Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD  
London, United Kingdom

Specialties: Infectious Diseases, Contesto Preguntas en Español

Interests: STD, HIV, Infectious Disease, Genitourinary Medicine
60 Harley Street, LONDON W1G 7HA
+44 20 7637 1600
London, United Kingdom
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HIV through fingering a Vagina

Jan 20, 2010 - 65 comments








HIV transmission through fingering - inserting a finger into a vagina seems to cause a lot of anxiety worldwide.

Fingering is a zero risk activity as far as we are aware. There are no reported cases worldwide of people becoming HIV positive after fingering a woman with HIV.

People are generally very concerrned about the presence of tiny cuts on their fingers or around their finger-nails which they fear may pose an extra risk by being so called open wounds. An open wound is a cut which is freshly made and freshly actively bleeding. This does not mean an old healed paper cut for example. It does have to be 1) fresh and 2) open and bleeding. Even in this scenario, there is no evidence that it poses a risk with no reported cases worldwide.

The vastly most common routes for transfer of HIV are by unprotected vaginal or anal sex and then by sharing needles for injecting drugs and mother to child transmission during birth or breast feeding.

HIV transmission by fingering is not a risk.

However, it would be polite and very much more comfortable for the person to be fingered (the "fingeree") if the fingerer cut his or her nails and also used some lubricating fluid to make the entire excericse enjoyable for all concerned and less likely to injure the fingeree.

Remember that if you think you might have exposed yourself to HIV then the best approach is to test as soon as you are able. We know that testing and identifying new HIV positive people is very important in terms of their own health but also in reducing the chances of HIV spread to others. The biggest risk of HIV infection is through having unprotected sex with someone who has just become HIV positive.

If you do think you have been exposed then you should obtain medical advice regarding the use of Post Exposure Prophylaxis to reduce your chances of acquiring the infection. The earlier you do this the better.

Posted by Freedomhealth

HPV vaccinations: Cervarix and Gardasil

Jan 20, 2010 - 0 comments








Doubts have been raised over the safety of the Cervarix vaccine this week, following the tragic death of 14-year-old Natalie Morton after being given the jab at her Coventry school.
About 1.4 million Cervarix vaccines have been given to schoolgirls aged 12 and over as part of the Governments’ national campaign to combat cervical cancer. Coupled with screening for over-25’s, potentially 700 lives a year could be saved.
Cervical cancer is the second most common cancer in women under thirty five, resulting in 3,000 cases a year, and causing the death of 21 females each week in the UK or around 1000 per year. Seventy percent of these can be prevented by using one of the HPV vaccines available. Ninety nine percent of all cervical cancers are caused by HPV, or human papillomavirus, a family of viruses that affect the skin and moist membranes lining the body.
What is HPV?
Sometimes called the ‘wart virus’ or ‘genital wart virus’, HPV is passed by sexual contact with someone who has it. It’s very common and over half of all women who have sex will get infected with HPV at some time in their life.
HPV infects the cells of the surface of the cervix where it can stay for many years without any symptoms. The HPV virus can damage these cells leading to changes in their appearance, and over time, these changes can develop into cervical cancer.
There are over a hundred types of the HPV virus, but only thirteen of them are known to cause cancer. Often the virus causes no harm, and goes away without treatment.
How the vaccine works :
The HPV vaccine protects against the two strains of HPV (16 and 18) that cause cervical cancer in over 70% of women. Cervarix protects against types 16 and 18 and the rival vaccine Gardasil protects against types 16 and 18 and also the benign types 6 and 11. It does not protect against any other sexually transmitted infections or against pregnancy.
How safe is the vaccine?
Both major anti-cervical cancer vaccines, Cervarix and Gardasil, have undergone rigorous safety testing as part of the licensing process required in the UK and other European countries (PATRICIA and FUTURE II research). www.cancerhelp.org.uk
Possible side effects :
The side effects are usually mild and include :
• Headache
• Aching muscles
• Redness and soreness around the site of the injection
• Fever
• Feeling and being sick
• Stomach pain
• Diarrhoea
• Itching, rash
• Dizziness
The Medical and Healthcare Products Regulatory Agency (or MHRA) monitors vaccine safety via the Yellow Card Scheme which encourages the reporting of suspected side effects. You can report adverse reactions online or by post.

A small number of people experience an idiosyncratic or unpredictable reaction, similar to an anaphylactic shock. Extreme allergic reactions are a rare but recognised side effects of most vaccines, and symptoms include difficulty breathing and collapse.
When side effects do occur, the health professional giving the vaccine will have been fully trained in how to effectively deal with it. If you or your child has an anaphylactic reaction, following treatment, they will usually fully recover within a few hours.

Posted by Freedomhealth

Ultra-fast, ultra-early HIV-1, HIV-2, Hepatitis C RNA test/testing London from 7 days post exposure with added Hepatitis B DNA and Syphilis IgG/IgM

Jan 20, 2010 - 4 comments

7 day HIV tes


Hepatitis B virus DNA








early hiv


Hepatitis C RNA test







Ultra-fast, accurate identification of HIV 1 (Group M and Group O) RNA, HIV 2 RNA,
Hepatitis C Virus RNA and Hepatitis B Virus DNA in human plasma from as early as 7
days post exposure.

Preliminary diagnosis of very early HIV and Hepatitis C disease is now possible at
7 days post possible exposure. This time frame was previously unavailable but utilisation of standard routine technology in a novel diagnostic style will facilitate very early diagnosis.

The technique utilises a fully automated system made by Roche and the testing method
uses polymerase chain reaction (PCR) or NAT (Nucleic Acid Amplification) to
detect miniscule amounts of viral (and the technique can be applied to bacteria) genetic material.

The technique was invented in the early 1980's by a Dr Kary Mullis, who later won the Nobel Prize for the invetion of such an elegant molecular biological technique.
Initially, the test was cumbersome and required intensive well-trained technicians to run it.

In addition, the cost of running the test, partly because of the numbers of people involved was high.

Automation via the Roche Taq Multiplex device has enabled highly sensitive, highly specific,fully automated testing to be run on human blood with the detection of HIV-1and HIV-2 possible from 6 or 7 days post exposure; detection of Hepatitis C from 6 or 7 days post exposure and Hepatitis B virus from 20 days post exposure.

The technique has had most application so far in terms of screening the human blood supply from blood donors and has reduced the numbers of inadvertent contamination with HIV and Hepatitis C virus very considerably. The technique is also employed in organ donation settings where organs to be donated are screened for the HIV-1, HIV-2,Hepatitis C and Hepatitis B viruses.

Thinking laterally and working with The Doctors Laboratory ( a major global referral laboratory in London and CPA, UKNEQUAS, WEQAS, ISFG and EMON approved for quality, robustness and high standards), we have collaborated to apply the blood and tissue screening, ultra-high sensitive technique to beginning the diagnostic process for the
diseases identified.

The process works as follows. We take a measured amount of blood sufficient to run the three NAT tests for HIV-1 and HIV-2; Hepatitis C virus and Hepatitis B virus. We can also include syphilis IgG and IgM within that screen. The test is performed using the Roche platform and runs on the "sample in, results ou" technique
which reduces chances of contamination of product etc to zero. Should a positive sample be produced the whole specimen is drilled down to identify the virus producing the positive result and further confirmatory tests are performed.

The outcome is a highly sensitive, highly accurate detection methodology for detection of the identifed viruses. The turnaround time is swift, taking a maximum of 4 days.

This has great potential in terms of early identification of newly infected HIV positive patients and also to allow those who think they may have been infected to relax and enjoy considerable peace of mind.

The identification of patients newly infected with HIV is important because it presents several interventional opportunities.It allows for very early identification of newly infected HIV positive people which provides
the opportunity to anticpate and if necessary terminate by the use of anti-retroviral drugs the seroconversion illness; to mitigate the chances of that infection being transmitted unknowingly onwards to another individual; possibly
to alter the course of the HIV illness by allowing a very early intervention to limit immune system damage should early intervention at the very early stage be proved to be beneficial.

In the FDA Workshop on Implementation of Nucleic Acid Testing as long ago as 1999, a Dr Busch identified the well-known phrase, the "window period" as being of critical importance in identifying and targetingin terms of NAAT.

The window period for HIV 1 and Hepatitis C virus has to date depended very largely on the sensitivity of the HIV 1 and Hepatitis C antibody detection devices.

This was improved on for HIV by the introduction of parallel screening with HIV 1 p24antigen which reduces the HIV 1 detection interval by a week or so. In symptomatic individuals the combination of HIV 1 and HIV 1p24 antigen has successfully identified HIV positive individuals at 12 days post infection. Co-infection with
Hepatitis C and HIV has presented a diagnostic conundrum with occasional delayed sero-conversion - a group referred to as "immuno-silent".

Studies on blood taken sequentially and regularly from people in the evolving phases of HIV and Hepatitis C diseases have given valuable information on the window period and which markers appear at what stage. Dr Busch coined the phrase "the eclipse period" which I think is a very elegant way of describing the time between physical transfer of infection to a person and the time when current testing methodologies can identify the illnesses.

Almost invariably when a person has been exposed to
HIV then by the time they have symptoms they are already in a "viraemic" phase where there is lots of virus detected.

With lots of virus comes lots of core viral proteins-referred to as p24 antigen
and so the combined HIV-1 and HIV-1 P24 antigen test is virtually always positive in the symptomatic patient.

So coming back to Dr Busch and his "eclipse phase", this is the time period we are interested in detecting and the blood and organ donation services across Europe and the USA have utilised highly sensitive NAT techniques to identify early infection to halt contamination of the transfusion blood supply and transplanted organs.

Use of Nucleic acid Amplification Testing or PCR will reduce the window period, currently contained in the "eclipse phase" as described above, and allow early identification of newly infected HIV positive and Hepatitis C positive individuals at 7 days post infection. Similarly, early identification of hepatitis B will be possible with reduction of the window period for this illness to 20 days.
Labels: 7 day HIV test, Hepatitis B virus DNA, Hepatitis C RNA test from 7 days, HIV PCR test, Nucleic Acid Amplification technique, polymerase chain reaction, ultra-fast HIV 1 and 2 RNA testing London

Posted by Freedomhealth