[Question #10188] Concerns about potential HIV transmission and pep

25 months ago

I recently had an encounter with a Russian female massage therapist. During the encounter, we engaged in brief genitals rubbing while both of us were oiled up and she was on top of me. I am unsure if there was any exchange of bodily fluids during this activity due to the oil presence, but when i touched her she was wet.It's important to note that at the time, I had several cysts and pimples in my pubic hair area. Additionally, I fingered the massage therapist on multiple occasions.Given these circumstances, I am extremely concerned about the risk of HIV transmission. I currently have a bottle of Biktarvy with me, and I'm wondering if I should start taking it immediately as a PEP. It has been approximately 15 hours since the incident occurred. The reason I am particularly concerned is that I am unable to seek medical assistance for HIV-related concerns in the UAE.

Edward W. Hook M.D.

25 months ago

Welcome to our forum and thanks for your questions. I urge you not to start taking post exposure prophylaxis as the encounter you described did not put you at risk for acquisition of HIV, or any other STI. HIV is transmitted only through penetrative sexual contact or injection of infected material deep into tissue. Body to body rubbing, even in the presence of acne, pimples, scrapes, or other sores is not a risk for HIV. If anything, the use of massage oil reduces the risk. Most importantly, you do not know that your therapist had HIV, and it is statistically unlikely that she did.

Similarly, masturbation of a partner in which you get that partners genital secretions on your own hands or fingers does not pose a risk for acquiring any STI, including HIV. As for body to body rubbing this is true, even if there were cuts or scrapes on your fingers. The US CDC and world health organization, as well as virtually all experts classify the sorts of exposures that you described as being no risk events.

I see no reason for concern, and not even a reason for testing related to the encounter you just described. Please don’t worry. EWH.

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25 months ago

Thank you doctor for your prompt reply. I just want to ensure you have a clear understanding. The genital rubbing was naked ( her vagina on my penis) with no penetration. If I understand correctly this is of no concern?

Edward W. Hook M.D.

25 months ago

Correct. With no penetration there is no risk. I realize that it is possible or even likely that some of her genital secretions may have contacted your penis. Still no risk, no medical or scientific reason for testing and no need for PEP. Please don’t worry. EWH ---

24 months ago

Hi Doc,

I am currently experiencing some concerning symptoms, including fatigue, a slight rash, and a constant headache. While I am uncertain whether these symptoms may be related to stress and anxiety, I would like to seek your advice on a potential course of action.

Given my concerns, I have been contemplating getting a HIV RNA PCR test. I understand that the recommended test is a 4th generation at 45 days, but I am finding it difficult to handle such a prolonged period of uncertainty. My question is, would a HIV RNA PCR test taken at the 15-day mark be sufficient to provide some level of reassurance? Or would it be more advisable to wait the full 45 days for a more reliable result?

Additionally, I am curious about the accuracy and sensitivity of the HIV RNA PCR test at the 15-day mark, and whether it would offer a reasonable indication of my HIV status at that time.

Regards,

Edward W. Hook M.D.

24 months ago

Thank you for the additional information. The symptoms that you described are entirely nonspecific and, given the nature of the exposures you described are virtually certainly not due to HIV. They certainly could be a reflection of anxiety on your part as you suggest. You can certainly prove this with an HIV, RNA PCR test at this time. HIVPCR tests taken any time more than 11 to 12 days following an encounter are considered by most authorities to be conclusive. While those same authorities suggest a follow up fourth generation test at 45 days for purposes of confirmation out of an abundance of caution, I have never seen or heard of a person with an HIVPCR test, which was negative more than 11 days following their encounter go on to become positive. Thus at this time a negative HIVPCR test would conclusively prove both that your symptoms are not due to HIV, and that you did not acquire HIV from the encounter you described. EWH ---

24 months ago

Dear Dr. Thank you for help as usual. Just an update, for the past week I have been developing follucitis and red flat rash that goes all over my body ( leg, chest, back, hands, etc..) now I remembered one important observation that the lady I engaged with had a full body rash, when I questioned her about the rash she get nervous and said its because of the oil which I highly doubt. Now based on my exposure, what possible stds/stis I might have caught that I do need to test for if any?

Edward W. Hook M.D.

24 months ago

Final response. My assessment of your situation remains unchanged. You should see a dermatologist. EWH ---