[Question #5053] What should i do?

26 months ago
Helle doctors, I am a 28 year old female. I was tested 6 months back for STDS, and it was negative for everything. However, I was drunk and got physically intimate with my friend. I started freaking out the next morning, as he was never tested for any stds ever. I expressed my concerns to him and asked him to get tested. His all reports came back negative. But what is bothering me is, what if he was still in a phase where his tests were not 100% conclusive. For example, I have read on the blogs that all tests can be ruled out at 6 weeks. What if he was exposed to something else in less than 6 weeks? Are his tests conclusive for me to feel risk free? He got tested 1 week after the night that we had the encounter. Also, we did not actually have sex, or even take off our pants. He did finger me from outside the pants ,but i was topless when he bit my nipples too hard,  ( there was a break in the skin ) and a lot of deep vigorous kissing. I am fearful as I think that the blood from his mouth must have entered my body through the cut on my nipple that he gave while biting and sucking. or through deep kissing that we did. Also I read on CDC, kissing can be a risk factor, but on the same site when I scrolled down, it said kissing is not a risk factor. Which one is true? Also, what should I do? Should I get tested after 6 weeks from the incident? your help is much appreciated. thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to our Forum and thanks for your confidence in our advice.  I hope that that I am about to tell you that the activities that you describe did not put you at meaningful risk for any STI, including HIV.  I say this for a number of reasons which i will list below:
1.  Your partner was low risk.  Presuming he was tested for common STIs such as chlamydia and gonorrhea, as well as HIV, the fact that, irrespective of his past sexual history, he was negative when tested a week after your encounter makes it very, very unlikely that he had any STI.
2.  The possibility that he might have been incubating HIV (none of the other STIs would have still been incubating a week after your encounter)  in the interval is very, very unlikely from an actuarial perspective (i.e. he had managed to not be infected until just before your encounter and then had become infected is very, very unlikely). 
3.  The activities you describe are not risky for STIs or HIV.  There is no risk at all from being masturbated by him (inside or outside your pants, still no risk).  Similarly, there is absolutely no risk for HIV from kissing either, even vigorous French kissing.  Finally, the mechanics of transferring blood into your system though biting simply does not work.  

Putting all of these reasons together, I see no medical reason for you to concerned about these events and no medical reason for testing  If you are worried, of course you can get tested but when you do, I am confident that they will be negative proving that you were not infected.   I hope that this comment is helpful.  EWH
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25 months ago
thank you for your response. So even with vigorous kissing which might cause trauma is not a risk? Coz he sucked on my tongue very very hard and i did have a sore on my tongue. so it got me thinking if he had a bleed point in his mouth it might have introduced blood in my mouth through the sore. Can i get HIV this way? does this change your assessment? should i get tested or not?
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Thanks for the additional information although it does not change my assessment or advice.  No matter how vigorous the kissing, no matter whether he had blood in his mouth, dental disease or an open sore in his mouth, still no risk. There has NEVER been a case of HIV acquired from kissing an infected person, not ever.

As for testing, there is no medical need for testing.  OTOH, if it would ease your mind, I would suggest a single test.  At 4 weeks a combination HIV antigen/antibody test would be 99+% conclusive and at 6 weeks, completely conclusive.  

I hope this information is helpful.  EWH
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25 months ago
thank you Dr. Hook for your reply. It did put me at ease. I will get tested just to be on the safer side. However, I do have concerns about getting the way  of getting tested. I have germophobia and fear of surface contamination. I'm an international medical student, here for my USMLE STEP 2 exam. I've never gotten tested here in the US. But when i was back in my home country, I know a fellow med student, who had a scare of reused needle that was used on her( or assumed it was reused, i dont know that well ) and was on PEP for prophylaxis. I thereafter, fear either having a needle-stick exposure myself or fear having a needle be reused on me. So I am skeptical about where I should get tested. I go back to my home country only after 6 months and I cannot go without not finding out if the exposure ( vigorous kissing ) was uneventful in terms of HIV transmission. So I have following questions for you
1) Is  it safe to get tested at any location ( PCP's office, LabWorks, Quest Diagnostics etc ) ?? Which is your recommendation?
2) Is it possible to reuse needles here in the US? I know most labs use non-reusable needles here ( unlike my home country ) . But is it the same at a PCP's office as well?
3) Can I directly get tested without seeing a doctor? Walk in to a lab and et tested without a prescription?
4) I have been experiencing nasal congestion, cold and sneezing since 10-14 days( it started 3 weeks after the event ), which has not completely gotten better. Can it be possible that it could be coz of me getting HIV from the exposure I described below??
5) I do understand as you mentioned kissing ( even vigorous ) is not a risk factor. But I have always followed CDC guidelines throughout my med school and through USMLE to learn most of the topics. They describe kissing as a possible risk event if both parters have bleeding points, and later contradict it by saying it is not a risk factors when you scroll down the page.
Thank you very much for all that you have done. I will consider myself to be fortunate  in future, if i can be even half good of a doctor as you and Dr. HHH. 
25 months ago
Do let me know if you need any other information from my side.
Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Where in theU.S are you located?---
25 months ago
I am in Tampa right now, will go to NYC next, then Atlanta and finally Houston to take my STEP 2 CS exam

Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Thank you.  Answers to your questions below:
1.  Yes.  Some locations are easier and cheaper than others.  In Forida, NYC, and Atlanta there are high quality STD Clinics where testing can often be obtained very I expensively and sometimes for free.  Testing can also be done at a private doctors office or commercial laboratory.  Testing at all sites mentioned will be safe.
2.  It is not permitted to re-use needles in the U.S.
3.  Yes.  No prescription is needed.  See my comment number 1 above.
4.  No, your respiratory tract infection should not make you more vulnerable to HIV.
5.  Kissing is not a risk for HIV, please don't worry.

I hope my comments have helped.  As this is my 3rd response, this thread will be closed shortly without further replies.  Please don't worry and good luck on your USMLE.  EWH
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