[Question #3136] Semen Eye Exposure and scared

40 months ago

Hi Drs.,
I was on here over a year ago about testing from experience and I need some new help.

2 weeks ago had an experience with a transsexual (MTF) escort in Houston. All was condom protected (oral both ways, and anal with me being the receptive partner)
We changed condoms a few times throughout the experience to make sure they were fully intact and we were protected, lots of lube as well.
At the end during ejaculation, one (maybe two drops) of their semen went into my eyes. It was at the beginning of ejaculation. It was not what I would call a lot, just kind of the first that leaked out some. My eyes (and face) did burn and were irritated for a day, but that could of been b/c I used a baby wipe (she had) to clean my eyes and face afterwards.

I have become paranoid over this. I have discussed with her, her STI and HIV status, with her claiming that she is 100% free from infection and has proof from testing.
I believe she is always using protecting, because of how she acted.

My questions are:

1. Was PeP warranted for this exposure?
2. What is my risk level?
3. Do I need to test? If so when would be conclusive for this event?
4. Can I continue my relationship with my partner without fear of infecting him with HIV?

I have become overly paranoid about HIV and am worried that every moment when my head hurts or I feel tired, etc, that it is ARS.
When odds are it is a cold or allergies!

Please give me some of the amazing advice you always give people!

Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Welcome back to the Forum. This time around I will be answering your question but I did review your interaction with Dr. Handsfield a year ago and agree with his messages to you with one minor change.  As an FYI, in the interval since you were last on the site further information about the accuracy of combination HIV antigen/antibody tests ( they are also called duo or 4th generation tests) has become available.  In the past  we said thee these tests were 100% conclusive 4 weeks after an exposure.  more recently a very small number of cases of HIV have been detected between 4 and 6 weeks leading the CDC to revise its performance estimates to say that test results are not conclusive until 6 weeks (42 days) after exposure and that 4 weeks they are over 99% accurate.  This does not change my assessment of your old exposure- I would not have worried and agree with Dr. Handsfield's assessment. 

With this, let's now go do your more recent exposure, starting with letting me congratulate you on your current commitment to condom-protected safe sex.  Good job!  In addition, I would classify your exposures as close to no risk for HIV or other STIs- condoms work and your partner told you that she tested regularly and was not HIV infected.  It was a good idea to ask since about 8% of transsexual women have HIV but in your instance, I would believe her- there was no reason to lie and most people in these situations tell the truth.  Please find the answers to your specific questions below:

1. Was PeP warranted for this exposure?
You practiced safe sex with a person who told you that they had been tested and were not infected.  Thus, were it me, while the decision is a personal one, I would not have sought PEP.

2. What is my risk level?
Low.  Your sexual contact was condom protected and so your only potential exposure would be the possible contamination of your eye.  while this is theoretically associated with risk for HIV, to my knowledge there has never been a case of HIV transmitted in this way.  Although the eye does have mucous membranes, exposures of this sort have no trauma/friction associated with them to facilitate transmission of infection and the blink reflex is more effective than people appreciate at keeping foreign material out of the eye. 

3. Do I need to test? If so when would be conclusive for this event?
Testing is a personal choice.  Personally, I see no need for testing related to the events you describe.  On the other hand, for all sexually active persons we advocate for periodic (every 6 to 12 month, depending on the level of activity and partner number during that period) sexual health check-ups which would include testing for STIs including HIV.  We advocate this is the same way we advocate for our patients to get their blood pressure and cholesterol checked periodically.

4. Can I continue my relationship with my partner without fear of infecting him with HIV?
Yes.

I hope this information is helpful.  While there is a tiny theoretical risk to the events you describe, I would classify it as theoretical only and would not be worried.  Feel free to follow-up if any of this is unclear.  EWH
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40 months ago
Thank you Dr.  Hook.
I was aware of the recent update to the testing recommendations and was tested at my physical in Oct with a 4th gen test.

As for my current exposure, if I were to test at 21 days, based on all the information at hand, could I consider ghat conclusive? I know that’s early.
Or would you recommend waiting 6 weeks?
Just want to put this completely to bed.



40 months ago
Also, when I asked about continuing relationship with my partner, I was referring to unprotected.
So when you answered “Ye”, is that what you assumed as well?


Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
21 days might be a bit early to really feel that results were conclusive as I think only about 90% of recent infections would have been detected by then. On the other hand, at 4 weeks I would be comfortable and not feel a need for additional testing. 

Yes, I did assume you were referring to unprotected sex.  Sorry I was not clearer.  EWH
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40 months ago
Thank you Dr. Hook.
To summarize and confirm:

1. Very low, basically theoretical risk from semen in eye. No cases of infection you are aware of.

2. No need to worry or for testing regarding this event.

3. Continuing unprotected sex with partner is ok

4. If testing for personal comfortability, then 4 weeks is enough, but 6 weeks is full conclusive based on CDC recommendations.

Also, I have read from some of your old posts and other information that the tears/moisture in your eyes have enzymes that protect the eyes from infections and lysozyme can inactivate HIV. 
Would I be correct on what I have read?

40 months ago
Hi Dr hook,

I can’t shake this mentally and I know you said the risk was almost zero and testing is not need but I feel I need it.

I am going to get tested 27 days after the exposure (because of work travel), would that be close enough for the 28 days you suggested?
I will also get tested after 6 weeks.


Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Sorry for the delayed response to your earlier question  Your summary is correct.  Testing with a combination HIV antigen/antibody test at 27 days will be at least 98% accurate and will provide you with information to confirm what I have told you about this being a no risk event.  EWH
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40 months ago
No need to apologize for the delayed response!

Thank you!