Just wanna say first. I’ve been following you guys for a while, and you guys do great work here so thank you. 

So I’m unfortunately forming a habit of m2m hook ups every about 18 months or so. My first one I had pretty bad hiv anxiety even though it was a super low risk, anyway got tested multiple times all came back neg. And I moved on.  

Until yesterday, I couldn’t help myself and met up with someone I met online. I was more cautious this time. He said he was negative for all std/sti’s, and that he had been tested two months ago, and hadn’t hookup since. Idk if I believe him but whatever. So he ended up giving me brief oral, I wore a condom the whole time. But he did get a little past it with salvia so some got on the base of my penis that was unprotected. Then I anally fingered him with lube and my bare fingers pretty vigorously. That’s my main concern. I didn’t notice any blood in my hands. I didn’t have any cuts on the hand I used. But I do have an abrasion from three days ago that has scabbed over on my other hand. It’s probably a little less than a half inch long and a quarter inch wide but not very deep. I didn’t use that hand for anything besides touching myself. My other concern is right when we finished. I went to wash my hands and idk if it’s possible for any hiv to infect that cut from my one hand to the cut on my other and rubbing my hands together over the cut while washing. The soap was like lotion soap so idk how much it did to kill anything. Also we had some body to body contact. But no genital to genital. 

So my questions are- is there any risk at all for hiv or any STDs from this incident? I’m still within the three days should I try to get pep? Is this worth testing in 4-6 weeks?

Thanks again.

You have gone about your occasional same sex adventures with superb safety -- not only avoiding anal sex (the main HIV risk between men) but using condoms for oral sex, and otherwise limited to hand-genital contact, fingering, etc. In addition, you also are discussing HIV status with partners before proceeding, which adds a wide margin of safety. (Although people of course can lie, for the most part they are truthful when asked directly about STI/HIV status.)

There have never been any published reports of HIV infection that occurred in people whose only exposures were fingering or hand genital contact, or of acquisition of the virus through an intact condom. And no reports of infection in anyone whose only possible risk was receiving oral sex (i.e. oral to penile transmission), even without a condom. And I've never come across such a patient myself. Could exposed cuts, abrasions, etc on the hands or fingers make some difference? In theory, yes -- but if you think about it, there must have been millions if not billions of fingering or mutual masturbation events between HIV infected and uninfected partners in the presence of hangnails, healing cuts, etc -- and still no reports of virus transmission in such circumstances. Does all this prove it cannot happen? No, of course not. But it does prove that any risk is microscopically low.

I definitely would not recommend PEP in this circumstance; indeed if you came to my clinic with this story, we would refuse to prescribe it. I don't even think you need testing for HIV or other STDs. That said, we understand that some anxious persons need HIV testing for reassurance; a negative test result often is more reassuring than professional advice, no matter how expert. (We don't take it personally!) If that applies to you, I would advise a lab-based HIV antigen-antibody (AgAb) test (i.e. 4th generation) when 6 weeks have passed. But if you have a regular sex partner, I would advise no need to modify your sexual activities with that person.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thanks doc, you guys are awesome.

RNA testing is expensive and not generally advised in such low risk situations as yours. And although negative results are highly reliable 2 weeks after the last possible exposure, they are not considered quite 100% proof -- so later AgAb testing is still recommended. But you're free to do it if you need the earlier reassurance. At a personal level, if somehow I were in your situation I definitely wouldn't do it. But then I wouldn't be tested for HIV at all.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.