[Question #3802] Queries

35 months ago
Hello Doctors, I'm a 26 years old healthy female. I've no history of any sorts of exposure stories or risk assessments to give. My question to you however is:
Leaving out Sexual Intercourse, Injectable drugs, Needle-stick injuries, mother-baby transmission and blood transfusions, what other events include to potential risk for hiv/hepatitis transmission?
I've had Germophobia since a while and am working very hard to overcome it. I do get OCD over public toilets and door knobs, but am working to overcome it.
However, after extensive reading on this forum from your responses to other questions, I have understood that the above events hold a risk of exposure.
But what about any other day-to-day events? Anything in particular that I should avoid to not get HIV/Hepatitis/HPV? I've taken vaccines for the later two. But this question has always come to my head. Hope this is not too stupid for you. Thanks.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question, which isn't stupid at all. I'm happy to comment and hope you find my replies helpful.

Congratulations for being vaccinated against hepatitis B and HPV. You are now 100% protected against those infections (for HPV, against 9 on the most common and troublesome HPV types) and need not take any precautions whatsoever against those infections. For example, sex with known infected partners would be entirely safe, and so would exposure to their blood or sexual fluids.

In direct, succinct ply to your opening question:  Modes of transmission other than those mentioned are exceedingly rare. For HIV and hepatitis B and C, the main other risks probably are overt blood contact of sorts not mentioned, e.g. exposure to large amounts while caring for a victim immediately after a vehicular or other serious accident, including firearm injuries and other violence. Health professionals can be infected if injured with a sharp instrument while caring for an HIV or hepatitis-infected patient. Even sex is less risky than most people have come to believe. For example, the assumption that hep C is sexually transmitted is wrong, with the single major exception being men having protentially traumatic anal sexual practices (i.e. with potential blood exposure) with other men. The heterosexual partners of people with hep C have no higher chance of being infected themselves than anyone else not at sexual risk.

HPV of course is not a blood borne infection, and the risks are different, with no risk from blood. But also no known risks other than direct sexual exposure.

None of these ever has been shown to be transmitted through environmental contamination, i.e. no risk from shared toilets (public or otherwise), towels, eating utensils, shared kitchens or foods, etc. The children of people with these and other STDs never catch it despite years of living in the same household and having all the normal contacts between parent and child (excluding transmission during vaginal delivery or by nursing).

Being germophobic isn't necessarily harmful, if not taken to extremes. It probably reduces your risk of common colds, influenza, common diarrheal infections, and so on. Otherwise, however, it protects you against nothing, including the infections mentioned in your question.The main issue is whether it interferes with just getting along in life, friendships, etc. As you perhaps know, germophobia can be the harbinger of much more serious psychological disability, so don't ignore it if it begins to inhibit day to day happiness, friendships, etc. (For an excellent example of where it can lead, see The Aviator, the film biography of the "eccentric" billionaire industrialist Howard Hughes. Which by the way is an excellent movie in its own right, with Leonardo diCaprio and Cate Blanchett.)

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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35 months ago
Thank you for your detailed response. Your advice certainly helps me to understand this more clearly. So no risk with environmental contamination at all??
Even if the genitals come in direct contact with the secretions on the surfaces if present??
I also wanted to know if finger to genital transmission is possible??
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
In theory, one can imagine why contacts like these might have a chance of HIV transmission. However, from the very first days of the recognized HIV/AIDS epidemic, before we even knew the virus that causes it (i.e. in the early to mid 1980s), health officials were able to give the public 100% reassurance that casual contact and environmental exposures are risk free. How could we do that? Because even the busiest clinics with large numbers of AIDS patients had no patients without the typical sexual or blood exposures (unsafe sex, shared needles, etc). If such exposures could transmit the virus, there would be at least occasional persons with AIDS who lacked the standard risk factors. But there were none. Still there are virtually none today. When someone initially denies the standard risks, it always turns out s/he was wrong, either overtly lying (often to save face) or not knowing of a traditional risk, like a spouse who has sex with other men or uses IV drugs.

Similar comments apply to hand-genital contact, such as fingering. We never see patients with HIV whose only potential exposure was hand genital contact without intercourse. Given how often such contacts occur, the apparent absence of such cases is powerful evidence. The same applies pretty much to viral hepatitis, even though hep A and B generallly are more easily transmitted than HIV, and also to all non-intimate personal contacts with other persons, food contaminated by an infected waiter or other food handler, and household members of persons with HIV. Do such exposures EVER transmit HIV or hepatitis? Maybe. But if so, it is so rare that neither I nor any other specialist I know has ever seen such a case, and none have been reported in the medical literature.

To put it another way, fearful persons (such as germophobes) should concentrate not on theoretical biology ("Can HIV survive outside the body? How long? In what sort of conditions?) but on the epidemiologic data, which provide solid evidence against such risks. 

Does this also help?
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