[Question #11417] Massage

Avatar photo
14 months ago
Hi. This is a really wonderful forum. 
I graduated medical school and soon applying for surgery residency hopefully. I have this issues that really doesn’t make me sleep and focus on my career. They haven’t taught us much about hiv and std, that why i came here to std and hiv experts.
- i go to massage parlor every now and then, they do the massage and offer happy endings. 
They gave me a handjob and i fingered them. Now my fingers are not really in good condition, i dont put care on them. They dry, peeled skin, and when i put pressure on my fingers it stings little bit. 
- i had a cut under my nails, there was blood, 30 mins after i went and fingered her so deep inside and my fingers was inside rubbing until she orgasm then i pull out my finger. 
1. Is fingering low or no risk of hiv?
2. Will the virus enter through the cut and infect me. 
3. Im really worried. I dont want couple of deep fingering with cut and bad fingers lead to hiv and affect my future. I tried to think medically how will hiv transmit through fingering but due to stress of my career i started thinking irrationally.
4. Can you please explain to me the risk of fingering and why its not a risk medically. I read that some people got infected this way but how. 
I never did any type of sex with them except digital (finger) penetration without taking my finger out. 
Avatar photo
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum and thanks for your confidence in our services. It's always a pleasure to address the concerns of fellow physicians and other health professionals. I'm sorry to hear of the poor level of your HIV/STD education and training. Both Dr. Hook and I (and many others) have been deeply involved for decades in programs designed to improve such training of health professionals. I wonder where you are:  efforts along these lines have been fairly successful in North America and Western Europe, but it remains a neglected aspect of medical training in many places, probably especially in countries with conservative cultural or religious attitudes.

HIV is virtually never sexually transmitted except by penetrative sex, i.e. penile-vaginal or penile-anal intercourse. While some infected persons have expressed their beliefs that they were infected by oral sex, fingering, hand-genital contact (i.e. masturbation by a partner), in the 40+ years of the worldwide HIV/AIDS epidemic, there have been few if any proved cases of such transmission. Exposure of skin lesions -- recent or healing cuts (e.g. shaving wounds), acne, or dermatitis -- to HIV infected blood or genital fluids in theory could be risky, but here too there have been no proved cases. Such events can be considered zero risk, despite advice to the contrary from some sources, especially nonprofessional online sources. Finally, in regard to your specific events, nobody has ever been known to acquire HIV during a massage, assuming there was no condomless penetrative sex.

Why are such exposures such low risk? I'm guessing you assume that most or all viral infections can be transmitted with very minimal exposure, i.e. that "just one virus" is enough. This is untrue for almost all infections. Rabies maybe an exception; and measles and norovirus indeed can be transmitted by trivial exposures that involve minute quantities of virus. But most viral infections require much more substantial exposure for infection to take hold. (Same for most bacterial infections, by the way.) For HIV, large amounts of virus must contact substantial numbers of immune active cells carrying the CD4 surface protein; and these cells typically are internal and difficult to access. For example, when an HIV infected male (in whom semen contains billions of HIV) ejaculates in the vagina, the risk she will be infected averages roughly once for every 1,000 exposures. This is why more than half the spouses of HIV infected persons remain uninfected, even after months or years of regular intercourse (which probably you also did not know). In other words, for the specific exposures you ask about, the amounts of virus exposure and their contact with CD4+ cells simply are too low to allow transmission.

You don't mention your sexual attractions. If your massage partners are female, it is statistically unlikely any of them have HIV. If male, or if you have sex with men, the risks would be greater, but still only with penetrating sex. I won't go further into sexual safety, but that's where your potential future HIV risks lie -- and not in the kinds of exposures you have described.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes for a successful medical/surgery career.

HHH, MD
---
---
---
---
---
Avatar photo
14 months ago
Thanks for this educational reply, i needed that. 
- The people who expressed their belief that they got it this way are not true, maybe because of shame and guilt. You mean hiv never transmitted by the activities those people say they got it from?
- i spoke with medhelp and poz.com and they said air inactivates the virus but they didn’t anything else, but my question is how air inactivates the virus if my finger were inside and never pulled out for awhile?
- From dozen of deep fingering and some people said they got it this way makes me think i might have got it from too much fingering not once. Have you see or read a proven documented case or even a case of someone got it through just fingering. Most people dont just do fingering and not actual sex, they do it both, so how can you distinguish they got it from either penile sex or fingering?
- is CD4 active cells surface proteins present in the fingers, or present in the cut that i got the flesh underneath the nail from clipping my nails or when you pull the hangnail and tiny bleeding comes out?
- my sexual attraction are females and i had one protected vaginal sex short and the rest was fingering, im avoiding sexual intercourse and i want to do it with someone special. 
-It just with too much of this act that i thought its totally risk free plus the small injury and hangnails and just poorly maintained finger because i usually work extracurricular activites which caused peeled skin and my finger are just sore all the time when i press them made me think irrationally i might have got it.
Avatar photo
14 months ago
I would like to have a third reply with you if you dont mind. Thanks
Avatar photo
H. Hunter Handsfield, MD
14 months ago
I cannot prove that nobody ever became infected by such exposures. But none have ever been scientifically documented. Of course the number of exposures increases the risk compared with one exposure, but that applies to vaginal and anal sex. You probably could have fingering with an HIV infected partner every day for life and never be infected.

Yes, HIV dies promptly when it dries. But that probably is not the main reason such exposures carry little or no risk. Re-read my explanation above.

CD4 cells are not on body surfaces.

"Peeled skin" probably does not increase HIV risk.
---
Avatar photo
14 months ago
Should i be worried doctor? Do i need testing from dozen of fingering with a cut and other minor issues in skin and short protected sex?
Can i resume unprotected sex with my partner without worrying?
You are expert in this and i trust your expertise. 
Avatar photo
14 months ago
Thank you very much doctor for your time. I really appreciate it. I just dont want this to affect my future career. I never thought that fingering deep or mutual masterbuation is a risk but just read that someone got it that way and i got spooked. 
Avatar photo
14 months ago
CDC & WHO dont mention fingering as a risk of hiv so i assume it aint a risk after all. 
Avatar photo
H. Hunter Handsfield, MD
14 months ago
I cannot make these decisions for you. I've given you a reasoned, science based judgment of the risks of the events you describe; the rest if up to you. If somehow I were personally in your situation, I would feel no need for testing and would continue sex with my wife without worry. I agree with the CDC advice, which is clear from my comments above.

Your follow-up comments show you are reacting emotionally and not objectively to these issues. My final advice is that you take advantage of your medical training and think critically. It's your duty for your future patients, and obviously the best way to deal with personal health questions as well. 

That concludes this thread. Best wishes for success in your training and career.
---