First off, thank you for the work you do on this site. It really is an amazing resource that you provide. To my question. I am a bisexual male and based on your advise on what is risky and not risky behavior regarding HIV, I stick to only mutual masturbation with other men. Over the past couple of years, I have engaged in mutual masturbation with a handful of men of unknown status (although I do generally ask if they are clean).  Never any oral sex and certainly never anal.  In addition, I try to make sure there is not an exchange of bodily fluids from hand to genitals and back but can’t say that never happens. Anyway, I do know your stance on mutual masturbation but you also “never say never”. That all being said, I have a question on opportunistic infections. Over the last couple of months, I’ve noticed a couple of my toe nails have become discolored (white) and seem to have come loose from the nail bed. I do walk around the gym locker room with bare feet. Could this be an opportunistic infection common with HIV?  I’ve just never had anything like this before so it has me a little concerned. Any thoughts you could provide would be appreciated. Any testing needed? Thanks again. 

Welcome to the forum.  I'll be glad to comment.  Let me first congratulate you on your commitment to safe sex- it will keep you safe.  Let me comment on our "never say never" stance.  Years ago we stated that there was no risk for acquiring HIV from performing oral sex on an infected person.   Several years ago however, a few persons who stated they had only performed oral sex on partners acquired HIV and this led us to revise out statement.  Getting HIV in this way remains extraordinarily rare and neither of us on this forum has EVER seen a person who acquired HIV in this way.  Thus we now consider performing oral sex on an infected person a very low but not no risk event.  In contract, there are still NO instances in which HIV has been acquired through mutual masturbation and even the most conservative scientific sources such as the CDC still classify mutual masturbation as a no risk encounter.  this is the case even in persons with scrapes and cuts on their hands and fingers, with infected cuticles or rashes infecting their hands.  Thus, I am confident that you do not have HIV.  OTOH, if you wish to test, no one would say not to do it, just that it is not necessary.

As far as your toe nail is concerned, this sounds like a fungal infection.  Such infections are common and are not strongly associated with HIV. You certainly could have caught it in a locker room.  I would not worry about it.

Thus I see no reason to seek testing other than for your own information.  I do not consider your toe infection to suggest any sort of immune deficiency or to raise concerns about HIV.

I hope my comments are helpful.  If there are further questions, please don't hesitate to use your up to two follow-up questions for clarification.  EWH

Thank you for the quick and thorough reply. I generally do not get concerned from what gets on my hands. What seems concerning is if they have precum on their hands and then touch my penis with it.  I know that HIV quickly becomes inactive outside the body but it just seems risky. Can I ask the question this way? If someone were to stick to only mutual masturbation with the presumption that you will inevitably get the other persons precum on you in  the process, would you recommend them being on PREP? Again, with no other sexual activity taking place?

None of these symptoms concern me in the least.  Stress and anxiety can certainly do this.  Your exposures were no risk and there really is no reason for concern.

As you know, our Forum permits up to three responses to client questions.  This is my third response. Thus, this thread will be closed in a few hours without further replies.  I hope the information I have provided has been helpful to you.  EWH