Dr. Hook,

This is hopefully a quick follow-up to a question I had a couple of months back (#2651, which in turn was addressing your advice in #1104). Just to recap briefly, I was living with my parents and my foreign girlfriend for 2-3 months, who like that poster in #1104 I am worried she may have HIV or Hep or some other STD, and passed onto my family through shared razors. I am no longer with my girlfriend so cannot have her tested. None of us have ever been vaccinated against Hep B.

You very kindly provided re-assurance that the risk to my family (parents) would be <1% overall over a 2-3 month period, from HIV/Hep B/Hep C/syphillis or in fact any other STD. This is from sharing razors/toothbrushes, towels, bedding etc.

The reason I am asking this is one factor I neglected to mention before - is that my parents are both on long-term steroid medication for asthma, and as such have thin skin which cuts and bruises very easily (this is a common side-effect of long-term steroid treatment I believe). They are in their early 60s.

So my question is, given the weak skin of some asthma steroid users, would they be at greater risk of HIV/Hep B/C etc. from sharing towels, washcloths, razors/toothbrushes? Or would the increase in risk be small enough that it would still be <1% overall over a 2-3 month period? 

Thinking about this now I'm getting quite worried, so your advice would be most appreciated Dr. Many kind thanks 

Now you're aking if somone on serioids might be at higher risk for HIV or other STDs through shared razors, towels, and personal hygiene implements. The answer is no. Steroids and other immunosuppressive drugs are not known to elevate the risk of acquiring blood borne viruses or STDs. Once in a while they make established infections worse, but there is no effect on acquistion if exposed. Anyway, the doses of steroid likely to interfere with skin integrity are far higher than the doses usually used for asthma, chronic bronchitis, etc. It is unlikely their skin integreity is abnormal -- but even if it is, they are not at risk from such exposures. Being "quite worried" over this is unjustified. 

I have the impression you are overly obsessed with nonsexual transmission of such infections. Perhaps counseling is in order, if these thoughts continue to bother you. I suggest it from compassion, not criticism. I also would underscore part of Dr. Hook's advice about online searching on this topic. Like many anxious internet users, it seems you are being drawn to information that inflames your fears while missing the probably much more voluminous reassuring information that is there. It also seems you lack the scientific knowledge to accurately interpret and understand what you find. If you continue, at least limit yourself to resources that are professionally sponsored and managed, and especially avoid sites developed by and for infected persons or those worried about HIV.

Finally, please note the forum does not permit repeated questions on the same topic or exposure. This being your third, it will have to be your last one; future similar questions will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you understanding. 

Best wishes and stay safe--  HHH, MD

One final point which I wasn't sure if covered in your response (because I didn't mention it) was whether there would be any increase in risk of oral herpes/hsv1/hsv2? Or is there still no material increase in the risk of contracting herpes (via non-sexual exposures)?

You referred to STDs but just wanted to check if this included hsv1, oral herpes etc. If so I apologise in advance Dr.

Thank you again Dr,

- When you say steroid treatment probably never increases the risk of any infection, this is STD infections you are referring to? As I read on the NHS website that steroids increase risk of infection of shingles or measles - this is fine, I'm not concerned about these diseases, but just wanted to check I understood your answer corrrectly? (NHS link here - https://www.nhs.uk/conditions/steroid-tablets/#side-effects)

- When you say for HIV there is "probably" no increased risk of infection, can I take this as meaning that there is effectively no material increase in risk? As in your first answer you stated there was no material increase in risk from bloodborne viruses or STDs, so can I take it "probably" means effectively certain in this context?

Thank you so much again Dr, this has been so very helpful.

There has never been any scientific evidence that steroids increase the risk of HIV if exposed, and from what we know of the biology of HIV infection, no reason to suspect it would be a problem. But it is impossible to prove a negative, so nobody can say it couldn't happen. But if there is any such effect, it is obviously trivial -- otherwise it would have been noticed and reported.

You really are obsessed with this business. There is no basis for your concerns. Just let it go, including stopping online research about it. If you cannot, despite the repeated, reasoned, science based reassurance you have had, you should consider counseling about it. I suggest it from compassion, not criticism.

That concludes this thread. Please notice and comply with the last paragraph of my initial reply above.