[Question #3252] HIV Concern

37 months ago
Dear Doctor,

My concern is about HIV through a bite. At a bar last night here in the US, a woman started flirting and coming on to me. Although I tried moving away from her, she kept trying to get me to dance. In the process, she unzipped my jacket and gave me what seemed like a hug. But the next thing I knew, she bit me in my chest area. I was caught by surprise and concerned about it at the moment because I could feel that the bite was kind of strong. I had a t-shirt and very light/thin sweater on. The woman was hispanic, I'm a male, and the bar didn't seem to be the nicest/cleanest place. 

When I looked in the miror this morning, I could see a small bright red spot on my chest where she bit me. I can't tell how open it is or how much the skin broke because it's hard to get a good look at it. I just know that the spot (bite mark) is bright red with some indentation in it. When I put a tissue against it, I didn't see any blood on the tissue. I'm not sure if it was bleeding last night though. I did not see any blood on my sweater. One other thing about the encoutner that I also noticed was that as she was talking to me some of her saliva/spit hit my face and mouth. My questions are:

1.  What is my risk for HIV from having gotten bitten?
2. Would you recommend PEP?
3. Is there any risk if some of her saliva/spit got into my mouth?
4. Do I need to be tested or concerned about Hep B, Hep C, syphilis, or any other STD's?

Thank you for your help and great service.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Thanks for your question. I logged in soon after you posted it:  most users should not expect nearly real-time replies!

First, biting is one of those theoretical exposures that often are listed as risks for HIV but that occur rarely if ever. I am not aware of a single reliably reported case of HIV being transmitted through a bite. And over the 4 decades of the worldwide HIV/AIDS pandemic, there must have been millions of bites (or other injuries by teeth) by HIV infected persons. So any risk is obviously miniscule. One of the reasons is that any oral exposure is low risk; oral sex has never been shown to transmit HIV from mouth to penis, for example. (Among the reasons is that saliva doesn't transmit the virus. In fact, saliva kills HIV.) Second, it sounds like your skin wasn't even broken. Without an obvious cut with bleeding, it is fair to assume no risk at all. And finally, the odds any particular woman in the US has HIV is extremely low, under one chance in a thousand on average -- even for the most sexually active women. Heterosexually transmitted HIV remains quite uncommon in the US, especially from casual one-time contacts. Almost all heterosexual transmissions occur in longstanding relationships in which one person has HIV, often unknown to the partner. For all these same reasons, the potential saliva contact with your face and mouth carried no risk of HIV.

Those comments pretty well cover your questions, but to be sure there is no misunderstanding:

1) Zero risk.
2) I definitely would not recommend PEP in this circumstance.
3) No risk here either.
4) Same for all other STDs. It is statistically unlikely a woman like this has any of these infections; and if she does, little or no risk of transmission.

So I don't recommend testing for anything, and if you have a regular sex partner, you can safely continue your usual sexual practices without risk of transmitting anything related to these events.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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37 months ago
Dr. Handsfield,

Thank you so much for your quick response and clear answers. I greatly appreciate your help and putting my mind at ease.