[Question #480] nonsexual transmission of hpv, hiv, hep c and hep b

42 months ago
Hi Drs.

(I apologize in advance for the long post but wasn't sure how to condense this. If needed, I will make these into a couple of posts and pay the money needed. Drs. have
tried to reassure me but at this point I need some concrete scientific facts and not just generalizations.)

I am a female and have some questions about the nonsexual transmission of high risk hpv, as well as hiv and hep c and hep b.

I do have high risk hpv, as well as ocd (which I am in therapy for). My ocd led me to wash my hands to the point where they are always red and raw and crack and bleed
and have surface cuts. This is due to the fact that I was, and am continue to be, afraid of giving hpv to my son if I have it on my hands from touching dirty laundry
or something and then changing his diaper, feeding him, etc. I've always had ocd, but it seems to have gotten a lot worse since my son was born 19 months ago.

Also, recently do to the cuts on my hands, I have become worried about blood borne infections (hiv, hep c and hep b).

I have asked my dr about the following incidents and was told that unless I start having sex with a lot of people, get stabbed with a needle, or get a pint of
blood injected in me, I am not at risk of hiv, hep c or hep b, but I keep worrying I am. I am also worrying about passing hpv to my son. I am writing to you in the
hopes of alleviating my fears as to whether or not these are risks if I see the answers in black and white.

1.)  high risk HPV:  Should I be worried about infecting my son (or anyone else)? I keep washing my hands after touching dirty clothes, eating,
taking a shower, having sex, touching objects, etc. because I am afraid of giving it to my son if my hands are dirty, have body fluids on them, or if they are raw
and have open cuts on them. Also, my butt seems to sweat and go through my clothes and I am scared this could give him hpv if he comes into contact with my clothes.
He was delivered vaginally, brestfed until he was almost 16 months old, and I do normal care for him, change his diaper, feed him, share food and drink from my plate/
cup with him, etc. He plays on our bed when the sheets might be dirty. Also, I used to take his temperature rectally and not thinking I would place the
vaseline on the thermometer with my fingers before taking his temperature. I was told that there is no way my son could contract this from me from my hands
or any other way but I worry.
Are these circumstances (or any circumstances) under which my son would be vulnerable to contamination of high risk hpv from me?

hiv, hep c and hep b

2.) Blood on toilet (end of April 2015):  I sat on toilet seat in dr. office and when I got up I noticed blood, which I then cleaned up. It may have been mine, but
if it wasn't I am nervous due to the cracks and openings in my hands. (A similar incident happened at our house with blood I know wasn't mine
after someone with hep c visited the house). If the blood wasnt mine, would I be at risk for hep c or hiv?

3.)  (end of Aug. 2015):  Blood on top of paper towel roll near a glucose testing kit with visible blood on it. I was at someone's house and washed my hands before
going to change my son's diaper. After drying my hands, I noticed the blood on the paper towel roll. I immediately washed my hands again before changing his diaper.
After changing his diaper, I began to worry about the blood getting into my cuts from the towel or still having blood on my hands and transferring it to
my son's genitals/anus from my hands either directly or on his diaper/wipes. In addition, I changed him on someone else's diaper changing pad, which had just been
used. I also handled his food, etc after this.

After this, my son began to get sick with fevers, ear infections, diarrhea, colds, coughs, runny nose, pneumonia, swollen lymph nodes, rash, grabbing throat and ears.
One day he threw up several times. Another, he refused to eat lunch. His dr. said it was due to him starting daycare (after this incident) even though
he had never been sick before this incident and had been breastfed, which I thought would boost his immune system. (My husband had to convince me
not to stop breastfeeding due to events 2 and 3). His dr. does not want to test him since he was not stabbed with a needle and says it wasnt a risk but I worry about
hiv and hep c (and hep b since I dont know if he was vaccinated yet).

4.)  (end of Oct. 2015):  touching someone's hand in store:  Took bag from worker then went to car where I used hand sanitizer. Then noticed blood on my finger near
a cut and I put a bandaid over it. I then began to worry about cut I noticed on the worker's hand and if our cuts touched and if we had both been bleeding at the
time.

5.) (Dec. 19, 2015):  I went back to the dr to express my concerns and was told that the above events werent risks. I insisted on blood testing anyway. They also
took a throat swab for strep. After the technician took my blood, she disposed of the needle in the biohazard container she had brought in. Without changing
her gloves, she then took the throat swab. After leaving the clinic, I became worried that she somehow got someone else's blood on the gloves from
inside/outside the container and then onto the swab and into my mouth when it was wiped inside my mouth, tongue, cheek, gums. But when I mentioned it to the dr
he said it wouldnt happen that way because the swab was sterile when taken out of package and wouldnt have been touched and even if it happened that way it would not
be a concern even with open sores, cuts, bleeding gums, burns inside mouth or if I swallowed blood and that I had a better chance of being struck by
lightning. He did not recommend additional testing. Yet, two weeks later, I had sore throat, swollen lymph nodes. stuffy nose, cough, sinus pressure, ear ache,
headaches, fatigue, nausea, loose bowels, genital spasms, and I felt warm. But no fever or rash. Two and a half weeks after this incident, I got my period and
 had bad cramps for several days even though normally its just bad the first day. A little over 5 weeks after this dr visit, I now have an ear ache, stuffy nose,
swollen lymph nodes, sore muscles, nausea, headache, swollen glands, and white spots on the glands. Last night I also woke up and have sweat on my face/forehand and
 my shirt was damp. I think I feel warm. But no fever or rash. Temperature today at dr office was 98.5 taken orally (usually it is 97 something). Dr. did not take test
 for strep but
said white spots were consistent with strep and gave me an antibiotic and was still not concerned it could be due to hiv or hep c. IF there had been blood
on the swab that was used on me on Dec 19 (and I know this would be highly unlikely) would this be a reason to be concerned and get tested?

My husband (and therapist and dr.) thinks I need to get over these fears and that I was never at risk from any of these events and neither was my son.

So I was wondering if you recommended testing for hep c or hiv for me or hiv or hep c or hep b testing for my son? I do not want to keep
getting tested or put my son through that but I dont want to find out years later that we have something and should have been tested nor do I want to put my husband
at risk. And I worry every time he gets sick or I get sick or I hear of someone getting sick from the house from event #3.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
The quick reply is that none of these infections is transmitted in the environment or nonsexually -- only by sex or direct blood exposure. The exposures you describe, based on my quick scan, are risk free.

However, as clearly stated on the forum home page before you posted. the maximum permitted length of a new question is 1,500 characters, about 450 words. Yours is over 7,000 characters. You must have written it in another program, like Word, then pasted it, which bypasses the character limit. If you need a more detailed reply, please condense your question to the permitted limit (about a quarter its present length) then re-post it in a follow-up window.

Thanks--  HHH, MD
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42 months ago
Female, concern about hiv hep c, b via direct blood exposure (have ocd & dry hands w/ surface cuts that bleed, in therapy) 1)toilet, when got up saw blood, which cleaned up. Nervous due to cracks/cuts on hands 2)At someones home & washed hands. After drying hands w/ paper towel saw blood on paper toll roll (glucose kit w/ blood on it nearby) Immediately wash hands again then change sons diaper. Worry blood getting into my cuts from towel/still have blood on hands & transfer to son from hands either directly to genitals/anus or on diapers/wipes. Son gets sick: fevers, ear infections, diarrhea, rash, etc, intermittently. Dr say due to daycare 3)took bag from worker then use sanitizer. Notice blood on finger near cut & put on Bandaid. Worry about cut saw on workers hand & if cuts touched & both bleeding 4) Went to dr 12/19/15 for blood tests. Took swab for strep. After tech took blood disposed of needle in biohazard container she brought in. Without changing gloves, took throat swab. Worry tech got someones blood on her gloves/hand from inside/outside container to my mouth from swab. Mention to dr who said wouldnt happen that way b/c swab sterile when take from package & wouldnt have been touched & if happen wouldnt be concern even with open sores in mouth, etc.. 2 weeks later sore throat, swollen lymph nodes, stuffy nose/cough, earache, headache, nausea, loose bowels, genital spasms, felt warm. 2.5 week after this incident period & bad cramps for few days even though normally bad first day. Little over 5 week after this dr visit have lot of same symptoms as 2 wk after incident & now gums feel weird & white spots on tonsils. Dr didnt take test for strep but said symptoms consistent w/ strep gave antibiotic. On med 5 days throat/ears still hurt/sore. IF there was blood on swab that was used Dec 19 would be reason to be concerned? Recommend testing for me or son for any event above?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum and thank you for abbreviating your question. I hope you understand the policy. The moderators don't have the time and energy to read such long essays, and in 10 years on this or our previous online forum, Dr. Hook and I have never seen a question that could easily be expressed well within the requested limit.

Before answering your specific question, a general comment about STDs and their transmission. Many people assume that these are just infections that involve the blood or sexual organs, and that other kinds of exposures can easily transmit them. Not true. All these viruses and bacteria are difficult or impossible to transmit by quick, casual contact. They evolved to require the direct exchange of genital fluids or intimant skin contact, or directly bloodstream exposure, to be passed from one person to another. That's why they are sexually transmitted -- unlike colds, influenza, gastrointestinal infections, and many others, they cannot be transmitted except when large amounts come into contact with certain kinds of cells, which typically are located deep inside. None of the events you describe meet these standards.

In addition to those biological reasons, the experience of STD experts and other doctors is that we never see infections with these bacteria and viruses in people who have not had sexual or blood exposures. In the world's busiest HIV/AIDS or STD clinics, there never are patients whose only possible contacts were non-sexual, casual contacts with other persons, or via toilets, towels, and so on. If you think about it, if exposures like yours occurred with any measurable frequency, there would be at least rare infected patients who haven't had sex or blood exposures. But there are none.

To your specific questions:

1) Nobody gets hepatitis b or c (or HPV or HIV) by such exposures.
2) The doctor is correct. There is no reason to suspect anything except exposures to other kids (in daycare or elsewhere) or other non-intimate contact.
3) Nobody gets infected by this sort of contact.
4) Nobody ever gets infected by having blood drawn or other specimens collected. Here again, I agree with your doctor. The symptoms you report are typical for non-intimately transmitted viruses, e.g. that you may have caught from your kids. Every human being and every parent of young children has such illnesses all the time. It's part of being human and having a family!

Therefore, I do not recommend testing of your son or you for any of these viruses, or any other STD. Truly, you do not need to ever worry about getting any of these infections except by direct blood sharing or sex. To avoid them, all you need to is select your sex partners wisely, use condoms or other safe sex practices for any new or possibly non-monogamous partners, and do not share drug injection equipment with anyone. That's all.

I hope this has been helpful. Best wishes--  HHH, MD

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42 months ago

Thanks for insightful response. Just had few follow up questions to tie up loose ends as I continue to struggle with ocd & understanding that I truly am ok. In terms of the possible (unlikely) exposure to blood in my mouth when taking throat swab: I still have throat/earache even after ten days on the meds. worse once began taking the meds than before. Done with meds now but throat still itchy/feels weird. A couple days woke up sweaty, shirt damp, red dots on palms of hand. Have sore inside mouth now. Also no one I know has been sick with either strep or a bad throat/earache recently. And timing of the illness after the event makes me worry. (My son did go to dr this week & they found white dots in throat/ulcers but strep test negative & has bad cough).

I do not have a very strong understanding of biology so forgive me for the following questions, as am trying to make sense of this:  You mention that it would take a large amount of virus/exposure to susceptible tissue for infection. Would that be true even if hiv, hep c or hep b was exposed to inside of my mouth, swallowed or rubbed into an open cut/sore on cheek, bleeding gums etc? Or if virus was exposed to genitals like in the possible case of my son? My son was breastfed & was never really sick til few weeks after the possible exposure.

   My dr mentioned that unless stabbed with needle or exposed to a pint of blood into bloodstream not a risk. Also that blood is not infectious once exposed to air no matter how long its in the environment. Is this accurate? (would this be true for the events I described in last post?) was a little confused by what you mean when say direct blood sharing & direct blood exposure, as well as need to be exposed to certain types of cells. Would you be able to clarify? I do not want to be afraid every time I perceive something to be a risk.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
None of your symptoms has anything to do with HPV or any of the other infections mentioned in your initial question, which do not cause throat pain, earache, itchiness, skin rash ("red dots"), or sores in the mouth.

Your doctor is exactly right. "Direct blood sharing & direct blood exposure, as well as need to be exposed to certain types of cells" is complex, but basically refers to injecting blood into your own bloodstream or stabbing mentioned by your doctor. HIV can only cauase infection by entering certain kinds of cells that are located in places like blood, deep inside the genital tract, under the skin, etc.

But it is wrong to focus on the biological reasons why certain exposures are low risk. The busiest HIV and STD clinics never see people with these who did not have typical exposures, i.e. unprotected sex, shared drug injection equipment, etc. If these various nonsexual exposures could transmit these viruses, there would be at least occasional patients without the traditional risk factors. But there aren't any. The biological explanations really shouldn't matter.

Finally, I'm afraid I cannot solve the problem in your closing sentence. With OCD there's always a "yes but" or "could I be the exception" concern, right? No matter how often or how well I, your doctor, or anyone else explains these things, I doubt your fears will melt away. Intellectual knowledge and explanations are not the answer to OCD related fears and anxieties. Proper treatment of the OCD itself is the solution. I hope you are able to find that and come to peace with your irrational fears about nonsexual transmission of these infections.

I notice you have also posted these questions in a new thread. I'm going to delete it. The answers will not be any different than you had in this thread, and repetative anxiety-driven questions are against forum policy. Contact ASHA if you would like to request reimbursement of the new posting fee.

That completes the two follow-ups that come with each posting fee and so closes this thread. Best wishes to you.

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