[Question #5060] HIV Risk & Testing

26 months ago
Dear Doctors,

On 26 Feb I had protected oral and vaginal intercourse with two CSWs in Switzerland. Not worried about that, however I had a healing wound from an inguinal hernia from two months prior a few inches above the base of my penis.  Most of the scar is just that, but closer to the penis, it regular scabs and reopens with a bit of blood. A few hours prior to intercourse I noticed the scab had reopened and stupidly I did not cover it with a bandaid. As both ladies rode me, what is the risk of vaginal fluid getting into this healing wound? 

I had a 21-day and 30-day DUO test that came back negative. It seems Dr Hooks and Dr Handsfield’s opinion has changed from a 28 day conclusive to 42. Do I need to retest?

Last note. I know I am overly anxious which is really wrecking my health. Headaches, fatigue , throat irritation and bowel movements are currently occurring.  Possible ARS at 5 + weeks post incident?

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum. Thanks for your question.

Our change from 4 to 6 weeks as the testing window for the antigen-antibody (duo, 4th generation) HIV tests isn't all that recent:  over a year ago, based on a scientific review of HIV tests, at which time we modified our advice from 4 to 6  weeks. However, these tests are virtually conclusive by 4 weeks -- it's very rare that 6 weeks is necessary. Your 30 day result is extremely reliable. Your exposure really wasn't as high risk just because of your healing inguinal wound and scar. The odds are strong neither of your CSW partners had HIV; and superficial contact with genital fluids with such a wound probably carries little or no risk of transmission. And your symptoms are not really typical of ARS. All things considered, there is no realistic chance you have HIV, and if I were you, I would not feel a need for additional testing. But anxious persons often are more reassured by testing than by expert opinion based on scientific analysis and probabilities. If that applies to you, have another duo test 6+ weeks after your last exposure. I am very confident it will be negative.

I hope this information is helpful. Let me know if anything isnt' clear.

HHH, MD
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26 months ago
Sir,

Thank you for the quick response and reassurance. I do value your opinion, as does surely many worried souls browsing the web for their concerns. As any worried person would note, it may be just a word play, but I would ask for your clarification as to this being a high risk event?  

I had thought that vaginal fluid that may contain HIV, when exposed to an external environment, quickly destabilizes and loses its infective qualities?

I wasn’t aware of the change in testing window from 4 to 6 weeks. Your previous forums on another site seem to have taken on a gospel like quality. 

The protected nature of the act does not concern me in the least, however as you indicated, due to anxiety, I will follow up with a test at 42 days. 

Sincerely,

Herren
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Heterosexually transmitted HIV is rare in most of western Europe, including Switzerland, and on average well under 1% of female sex workers has HIV. If HIV is present, from a single epsiode of unprotected vaginal sex, the average risk to the male parter is 1 in 2,500. So even without a condom, your risk would translate to something around 1 in 250,000. We can double that, since you had two such events, so 1 chance in 125,000. That's equivalent to having such exposures once daily for 342 years before transmission might be likely. Now wouldn't you classify that as "low risk"? I would. (As for oral sex, even unprotected the risk is even lower. There have been few if any proved cases of oral to penile HIV transmission.)---
26 months ago
Sir,

Perhaps I mis-spoke on my concerns. I’m not concerned with the transmissions aspects of the vaginal and oral sex as they were protected. 

Rather, I read your note about the high risk nature of the event, “Your exposure wasn’t really as high risk just because of your healing inguinal wound and scar”, and wanted to know if the passing of vaginal secretions that may contain HIV to this wound is truely that? As noted, I thought extenal transfer of infected fluid was mitigated with exposure to the external environment. This is seems is the real risk, not the protected sex. 

Upon your follow up, I will have no other questions. Again, I thank you for your support and hope you have a blessed day. 

Respectfully,

Herren
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Sorry I misunderstood. In any case, to my knowledge there has never been a reported case of HIV transmitted by exposure to a pre-existing wound. The single exception I am aware of was a health care provider over 20 years ago, who had severe eczema of the hands and in whom HIV infected blood got inside her latex glove. (I don't recall how that happened.) Her eczema was then exposed the the blood for a prolonged periods (minutes? hours?). In other words, virtually all HIV transmissions via wounds occurred when the wound itself was caused by sharp instrument contaminated with visible blood.

I can of course understand a biological plausibility of transmission as you fear. OTOH, I also return to the low chance your partners had HIV; and the fact that existing wounds appear to be little or no risk, perhaps because blood clotting and other protective barriers prevent it. In any case, your risk on this account obviously was exceedingly low, probably zero.

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