[Question #4052] High risk sexual activity

30 months ago
One night stand w a dirty girl I met at bar. She fingered herself and licked her fingers repeatedly. Five minutes later she repeatedly spit on my penis and vigorously stroked w her hand. No other contact. I went to ER and received PEP, truvada and tivicay, taken within 19 hours of potential exposure. I am very anxious. What is risk of HIV?
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome to our Forum.  I'll try to help.  If you had asked me to prescribe PEP I would have declined.  There has never been a person who acquired HIV from receipt of masturbation or direct contact.  HIV can be found in very small amounts in saliva but the presence of the virus has never translated to causing infection. No one has ever been documented to have acquired HIV from receipt of oral sex or from receipt of masturbation, even when saliva is used as a lubricant which is often the case.  Your risk for HIV from the events you describe is zero.

I hope this information is helpful. If any part of this message is unclear or confusing, please feel free to use your up to 2 follow-ups to let me try again.  EWH 
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30 months ago
Thank you very much for your prompt response. I was given the meds because I was in an area of the southern u.s. with relatively high rates of HIV. My direct concern is that she licked her fingers several times after fingering herself, then spat upon my penis five minutes later in order to give me a hand job. Isn't there a risk her vaginal fluids caused hiv infection entering the penis membranes?  I have no idea if she was infected but let us assume so. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
I live in the Southern U.S.  Indeed rates of HIV are relatively high.  Even so, most women, even most "dirty" women do not have HIV with the likelihood of HIV being less than 1 in 50.  

I also think you have a misunderstanding of  how HIV is transmitted. HIV is spread only through DIRECT genital or ano-genital sexual contact or through injection of infected material deep into tissue.  As I said above, there has NEVER been a case of HIV documented to have been spread by exposure to genital secretions transferred on a persons hands or through exposure to saliva.  Non one, not ever.  Nor has there EVER been a case of HIV documented to have been transmitted through receipt of masturbation despite the fact that it is usual for persons to get each others genital secretions on one another.  This was a no risk encounter even if she was HIV infected.  Really.  EWH
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30 months ago
Thank you Dr. Please allow my last clarification as I'm admittedly uneducated in life sciences: My understanding is Direct contact would be my penis in her vagina, wherein infection from her vaginal fluid enters mucous membranes in the penis. I am equivocating that situation with the potential for her vaginal fluid to be transferred to me in 2 steps: 1) to her fingers by her licking them after they were inside her own vagina; 2) then her depositing same vaginal fluid on my penis by spitting.  Can you clarify how the situations are any different? Thank you for all your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
You are not equivocating, you are being argumentative. 
Facts:
1.  HIV is a fragile virus.  It becomes non-infectious upon contact with the air and temperatures below body temperature.
2.  The likelihood of transmission of infection depends on the quantity of virus one is exposed to.  The quantity of virus decreases about 11-fold with each transfer, i.e. from the vagina to the hand, and another 100-fold following transfer on the hand to skin.
3.  The mucosal surface of the urethra is far more susceptible to infection that intact skin on the surface of the penis.
4.  Numerous other complex biological issues which I have gone to school and trained for 8 years after college and been engaged in research on for over 35 years which are, I'm afraid too complex to describe in this setting. 
5.  Experience validates that this mode of transmission had NEVER been proven to occur despite literally millions of instances of exposure and lots of scientists looking for transmission to occur in this way.

Bottom line- you are more likely to be struck by a meteorite from space while reading this than to acquire HIV from the exposure you have described.  you can believe me or not.  Makes no difference to me.  you asked information, I have provided factual, science-based answers.  What you do from here is up to you.

This completes this thread. As per Forum guidelines, there will be no further replies and this thread will be closed in  a few hours.  Take care.  Good luck.  Watch out for meteorites.  EWH
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