[Question #319] HIV/STD risk?

108 months ago

Hi Doctors Handsfield/Hook,

Thanks very much for your posts, which I've read over the years and have always found to be very informative. Unfortunately, I now feel compelled to post myself.

Yesterday while very intoxicated in Thailand I was enticed back to my hotel room by a local female who I in the morning found out was transgender (pre-op), i.e. still a male with a penis. Her Whatsapp caption implied "she" is very likely an escort/CSW.

Initially, after a brief kiss (my gums may have bled), she claimed she was a 20-year-old virgin. This is when I stated that I wasn't going to have sex with her. She accepted this but still wanted to sleep beside me in the hotel room, and foolishly I agreed. We slept in the bed for 8 hours, with me barefeet in briefs and a shirt. In the morning once I realized she was transgender I told her to leave.

My only "injuries" were two pre-existing abrasions on the tops of my feet, which had bled some hours before, but had stopped by the time I got into bed - I found no blood on the sheets the next day. I felt no anal discomfort, and could see or feel nothing out of the ordinary on my penis. My questions:

1. Am I correct in assuming that being a transgender CSW, more likely than not she had HIV or Hep B (given it was Thailand)?

2. Is there a meaningful risk that somehow I was infected with HIV or other STDs by the kissing or through the (until recently bleeding) wounds on the tops of my feet? I didn't see any blood or wounds on her.

3. Is there a realistic chance I might have been violated while in a deep sleep (made deeper by alcohol and fatigue)? Is it fair to say that since I've never been penetrated anally before, that if it did happen, the chance of me sleeping through it and then in the morning feeling no discomfort whatsoever is low? And I guess sleeping through my penis being inserted is also most unlikely?

4. Given the nature of this exposure is it imperative for me to be tested after 4 or 8 weeks?

Thanks very much for your time!

Edward W. Hook M.D.

108 months ago

Welcome to our Forum. I will try to help. The short answer is that there is no realistic risk to you for HIV or any other STDs from the interactions you describe and, as a result, no medical reason for STD testing of any sort related to this encounter.

In response to your specific questions.

1. Rates of HIV among Thai CSWs (transgender or otherwise) are higher than in the general population of Thailand or most CSWs in North America. Despite that less than 25% (conservatively) would be expected to have HIV. I do not know the prevalence of hepatitis B in Thai CSWs.

2, no, no meaningful risk either from kissing of any sort of through your wounds.

3. If you had been "violated" you would have known it.

4. See above. No need for any sort of testing.

I hope my comments are helpful. eWH

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107 months ago

Hi Doctor,

Thanks very much for your informative answer, which has done much to reassure me.

Just a few brief follow-up questions, regarding the abrasions on my feet.

1. Am I correct in assuming that as long as blood is no longer actively flowing out that the abrasions are essentially no longer "open" wounds (even though they may not yet have visible scabs over them)? And hence already present a significant (impenetrable?) barrier to entry for HIV, Hep B etc?

2. Even if theoretically the wounds were somehow open to some degree, and somehow the CSW was bleeding without me noticing, and somehow some blood splashed into them, is the chance of infection comparable to a needlestick injury or is it lower?

3. Aside from blood splashes to theoretically open wounds, does contact between open wounds and other bodily fluids carry any meaningful risk of infection?

Thanks again for your time and help!

Edward W. Hook M.D.

107 months ago

Your continued questions suggest that you continue to be worried about a no risk event. There are NO (that's none, never) instances in which HIV has been documented through kissing, deep or otherwise- mouth sores and bleeding or not. Thus, even in the statistically unlikely event that your bedmate was HIV infected, the sorts contacts you mention and imagine would remain no risk. I do not know how to say this more clearly. Your "what if" questions serve the same purpose as questions like, "if an asteroid fell from space and hit me on the head would I have a concussion."- they just are not useful or helpful.

HIV is transmitted through blood transfer when it enters the body, has access to the circulation and then can go on to infect target cells such as lymphocytes. Even with shared needles, injection of contaminated blood does not lead to infection in the majority of instances.

In answer to your specific, what if questions.

1. when blood is not flowing from a wound the body has sealed off access to the circulation.

2. This is a silly question but yes, if blood splashed onto your recent wounds, the risk would still be les than a needle stick

3. No, contact of this sort is not a realistic concern.

I hope these responses will put your concerns to rest. You need to move on. EWH

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107 months ago

Thanks very much Dr. Hook. Your follow-up has certainly further reassured me and removed my last doubts. I really appreciate the great service you provide here. Wishing you a happy holiday season!