[Question #3412] Risk of exposure from fingering with dermatitis/eczema on hands/fingers

35 months ago
Recently I engaged in fingering with a Filipina possibly CSW in Japan (it was a bar where woman sit with you and get you to buy expensive champagne).

1.) What are the risks of fingering with very minor wounds?
2.) I have dermatitis/eczema on my fingers / hands that I used to finger her, does this increase the risk?

As far as I can remember this was the only sexual act we engaged in, I don't ever remember removing my pants, if but I may have blacked out / forgotten something. If we engaged in other acts such as oral / vaginal sex what are the chances of being infected. In the unlikely event we did (selling vaginal sex is illegal in Japan I believe for CSWs) how risky would this have been?

Kinda freaking out about this as my wife wants to get pregnant, but I am way to anxious to engage in unprotected sex with her. Would you advise against this in either case? What I know occured, fingering, and the other speculative exposure?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question.

As you may have seen if you scanned other threads on this forum, hand-genital contact and fingering is risk free for all STDs. In theory, an inflammatory rash or minor wounds on the finger or hand might raise the risk of HIV or other STDs. However, if you think about it, at any point in time many people (maybe 1-5%) have such conditions of the fingers and hands, so there must have been millions or billions of exposures to people with HIV or other STDs in the presence of such conditions. And still no documented transmission risk.

So I do not advise testing for HIV or any other STD and would suggest you continue unprotected sex with your wife without worry.

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

HHH, MD

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35 months ago
Hello Dr. Handsfield,

Thank you for your prompt reply. Do you recommend I get tested for the speculative, possible contact I mentioned?  I am extremely worried about this as my memory of the night is not clear, although the fingering is all I can recall. I considered PEP but I believe I am outside of the window for that now (the  incident will have been 4 days past at the earliest time I could receive PEP).

As for testing windows, the clinic I would use offers 30 minute rapid testing and claim that these are conclusive after 22-28 days. Are these results likely to be accurate? Are the rapid tests reliable, or do they provide many false positives / negatives?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I already said "...I do not advise testing for HIV or any other STD and would suggest you continue unprotected sex with your wife without worry." But of course you are free to be tested if it will help convince you that you were not at risk.

The rapid blood tests are nearly conclusive at 28 days, but not quite. For 100% conclusive results, it needs to be 6 weeks. These tests to not have any problem with false positive results. Of course all HIV tests can be "false negetive" if done too early, i.e. before the window period is over. I would recommend against the rapid oral fluids test, which sometimes takes as long as 3 months to turn positive.

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35 months ago
Thank you again doctor for your response. You have definitely assuaged my concerns over the fingering contact. I will probably test at 28-30 days anyway as there may have been something else that happened that I cannot remember. So may I ask one more follow up?

Out of curiosity, what are the chances of contracting HIV from female to male with unprotected vaginal sex? Does oral sex (either cunnilingus or bow job) pose any risk? How about if there is blood in the mouth? Once I also (separate occasion, many years ago) attempted anal sex with a Trans woman although this didn't work out, so I removed the condom, received oral sex and then reattempted to use the same condom. If the condom had become inverted after a few minutes and was reapplied would this pose any sort of risk? 

Once again, thank you for all the work you do here and previously on the MedHelp forums, your advice is always concise and helpful even for someone with diagnosed GAD/PPD like me. 

Thanks again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
CDC has published an estimate that the average risk of HIV by vaginal sex, female to male, if the woman is infected, is 1 in 2,500. That's equivalent to daily sex with infected women for 7 years before transmission would be likely. (That's why many wives and husbands of HIV infected persons never catch the virus -- which perhaps you didn't know.)  There has never been a proved case of HIV transmitted by cunnilingus and none from mouth to penis by oral sex. As for blood in the mouth, it probably does not elevate the transmission risk, especially if the blood isn't easily visible (and who would allow oral sex by a partner with a mouth full of blood??). Saliva inactivates HIV, which is why exposure to persons' mouths or saliva is rarely if ever risky -- and why small amounts of blood make no signficant difference in risk.

Condom reversal is not recommended, but any increased risk from it probably is very small, both for HIV and other STDs.

That completes the two follow-up comments and replies included with each question and so concludes this thread. Thanks for the thanks about our services. I'm glad to have helped. 
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