[Question #2498] Eye exposure?

96 months ago

Doctor,

Thanks in advance for fielding my question, as I’m quite concerned and your advice would be very helpful.

Before I provide my question, I would like to provide you with some context so that you may most comprehensively evaluate my situation. I am in my mid 30s. I’m healthy, in a monogamous heterosexual relationship, and have no medical conditions other than HSV1 (I get coldsores on my lips a few times a year). Almost ten years ago I received a diagnosis of an anxiety disorder, with a history of contamination fears, for which I still see a psychologist. My anxious symptoms have largely faded from my life, though in times of stress they do tend to flare up. I am experiencing some work related stress right now and this is making it hard for me to determine if I’ve had an exposure of if this is my anxiety.

I am traveling for work and today I was at an outdoor weight lifting area near my hotel. I was laying down on a bench press. As I finished my set, a man walked by my bench and spit. I felt some of the spit droplets hit my face. I was initially just annoyed but when I got up from the bench I saw that this man had somehow hurt his lip and it was injured with some blood. I asked him what happened and he said he hit his lip with a pull down bar. This triggered my anxiety. I wondered what if some of the droplets I felt were blood and they got into my eye. I did feel droplets near or on my eye but I don’t know if any droplets actually got into my eye. Does this constitute an exposure if this man had HIV or other blood borne illnesses?

96 months ago

Doctor,

I realized I wasn't clear: my concern is that the blood from his lip got into his spit which then may have got into my face when he spit near me. Sorry about the lack of precision in my question.

H. Hunter Handsfield, MD

96 months ago

Welcome to the forum. Thanks for your question.

In reply, I'm going to ask you to think objectively with the intellect you obviously have. (You write in an articular fashion that implies intelligence.) All humans participating in normal activities of daily life probably come into contact with other persons' saliva or other body secretions, sometimes with blood, on a regular basis. We don't notice most of them. What about the cashier who just scratched a bleeding bite or cut just before making change for you? The person in a crowd who coughed, spraying your face and eyes with saliva, that you didn't notice? And so on. This particular event, that you happened to notice, carried no more risk than those. I cannot say there was zero risk you could have acquired HIV or some other blood borne infection. However, there are no known cases in which this has happened. I will add that saliva rarely transmits any blood borne infections. For example, oral sex is risk free for the genital partner: no risk for oral to genital transmission of HIV. (Saliva kills HIV and is rarely if ever a source of infection.) Could saliva be contaminated with blood, given this fellow's recent lip injury? Sure. But so what? If nobody has ever been known to be infected by such events, you are not likely to be the first! On top of that, you don't even know that any droplets in fact contacted your eyes.

Bottom line: I see no reason for worry. You should not seek testing for any infection and should go forward with no worry.

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

HHH, MD

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96 months ago

Dr. Handsfield,

Thank you for your quick, thorough, and sincere reply. Since reading your response, I've felt no concern over the incident. I appreciated you pointing out something that I've long ago discussed with my psychologist: intolerance of uncertainty. I understand that certainty is not something typically provided by science.

Unfortunately, what occurred while I was at the fitness area did appear to trigger a set of anxious responses. As you may guess, I'm aware that I'm experiencing an episode of more significant anxiety and I'll be home soon to re-connect with my psychologist. In the duration, I'd like to get your knowledge about the following situation:

The anxiety I am experiencing now is rooted in me having seen a discarded syringe near a curb near my hotel. When I noticed this syringe I was walking near it and wearing flip-flops and worried I may have inadvertently been scraped or poked by this needle. It was very reassuring for me to read that even in a hospital, a needle stick is not an efficient means of infection. The statistics I saw stated that the risk of being infected with HIV is one in three-hundred per instance of exposure to an HIV infected needle. Unsurprisingly, my mind analyzed this and eventually wondered if the same sort of statistical number is likely the case for HIV2. I recognize that it is unlikely that similar studies have been done on HIV2 needle sticks, so data may be lacking. So what I'm asking you is whether or not you believe there would be a physiological, biological or chemical reason that a needle stick with a HIV2 needle would be more of a risk than a needle stick with a HIV1 needle. Is a HIV2 needle stick likely the same risk level (one in three-hundred chance per exposure) as a HIV1 needle stick.

Thanks again

H. Hunter Handsfield, MD

96 months ago

Once again, a little objective analysis should tell you how irrational this concern is. The quoted risk of 1 in 300 for needlestick is for health care personnel who get stuck in the process of using needles on HIV infected patients and doesn't apply to accidental injuries from discarded needles. There has never been a reported case of HIV by injury with a discarded drug injection needle; it's one of those theoretical risks with little basis in reality. Medical injury data are only for HIV1 because HIV2 infected persons rarely exist in the settings where such analyses have been done. But there is no reason to suppose HIV2 would be any different.

It is really pointless to keep speculating on risks associated with outandishly unlikely scenarios. Let's make this one the last.

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96 months ago

I'm now at a week long retreat with some friends and some other people. I had some drinks last night. I don't recall using someone else's toothbrush before bed but I may have. I doubt I would ever use a toothbrush that someone just used and handed to me but I suppose its possible. I know there is no hard data on this, but if I had used someone's toothbrush and if they were HIV positive, would my risk be small enough that you would not recommend testing? Will I put my girlfriend at risk when we have sex when I arrive home from my retreat? Thanks for all your help and support.

H. Hunter Handsfield, MD

96 months ago

Nobody has ever been reported to have acquried HIV through shared toothbrushes, even though that is always listed as a potential risk. But it's theoretical only and I certainly would not recommend testing in these circumstances or any change in your sexual practices with your partner.

You understand that irrational fear of infection or contamination is a significant mental health issue, and I'm sure you also understand that questions like these are a reflection of that problem, not actual medical risk. I'll just conclude this thread by pointing out that in the earliest days of the recognized HIV/AIDS epidemic, public health officials accurately advised the public that there is no risk from exposures other than sex or overt blood exchange, based on the fact that nobody had observed affected persons without such exposures. That remains true: the busiest HIV/AIDS clinics have essentially no patients without the standard risk factors, which all by itself is strong evidence against transmission through saliva, toothbrushes, or other non-intimate contact with infected persons. As long as you do not have unprotected sex or share drug injection equipment with HIV infected persons, you will never catch it yourself. You can safely ignore any and all other potential exposures that may come to mind as a result of your underlying mental health condition. Finally, I endorse your intent to see a psychologist.

That completes the two follow-up comments and replies included with each question and co concludes this thread. I hope the discussion has been helpful.

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