[Question #3600] ENT Doctor visit and HIV risk question

34 months ago
Sir - Thanks for taking my question. Me and my wife visited an ENT Doctor about 3 weeks back

1. I had ear wax.Doctor cleaned both ears with a curette. It was quick,about 45- 60 seconds in each ear. In 1 ear,there was slight bleeding due to minor scrape and no pain after that.After procedure, nurse directly kept curette in a box without sanitizing it. This got me worried. Is there any risk If there was microscopic blood from previous patient on the device and that got in touch with my scrape? I did not see any  dripping blood on the device. I think there was at-least 30 minutes gap after the last patient. Please let me know if there is any HIV risk here.

2. He had seen my wife's throat ( as she had some throat tightening) through flexible laryngoscope on video screen and took pictures. I did not see any dripping blood on the Scope. Is there any HiV risk if the scope is not cleaned properly and some microscopic blood is left on the scope. Not sure of time gap from last patient.He did not prick her as it was only viewing and there was no bleeding.Whole procedure was done in 2 minutes.  I am worried as inside of throat is all mucus tissue and easily susceptible to infection. The reason for this question is that 11 days after procedure, wife had fever for about 5 days. During these 5 days, she started to feel better on day 2/3  and about 4th day, the temperature became high again and she started coughing and had some phlegm as well and a bit tired. Doctor said she might have started with a viral and then had a secondary bacterial and put her on antibiotics. She is on day 19 today and she still has dry cough, some tiredness and a little headache on day 18 and day 19. There is no rash and she had body pain on day 1 of fever alone. Is there any HIV risk here? Thanks again
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to our Forum.  I'll try to help.  I am not sure where you reside but most doctors who do medical procedures, including curetting of ear wax or looking into patient's throats with scopes have protocols and specific procedures that they follow for cleaning their equipment.  I suspect that your ENT doctor does as well.  Further, I would point out that:
1.  There are no reported cases of HIV being acquired through the sort of exposure you describe and,
2.  It is statistically unlikely that the person your doctor saw before you had HIV or if they were, that the virus survived during the time interval between patients.  The HIV virus is quite fragile and becomes non-infectious in minutes (if not sooner) where exposed to the air and room temperature.

I would deem the events you describe as no risk events.  I see no reason for concern and no reason to testing.  Your wife's current symptoms do not suggest recent HIV and are likely to be coincidental.  I hope my comments are helpful to you.  EWH
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34 months ago
Sir - Thanks for the prompt response. Really grateful. Just a few more questions.

We reside in India.All my suspicions started when the nurse put the curette directly inside a box to re-use without sanitizing it.

1. Regarding my case wherein my ear was cleaned with a curette, you are suggesting that there is no risk even if some microscopic blood was left on the curette which got in touch with my minor scrape? Please confirm. I also assume that large quantity ( not microscopic) is needed for a risk and that I need to have a deep cut and not a minor cut. This along with the fact that curette was exposed to air makes it a " No Risk". Please confirm my understanding.

2. Regarding my wife's laryngoscopy case, I started getting worried only after her symptoms. Please confirm that these symptoms are not suggestive of primary HIV. Similar as above, I assume large quantity of blood is needed and not microscopic and that exposure to air would have neutralized any microscopic blood left on the scope. Also, there was no scrape or cut and it was only viewing and thus there was no portal for any blood entry. I was a little skeptical as I assume it is mucus and more susceptible to infection. Even if it is mucus, I assume it needs to be vigorously rubbed or poked. In a nutshell, please confirm that hers is also " No risk" as there was no visible blood, any microscopic blood woul d be rendered ineffective due to air exposure and simply viewing the throat does not provide a portal for entry.

Thanks again sir and grateful for your service.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
 Your follow-up questions are a bit repetitive and take the form of "what if" questions. I have done my best to answer. See below. 
1.  Correct
2.   Correct, her symptoms are not those of a recently acquired infection and I would categorize the procedure that you have described as being no risk. EWH
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34 months ago
Thanks much for your prompt response. I am convinced that this is no risk :-). Last unrelated question if you will allow me. 

Today, I was opening a coke can. As I could not open, I had asked my friend to open it. While opening, he had a small cut and then I tried to open it and I also had a small cut. There was little bleeding. I assume this is no HIV risk even if my friend had left some blood as our cuts were not deep. Please confirm.

Secondly, can HIV be spread if something is mixed in my drink? The coke tasted weird and so this question.

Very grateful and thanks for your time and help in this regard.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I wonder why you think your friend is HIV infected.  If he was however and through the events you describe you either got some of his fresh blood onto your cut or happened to ingest some of his blood as you drank your coke, there would still be no risk for HIV.  HIV is spread ONLY through DIRECT sexual contact of injection of infected material deep into tissue.  The sorts of exposures you describe do not lead to HIV transmission and do not necessitate testing for HIV.

I hope these answers are helpful to you.  This is my third and therefore final response to your questions.  This thread will be closed later today without further responses from me.  EWH
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