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Risk of HIV exposure
Hello, I am writing concerned about an encounter with a sex worker in Phucket, Thailand which happened 4 days ago. I want to preface by saying that I have HSV-1 genitally, although at the time it was not active. I usually see an outbreak at the base of the penis on the left side but there was nothing going on.
At my hotel we both jumped in the shower and the mutual touching and masturbation stated there. We stopped, showered with lots of soap and got out and then went to the bedroom. I pulled out some Carageenan lubricating jelly and placed some on her hand and mine as well. Then I started fingering her with my right hand as she was masturbating me with her left hand. I kissed and sucked on her breast a little and we exchanged very brief lip kissing almost like a peck a few times. At one point I placed my hand over hers and directed her motion. Not sure which hand I used and if there were vaginal secretions.
When we finished I had a lot of vaginal secretions on my right hand. I washed my hands with soap and we took showers immediately after. I also had some beta-dine with me and applied some on with a cotton ball after the shower but not in copious amounts, just enough to brush over my genital region.
My concerns are:
1. Since I have HSV-1 genitally is there increased risk of contracting HIV even though it was a hand-job and I understand that the risk with this type of activity is very low? I know that people with genital HSV-2 are known to have much higher risk of contracting HIV through sexual contact. I am worried that some of her vaginal secretions unintentionally got on my penis during the masturbation and could have been rubbed into the skin in the area where I usually get HSV-1 sores (again not active at the time but worried about micro-tears, etc. invisible to the eye)
2. At 1-2 weeks after the episode, is there any value in getting an RNA-PCR amplification test?
At my hotel we both jumped in the shower and the mutual touching and masturbation stated there. We stopped, showered with lots of soap and got out and then went to the bedroom. I pulled out some Carageenan lubricating jelly and placed some on her hand and mine as well. Then I started fingering her with my right hand as she was masturbating me with her left hand. I kissed and sucked on her breast a little and we exchanged very brief lip kissing almost like a peck a few times. At one point I placed my hand over hers and directed her motion. Not sure which hand I used and if there were vaginal secretions.
When we finished I had a lot of vaginal secretions on my right hand. I washed my hands with soap and we took showers immediately after. I also had some beta-dine with me and applied some on with a cotton ball after the shower but not in copious amounts, just enough to brush over my genital region.
My concerns are:
1. Since I have HSV-1 genitally is there increased risk of contracting HIV even though it was a hand-job and I understand that the risk with this type of activity is very low? I know that people with genital HSV-2 are known to have much higher risk of contracting HIV through sexual contact. I am worried that some of her vaginal secretions unintentionally got on my penis during the masturbation and could have been rubbed into the skin in the area where I usually get HSV-1 sores (again not active at the time but worried about micro-tears, etc. invisible to the eye)
2. At 1-2 weeks after the episode, is there any value in getting an RNA-PCR amplification test?
MEDICAL PROFESSIONAL
Welcome to the Forum. Unfortunately, you have posted on the wrong site. Questions about HIV belong on the HIV prevention site. I will do my best to answer your questions with this reply but, if you have additional questions or follow-up they must be on the HIV Prevention site. Sorry
First a general comment, then I will answer your specific questions. This was a no risk exposure. All of the activities that you describe were either kissing or masturbation and as such are not associated with risk of HIV, no matter what other modifying circumstances such as your genital herpes or a cut or sore on either of you, might be present. Thus you do not need to be concerned and do not need testing. No, in answer to your specific questions:
1. The available studies indicate that genital herpes due to HSV-2 increases the risk of acquiring HIV through sexual contact to infected partners y about 3-fold. The studies have not evaluated genital HSV-1 or, for that matter HSV-1 at any site. It is likely that some members of the comparison groups in the studies of HSV-2 had HSV-1 but most of them probably had oral infection, not genital HSV-1. Given the biological differences between the two infections which are too complex to go into here, despite the similarity of the viruses, if genital HSV-1 increases risk for HIV acquisition at all, it does so less strongly than HSV-2. As I said above however, in your case, there was no risk from the activities that you describe than therefore no reason for concern.
2. In general we do not recommend HIV PCR testing for diagnosis is HIV infection for several reasons. While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two. In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner. PCR tests are also more expensive than regular antibody tests. Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests. Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR. I would not recommend it for you.
Hope these comments are helpful. Further questions about HIV must be posted on the HIV Prevention Forum. EWH
First a general comment, then I will answer your specific questions. This was a no risk exposure. All of the activities that you describe were either kissing or masturbation and as such are not associated with risk of HIV, no matter what other modifying circumstances such as your genital herpes or a cut or sore on either of you, might be present. Thus you do not need to be concerned and do not need testing. No, in answer to your specific questions:
1. The available studies indicate that genital herpes due to HSV-2 increases the risk of acquiring HIV through sexual contact to infected partners y about 3-fold. The studies have not evaluated genital HSV-1 or, for that matter HSV-1 at any site. It is likely that some members of the comparison groups in the studies of HSV-2 had HSV-1 but most of them probably had oral infection, not genital HSV-1. Given the biological differences between the two infections which are too complex to go into here, despite the similarity of the viruses, if genital HSV-1 increases risk for HIV acquisition at all, it does so less strongly than HSV-2. As I said above however, in your case, there was no risk from the activities that you describe than therefore no reason for concern.
2. In general we do not recommend HIV PCR testing for diagnosis is HIV infection for several reasons. While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two. In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner. PCR tests are also more expensive than regular antibody tests. Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests. Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR. I would not recommend it for you.
Hope these comments are helpful. Further questions about HIV must be posted on the HIV Prevention Forum. EWH
MEDICAL PROFESSIONAL
Still no risk. EWH
Sorry Dr. Hook, but I mentioned that I did NOT become immune due to the Hepatitis B series vaccines as I was just tested 3 weeks ago and was Hbs Ab negative....thus my question about Hepatitis B and contact with vaginal secretions and saliva.
MEDICAL PROFESSIONAL
You do not need testing for hepatitis C which is not transmitted by kissing, nor for hepatitis B both because is is almost never transmittted by kissing and because your vaccination protects you. It is time for you to stop worrying about this and move on with your life. EWH
Dr. Hook, a follow-up to the above scenario which belongs on this forum:
1. Hepatitis B and C are transmitted through vaginal secretions and saliva. Since we engaged in (light) kissing and there very easily could have been exchange of her vaginal fluid on my genitals should I be worried about testing for these? I just recently tested for Hep B and C (blood) and was negative for both even though I had the 3 shot series of the Hep. B vaccine
2. At what period is best to repeat the Hep B and C blood testing to account for incubation periods, etc.
Thank you!
1. Hepatitis B and C are transmitted through vaginal secretions and saliva. Since we engaged in (light) kissing and there very easily could have been exchange of her vaginal fluid on my genitals should I be worried about testing for these? I just recently tested for Hep B and C (blood) and was negative for both even though I had the 3 shot series of the Hep. B vaccine
2. At what period is best to repeat the Hep B and C blood testing to account for incubation periods, etc.
Thank you!
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
