[Question #3947] Hiv transmission and digital penetration

85 months ago

Dear Doctors,

Approximately two years ago, Dr Hook patiently answered my questions regarding hiv risk exposure due to receptive anal fingering/fisting from a sex worker in a Australia. After 9 months I experience numbness in my toes which prevails today some 2&1/2 years later.

Acknowledgeing Dr Hooks advise about my having no risk but recommended testing for peace of mind, I eventually got tested (in Cambodia) and found to be hiv negative.

Of course, being not too clever, I repeated my sexual encounter with a female sex worker in Indonesia. Again I received unprotected oral on me and she fingered my anus and then inserted her whole hand briefly. No bleeding occurred and she wore gloves.

Since that time I have continued to be paranoid about HIV risk and attribute my ongoing toe numbness to hiv and perhaps a faulty test in Cambodia. I work at a remote mining site and only have access to major cities periodically. I plan to get tested when in Singapore at the end of the year but in the interim would appreciate your advice.

My specific questions:

1. Would numbness in toes and now in my fingers when sleeping at night, be due to possible hiv infection?

2. Does hiv neuropathy occur so quickly after infection, if it occurred (ie 1-2 years)?

3. Does neuropathy occur without other symptoms?

4. Is it rational to be concerned about hiv infection from receptive anal fingering/fisting partIcularly if gloves were worn?

I apologize if I am confirming Einstein’s alleged dictum that “stupidity is asking the same question over and over and expecting a different answer” but I cannot escape my thoughts I have put myself at risk.

Thank you for your time.

H. Hunter Handsfield, MD

85 months ago

Welcome back to the forum.

You describe an entirely safe sexual encounter. (Congratulations on limiting commercial sexual exposures to safe sex!) There has never been a proved cases of HIV transmission by oral sex, oral to penis; and fingering is risk free, even with her "whole hand", and especially with gloves. That said, whenever someone is concerned about HIV, testing always is recommended. Even when experts describe an exposure as zero risk, most people concerned about particular exposures or symptoms are equally or more reassured by negative test results than by expert opinion based on probability and statistics. Therefore, I endorse your plan to be tested soon -- but not because of your exposure or the symptoms described.

Even in developing countries and remote locations, HIV testing is highly automated. There is no reason to not have confidence in your previous negative test result in Cambodia or anywhere else.

To your specific questions:

1,3) HIV would never cause numbness, tingling, or neuropathy as the only or main symptom.

2) This is too soon for HIV neuropathy, which generally is a complication of advanced immune deficiency, i.e. in presence of other evidence of overt IDS.

4) This depends on what you consider "rational". it's certainly a normal human reaction to be concerned by exposures that one is worried about or by unexplained symptoms. But as explained, the risk of HIV from the exposure described was nil and your symptoms do not hint at HIV.

I'll be happy to comment further, if anything isn't clear. But be aware I am unlikely to have any additional or different opinions or advice unless and until you'd like to return to report your HIV test result. In the meantime, I hope these comments are helpful.

HHH, MD

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85 months ago

Dear Doctor Handsfield,

Thank you for your prompt and helpful advice.

I note all your remarks and also appreciate your comments on my commitment to safe sex.

I have no more questions.

Thanks you for your time and consideration of my concerns.

Regards

H. Hunter Handsfield, MD

85 months ago

I'm glad to have helped. Thanks for the thanks.---