[Question #4099] Follow up to question #4072

30 months ago
Hi Dr. Hook,
      One thing I omitted in the last question also my confusion is that during the rubbing, the messuse  and I were both naked. She used his butt and vulva area to rub my belly. I can feel  moisture around her labia. I think there might be some vaginal secretion during the process and may drop around my genital. I learned from your early answers that  the mucousal areas of the penis are far more susceptible.  My question as followed:
1.Is droplets of vaginal secretions directly contact with my urethral orfice a risk for HIV? 
2.Sir, last time you told me I don't need further testing. Mentally I want to regard my last testing(4th Gen.Duo, 30 days after exposure and 2 days after finishing PEP) as a ritual reassurance to end my endless imagination and anxiety. Could it be definitive on account of my exposure? How reliable is the testing?
Regard,
Nicholas
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Sorry you found it necessary to return. You are focusing on minute details about which there are no data. The important thing is that even the busiest STI or HIV/AIDS clinics and doctors never see patients with these infections who did not have intercourse. Genital rubbing, fingering, etc theoretically could transmit infection in some cases, but if the busy clinics never have such patients, surely you can understand that if this occurs at all, it is extremely rare.

1) Theoretically HIV could be transmitted by such contact. As just discussed, however probably it never happens.

2) You should not have had PEP after such an event. It means your test result at 30 days is NOT conclusive. You need to wait until at least 3 months after the exposure for conclusive testing, and some experts recommend 6 months. That's an important downside of PEP:  if it doesn't work, it prolongs the testing window and thus prolongs the period of anxiety. 

Don't get me wrong. I agree with Dr. Hook that you had a zero risk exposure and did not need testing, and certainly did not need PEP. But now you'll have to deal with the consequences of the anxiety that led you to seek PEP, i.e. with repeat testing in a few months. Discuss with the doctor or clinic where PEP was prescribed and follow their advice about follow-up testing.

HHH, MD
---
30 months ago
I got you Dr.Hunter. If I could just put this stuff behind and fully believe your conclusion that there is no risk,  there is no need for testing as reassurance, right?  Or it is mandatory once someone takes PEP?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
There is never such thing as "mandatory testing" for HIV. The chance you have HIV is zero for all practical purposes, both because it is unlikely your partner had HIV and the virus is extremely unlikely to have transmitted by the exposure as you have described it. On the other hand, after PEP, most experts would recommend follow-up testing at 3 and perhaps 6 months.

What should be done when there was no risk but PEP was taken anyway? That's almost a philosophical question and I don't have a clear answer.  But probably you should be tested after 3-6 month. You obviously are atypically anxious; 90% of people in your situation would not have given this kind of exposure a second thought. Highly anxious persons usually are more reassured by negative test results than by expert opinion based on probability and statistics. If you truly feel that without testing, you will go forward with 100% confidence you don't have HIV, that would be great. But if not, you'll need final testing at whatever time your PEP doctor or clinic recommends.

In other words, it's entirely up to you. I hope these comments help you come to the best decision that allows you to move forward without worry.

---
30 months ago
Thank you sir. Now I've decided to put this stuff behind and never take further testing. I know I'm the kind of persons who are likely to suffer from OCD. Especially after such an exposure. A lack of knowledge about HIV, guilty and the lack of responsibility in the doctor who prescribed PEP had made me extremely fearful of infection. Actually, several doctors I asked never explained completely and some words from them were terrifying such as"though never known, HIV can possibly transmit during a receipt of oral sex , like virus in a zombie movie. It is a bet about life. ' You can imagine how scared I was as an idiot about HIV, thus I took PEP, Luckily, another doctor I counseled told me there were no need for PEP and no risk. I was also fortunate to find your comments on Medhelp and this website. Dr. Hook and you help convince me there is no risk with your great knowledge.  Anyway, I guess the prolonged testing after PEP makes me give up to find reassurance from testing and move on without worries. So appreciate for what you did. BEST WISHES.
29 months ago
Hello doctor. From our last conversation, I got rid of anxiety a lot and do not seek for further testing. However, last week, three weeks after PEP, I found some white spots inside my lips and around the corners of my mouth.  Small but a lot, some joint together. I went to the clinic and the dentist thought these spots are sebaceous gland and may due to Fordyce ailment they  turned white. This symptom worried me a little. Is this symptom has something to do with ARS or other STI?  Is there still no need for testing? Should I pay attention tosymptoms and changes on my body? Thanks Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Fordyce spots are not an "ailment". They are entirely normal anatomic variant; everybody has them! This has nothing to do with ARS. Don't worry about it---