnaces in which person's skin has come into contact with infected secretions there ar NO instnaces in which it is known to lead to infection.  The more important question is why might this be the case. The reason is that with penetration there is repeated micro-abrsion which works the infected material into tissue. In contract surface contamination does not lead to infection, possibly because the virus is not worked into tissue as well as becasue the virus dies so quickly on exposure to the environment.  EWH

[ihopeso]

Thank you very much, Doctor Edward W Hook. Can you please further explain to me why "without penetration there is no risk from this either"? Why is penetration essential to cause the risk? I thought if her vaginal secretions containing HIV contacted my cracked skin, the risk would exist, though very minimal. So why is the risk ZERO here?

Please let me know for reassurance. Thank you again!

[Edward W Hook, MD]

Welcome to our Forum. I'll be pleased to comment.  As you have concluded, this was a no risk encounter.  Condom protected sex is safe sex and there is no risk for HIV with French kissing, even if you had cracked lips.  Further, even if there were vaginal secretions which dripped into can contacted your hemmorrhoids, without penetration there is no risk from this either.

I would not worry at all about this exposure.  There is no need for concern and no medical reason for testing.  EWH

[ihopeso]

I looked through previous posts and learned that the 1) case is not possible, but my 2) case is so rare that I haven't seen anyone post similar situations..